asthma and the vagus nerve
Question:
from CBI, MD: > The vagus nerve does go tot he gut (primarily) but also the heart and lungs > as well as other places. To my knowledge it does not have much to do with > inflammation. Ipatropium (Atrovent) is an "anticholinergic" inhaled > medication that acts by blocking this same system. The system is more active > in the large airways and consequantly has found great use in treating > smoking related COPD. Asthma is mor eof a disease of the mid to small sized > airways and would not be expected to be as responsive to agents that > modulate it. This is in agreement with the clinical experience with > Atrovent.
Is this to say ipratropium (Atrovent) is not effective as an asthma reliever? I noticed that albuterol on its own was only a slight reliever, but much better when combined or followed with ipratropium bromide, though I never took ipratropium without albuterol. There was a recent thread on this topic, started by me, cross-posted to sci.med.pharmacy and alt.support.asthma. But my "official" diagnosis, dating to April 1997, is doubtful: pneumonia, though there was no fever, no general weakness, and lab tests subsequently showed nothing infectious.
Response:
– Hide quoted text — Show quoted text -> from CBI, MD: > The vagus nerve does go tot he gut (primarily) but also the heart and lungs > as well as other places. To my knowledge it does not have much to do with > inflammation. Ipatropium (Atrovent) is an "anticholinergic" inhaled > medication that acts by blocking this same system. The system is more active > in the large airways and consequantly has found great use in treating > smoking related COPD. Asthma is mor eof a disease of the mid to small sized > airways and would not be expected to be as responsive to agents that > modulate it. This is in agreement with the clinical experience with > Atrovent. > Is this to say ipratropium (Atrovent) is not effective as an asthma
reliever? Usually, true asthmatics derive little relief from it, except possibly during acute exacerbations. The Atrovent works mostly on a different part of the airway than is typically involved in asthma. > I noticed that albuterol on its own was only a slight reliever, but much better > when combined or followed with ipratropium bromide, though I never took > ipratropium without albuterol.
If it works I wouldn’t fight it. > But my "official" diagnosis, dating to April 1997, is doubtful: pneumonia, > though there was no fever, no general weakness, and lab tests subsequently > showed nothing infectious.
Sounds like the pneumonia dx was doubtful but you also may not have been suffering from pure asthma. Atrovent is the drug of choice in emphysema, which tends to affect the larger airways. — CBI, MD
Response:
>I’m saying that there were probably naysayers about your profession before >it achieved mainstream status, just as you are apparently squeamish about >the technique in question.
This is the understatement of the century. Admittedly, the century is still young, but to date, this is most definitely it. Bob
Response:
I have some information on that which you can read if you care to. Lodi U. et al. Autonomic regulation in asthmatics with gastroesophageal reflux. Chest 1997;111:65-70. – Hide quoted text — Show quoted text -> Recently I had a long conversation with an emergency room physician > and medical researcher about the vagus nerve. He told me that in the > last year, scientists have found that electrostimulation of the vagus > nerve can help ameliorate chronic digestive problems including Crohn’s > (sp?) disease and irritable bowel syndrome. He told me that the > vagus is a large nerve that leads from the brainstem to the major > organs and that the vagus nerve seems to play a major role in the > inflammatory response. Since he said that the vagus connects to the > lungs, I asked if asthma and other chronic respiratory problems might > be addressed by treatments aimed at the vagus nerve, and he said yes, > it seemed like a promising area for further study. > I asked what he thought about anti-IGE, and he said that it intervenes > too far down the chain of immune response, that he would prefer a > medication that prevents binding of histamine to the cell membrane, > upstream of the IGE response. (Well, I think I have that right. > Mistakes are mine, of course.) > — > (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ > There are important differences between Milosevic and Sharon. For > example, Sharon has better hair.
