Electrolyte and water exchange in bronchial asthma, with emphasis on the influence of pitressin

Abstract

In a previous communication, the authors have presented evidence which indicated that various procedures inducing electrolyte and water changes in the body had a definite influence upon persistent bronchial asthma. An extremely low sodium chloride diet improved the asthmatic conditions, and fever therapy then led to remissions. The remissions were terminated by the ingestion of sodium chloride. During the periods of increased salt intake, the subject drank more water, stored much of it, and gained weight. The question therefore arose as to whether the increased water storage or the extra salt was instrumental in precipitating the asthmatic symptoms. The action of the pressor principle of the posterior lobe of the pituitary gland offers an answer to this question. This hormone, pitressin, when injected subcutaneously, causes a retention of body fluids without the aid of an increase in body salts. Many asthmatic children were given pitressin, and six of them with intractable asthma who tolerated the hormone were subjected to special studies. A total of twenty observations were made; three of the most typical studies are presented graphically on a chart. The subjects were all placed on an extremely low sodium chloride diet, and when pitressin was administered, there was a retention of water up to 2 kg. in some of the patients. Improvement in the asthma began during the antidiuretic phase and continued through the diuretic and subsequent periods, proving that the storage of large amounts of water in the body and its sudden loss had apparently little influence on the asthmatic symptoms. A review of the literature discloses investigations which indicate that, during pitressin antidiuresis and diuresis, despite low salt intake, sodium chloride is excreted, leading to a marked loss of body salt. It is apparent that bronchial asthma can be ameliorated, even in the presence of excessive hydration, if there is an associated depletion of sodium chloride. No positive therapeutic implications are warranted at this time, since the procedures outlined in this communication may still be considered rather involved and technically difficult to carry out with effective exactness. The whole subject is, therefore, of value more as an investigative tool rather than a therapeutic procedure.