Cumulative dose-response curves to carbachol given by aerosol were established using plethysmographic measurements of specific airways resistance (SRaw) in 10 patients with asthma and five healthy subjects. Two experiments were performed--a control test and one in which maximal respiratory manoeuvres (MRM) (two maximal inspirations and two maximal expirations) were made before each carbachol inhalation. MRM did not modify the dose-response curves in the normal subjects. In the patients these manoeuvres enhanced the bronchoconstrictor effect of carbachol: curves were shifted to the left and the mean dose of carbachol producing a twofold increase in initial SRaw was decreased from 0.373 mg to 0.189 mg (P less than 0.001). Bronchial provocation tests using methods which require MRM--for example, forced expiratory volume at one second--could overestimate the bronchial sensitivity of patients with asthma.
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