Response:
– Hide quoted text — Show quoted text ->Of course. Much better to jam the heels of the hand into the spinal cord >with great force, and apply electrodes to electrostimulate the areas near >it. That wouldn’t have any unwanted side effects. > First you have me jamming vitamin pills down someone’s throat. Now > you have me jamming the heel of my hand into the spinal cord with > great force. You have a rather violent perspective of how I treat my > patients. I am gentle. As for electrostimulation of muscles, it is > one thing to stimulate the muscle itself, and another thing altogether > to stimulate an entire cranial nerve. I could see the possibility in > implanting an electrode in a particular ganglia of that nerve, > however.
I think that you missed my point. I’m not having *you* jamming anything. I’m saying that there were probably naysayers about your profession before it achieved mainstream status, just as you are apparently squeamish about the technique in question. > Before the invention of >the pacemaker would you have decried the application of electrostimulation >to the SA node as being foolish? > I would have had my reservations. > Bob
Good. But the vagus stimulation will be subjected to further testing and peer review, and the side-effects and long term consequences cataloged.
Response:
> electrostimulation of the vagus nerve may help those with chronic > digestive problems: > Electrostimulating this very large and important cranial nerve while > searching for one or two specific responses (visceromotor to the gut, > for example) will likely yield myriad unwanted side-effects in other > target organs and tissues that this nerve innervates. > The physician I spoke to commented that there may be as yet unknown > unpleasant side effects to the electrostim of the vagus.
For asthmatics stimulation fo the vagus would likely lead to increased symptoms. In this condition is would be (theoretically) better to block it. > However, he > said that the quality of life improvement seen in some children with > irritable bowel syndrome was so great that they they could tolerate > some side effects.
Irritable bowels syndrome (IBS) is not an inflammatory condition and should not be confused with inflammatory bowel disorders (IBD) such as Crohn’s disease and ulcerative colitis. It would make perfect sense that IBS might respond well to vagal modulation. This conforms my suspicion that you confused what the researcher was saying about the vagus and inflammation. > I can’t find anything about this research (said to be 18 months old) > on Google, but perhaps someone who has access to Medline could do > better.
You have access: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi – CBI, MD "Believe those who are seeking the truth; doubt those who find it." -Andre Gide
Response:
>Recently I had a long conversation with an emergency room physician >and medical researcher about the vagus nerve. He told me that in the >last year, scientists have found that electrostimulation of the vagus >nerve can help ameliorate chronic digestive problems including Crohn’s >(sp?) disease and irritable bowel syndrome. He told me that the >vagus is a large nerve that leads from the brainstem to the major >organs and that the vagus nerve seems to play a major role in the >inflammatory response. Since he said that the vagus connects to the >lungs, I asked if asthma and other chronic respiratory problems might >be addressed by treatments aimed at the vagus nerve, and he said yes, >it seemed like a promising area for further study
Electrostimulating this very large and important cranial nerve while searching for one or two specific responses (visceromotor to the gut, for example) will likely yield myriad unwanted side-effects in other target organs and tissues that this nerve innervates. And some say that taking supplements is foolish! Please count me out of THAT clinical study! http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/h_n/cn/cn1/cn10.htm Bob
Response:
. Since he said that the vagus connects to the >lungs, I asked if asthma and other chronic respiratory problems might >be addressed by treatments aimed at the vagus nerve, and he said yes, >it seemed like a promising area for further study > Electrostimulating this very large and important cranial nerve while > searching for one or two specific responses (visceromotor to the gut, > for example) will likely yield myriad unwanted side-effects in other > target organs and tissues that this nerve innervates. And some say > that taking supplements is foolish! Please count me out of THAT > clinical study! > http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/h_n/cn/cn1/cn10.htm > Bob
Of course. Much better to jam the heels of the hand into the spinal cord with great force, and apply electrodes to electrostimulate the areas near it. That wouldn’t have any unwanted side effects. Before the invention of the pacemaker would you have decried the application of electrostimulation to the SA node as being foolish?
Response:
>Of course. Much better to jam the heels of the hand into the spinal cord >with great force, and apply electrodes to electrostimulate the areas near >it. That wouldn’t have any unwanted side effects.
