Capsaicin-induced reflex bronchoconstriction in the newborn

Although bronchoconstriction in response to C-fibre stimulation has been reported to be weak or absent in the newborn, pulmonary resistance and compliance have not been measured. We tested the hypothesis that capsaicin reflexly activates pulmonary efferent outflow to airway smooth muscle in the newborn. We measured breath-by-breath responses of inspiratory lung resistance (RLi) and dynamic compliance (CLdyn) in 13 newborn dogs and 4 newborn pigs during right heart injections of saline, capsaicin (25-50 micrograms/kg) and acetylcholine (ACh). Repeat capsaicin injections at 5 min intervals were made to test for desensitization in the newborn dog. All newborn dogs and 2 of 4 newborn pigs displayed a brisk bronchoconstriction; in the dog, RLi increased maximally by 97% +/- 13 (SE) and CLdyn decreased maximally by 32% +/- 2. In both species, initial capsaicin injections (CAP1) caused a long latency (time to peak heart rate 26.8 +/- 2 and 20 sec +/- 2.5) increase in heart rate (40% +/- 11 and 20.1% +/- 8.2 for the newborn dog and pig respectively). In the dog, but not the pig, capsaicin responses after the ACh trial (CAP2 and CAP3) caused a short latency bradycardia while the long latency tachycardia continued to be expressed in both species. The maximal changes in RLi and CLdyn, and the bradycardia, were reduced (i.e. desensitized) by 36%, 53% and 63% respectively if capsaicin injection was repeated within 5 min. Muscarinic blockade with atropine abolished the bronchoconstrictor and bradycardia responses to capsaicin but had no effect on the tachycardia. We conclude that the newborn possesses the neural circuitry to mount a bronchoconstrictor response to C-fibre stimulation. We speculate that the response is designed to reduce dead space and stabilize highly compliant airways of the newborn during the rapid shallow breathing that is typically associated with C-fibre stimulation.