Clinical lung and heart/lung transplantation
Albuterol Improves Impaired Mucociliary Clearance After Lung Transplantation

https://doi.org/10.1016/j.healun.2006.11.005Get rights and content

Background

Previous studies have shown that mucociliary clearance (MCC) is diminished after lung transplantation. However, it is unknown how early this deficit occurs after transplantation, or whether the abnormality can be improved by pharmacologic means. We hypothesized that impairment of MCC is evident soon after lung transplantation and that the defect in MCC can be improved by inhaled β2-adrenergic receptor agonists.

Methods

MCC and cough clearance (CC) were quantified in seven patients at 76 ± 48 days (mean ± standard deviation) after lung transplantation (baseline visit) and again 1 week later after an acute inhalation of albuterol. MCC was also determined once in four healthy subjects. To measure MCC, volunteers inhaled 99m-technetium-sulfur colloid aerosol, followed by gamma-camera imaging of their lungs for 76 minutes.

Results

Baseline MCC was significantly reduced in transplant patients, compared with healthy subjects, averaging 8.9 ± 7.3% and 20.9 ± 15.1%, respectively (p = 0.05). CC was not affected by transplantation. Acute inhalation of albuterol significantly improved MCC in transplant patients (31.9 ± 21.9%) compared with baseline values (p < 0.05).

Conclusions

MCC is diminished within a few months after transplantation. However, the response to albuterol suggests that the deficit is not static and can be improved with inhalation of a β2-adrenergic receptor agonist.

Section snippets

Transplant Patients

This study was approved by The Johns Hopkins Institutional Review Board. Between July 2001 and March 2003, 30 patients were transplanted at The Johns Hopkins Hospital for standard indications. Seven patients agreed to participate in the study by giving their informed consent.

Healthy Volunteers

MCC was also measured in four healthy volunteers who had no symptoms or history of respiratory disease. MCC in this population was compared with MCC measured in the lung transplant patients. We chose to make this comparison

Demographics

The demographics of the seven transplant patients studied are shown in Table 1. There were four male and three female patients, ranging in age from 29 to 61 years at the time of transplant. The average age was 53 ± 11 years.

Single-lung transplantation (SLT) was performed in five patients with chronic obstructive pulmonary disease and in one patient with α1-anti-trypsin deficiency. Three patients received a right lung at transplantation and three patients received a left lung. One subject

Discussion

Results from this study go beyond previous studies, which reported decreased MCC in lung transplant patients at 6 to 19 months after surgery.9, 10 Our study demonstrates that MCC is most likely impaired within 3 months after lung transplantation in the majority of patients. Although MCC was impaired in the allograft, we found that the secondary lung defense mechanism of CC was not affected by transplantation.

The etiology of the diminished MCC observed after lung transplantation is unknown, but

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  • Cited by (0)

    Supported by The Johns Hopkins Comprehensive Transplant Center and The Johns Hopkins University School of Medicine General Clinical Research Center (NIH/NCRR Grant M01RR00052).

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