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Bronchodilators, Pulmonary Function, and Asthma

MAURICIO J. DULFANO, M.D.
Ann Intern Med. 1968;68(4):955-956. doi:10.7326/0003-4819-68-4-955
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The previously undisputed benefits of isoproterenol, epinephrine, and aminophylline in treatment of bronchial asthma have recently come under critical review. For decades pulmonary physiologists characterized the asthmatic disturbance primarily in terms of increased work of breathing resulting from augmented airway resistance and uneven distribution of ventilation throughout the lung, while little attention was directed to the characteristics of pulmonary blood flow (Q) distribution, and the resultant effects on alveolar ventilation-perfusion ratios (VA/QT), "physiological" shunt (QS/QT), and the alveolar-arterial oxygen tension gradient (A-ao2D). The concept that hypoxemia and hypercapnia are infrequent in asthma (1) went unchallenged for years until convincing evidence

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