First you have me jamming vitamin pills down someone’s throat. Now you have me jamming the heel of my hand into the spinal cord with great force. You have a rather violent perspective of how I treat my patients. I am gentle. As for electrostimulation of muscles, it is one thing to stimulate the muscle itself, and another thing altogether to stimulate an entire cranial nerve. I could see the possibility in implanting an electrode in a particular ganglia of that nerve, however. Before the invention of >the pacemaker would you have decried the application of electrostimulation >to the SA node as being foolish?
I would have had my reservations. Bob
Response:
electrostimulation of the vagus nerve may help those with chronic digestive problems: > Electrostimulating this very large and important cranial nerve while > searching for one or two specific responses (visceromotor to the gut, > for example) will likely yield myriad unwanted side-effects in other > target organs and tissues that this nerve innervates.
The physician I spoke to commented that there may be as yet unknown unpleasant side effects to the electrostim of the vagus. However, he said that the quality of life improvement seen in some children with irritable bowel syndrome was so great that they they could tolerate some side effects. I can’t find anything about this research (said to be 18 months old) on Google, but perhaps someone who has access to Medline could do better. — (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ There are important differences between Milosevic and Sharon. For example, Sharon has better hair.
Response:
Recently I had a long conversation with an emergency room physician and medical researcher about the vagus nerve. He told me that in the last year, scientists have found that electrostimulation of the vagus nerve can help ameliorate chronic digestive problems including Crohn’s (sp?) disease and irritable bowel syndrome. He told me that the vagus is a large nerve that leads from the brainstem to the major organs and that the vagus nerve seems to play a major role in the inflammatory response. Since he said that the vagus connects to the lungs, I asked if asthma and other chronic respiratory problems might be addressed by treatments aimed at the vagus nerve, and he said yes, it seemed like a promising area for further study. I asked what he thought about anti-IGE, and he said that it intervenes too far down the chain of immune response, that he would prefer a medication that prevents binding of histamine to the cell membrane, upstream of the IGE response. (Well, I think I have that right. Mistakes are mine, of course.) — (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ There are important differences between Milosevic and Sharon. For example, Sharon has better hair.
Response:
> Recently I had a long conversation with an emergency room physician > and medical researcher about the vagus nerve. He told me that in the > last year, scientists have found that electrostimulation of the vagus > nerve can help ameliorate chronic digestive problems including Crohn’s > (sp?) disease and irritable bowel syndrome. He told me that the > vagus is a large nerve that leads from the brainstem to the major > organs and that the vagus nerve seems to play a major role in the > inflammatory response. Since he said that the vagus connects to the > lungs, I asked if asthma and other chronic respiratory problems might > be addressed by treatments aimed at the vagus nerve, and he said yes, > it seemed like a promising area for further study.
The vagus nerve does go tot he gut (primarily) but also the heart and lungs as well as other places. To my knowledge it does not have much to do with inflammation. Ipatropium (Atrovent) is an "anticholinergic" inhaled medication that acts by blocking this same system. The system is more active in the large airways and consequantly has found great use in treating smoking related COPD. Asthma is mor eof a disease of the mid to small sized airways and would not be expected to be as responsive to agents that modulate it. This is in agreement with the clinical experience with Atrovent. > I asked what he thought about anti-IGE, and he said that it intervenes > too far down the chain of immune response, that he would prefer a > medication that prevents binding of histamine to the cell membrane, > upstream of the IGE response. (Well, I think I have that right. > Mistakes are mine, of course.)
I think you have it backwards. IgE is at the start of the allergic response. It is crosslinking of IgE that triggers the release of histamine and other inflammatory mediators. Apparently it is easier to block histamine as evidenced by the fact that we have so many antihitamines available. I agree witht he logic (while believeing you have it reversed) that blocking events further "up stream" (i.e. IgE) would be more beneficial because it would prevent histamine release as well as the other mediators. — CBI, MD "Believe those who are seeking the truth; doubt those who find it." -Andre Gide
Response:
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