On the dissolution of vapors and gases.

The captive bubble technique in combination with axisymmetric drop shape analysis (ADSA-CB) and with micro gas chromatography is used to study the dynamics of dissolution of different gases and vapors in water in situ. The technique yields the changes in the interfacial tension and bubble volume and surface. As examples, the dissolution of methanol and hexane vapors, inhaled anesthetic vapors, and gases, that is, diethyl ether, chloroform, isoflurane, enflurane, sevoflurane, desflurane, N2O, and xenon, and as nonimmobilizers perfluoropentane and 1,1,2-trichloro-1,2,2-trifluoro-ethane (R113) were investigated. The examination of interfacial tension-time and bubble volume-time functions permits us to distinguish between water-soluble and -insoluble substances, gases, and vapors. Vapors and gases generally differ in terms of the strength of their intermolecular interactions. The main difference between dissolution processes of gases and vapors is that, during the entire process of gas dissolution, no surface tension change occurs. In contrast, during vapor dissolution the surface tension drops immediately and decreases continuously until it reaches the equilibrium surface tension of water at the end of dissolution. The results of this study show that it is possible to discriminate anesthetic vapors from anesthetic gases and nonimmobilizers by comparing their dissolution dynamics. The nonimmobilizers have extremely low or no solubility in water and change the surface tension only negligibly. By use of newly defined molecular dissolution/diffusion coefficients, a simple model for the determination of partition coefficients is developed.

Surfactant protein C mutations in sporadic forms of idiopathic interstitial pneumonias.

Interstitial pneumonias have recently been associated with mutations in the gene encoding surfactant protein C (SFTPC). In particular, SFTPC mutations have been reported in a number of familial forms of pulmonary fibrosis and in infants with interstitial lung diseases. The present study searched for SFTPC mutations in adult patients with sporadic idiopathic interstitial pneumonia. In total, 35 adult patients with sporadic idiopathic interstitial pneumonia and 50 healthy subjects were investigated for SFTPC mutations by direct DNA sequencing. Of the patients with sporadic idiopathic interstitial pneumonia, 25 suffered from idiopathic pulmonary fibrosis and 10 patients from nonspecific interstitial pneumonia. Only two frequent nonsynonymous variants, T138N and S186N, were detected. Allele frequencies of both variations as well as of other identified noncoding alterations did not differ significantly between the diverse patient groups and control subjects. In conclusion, mutations in the gene encoding surfactant protein C are not common in sporadic cases of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia, suggesting that the mutated gene does not play an important role in the pathogenesis of these forms of idiopathic interstitial pneumonia.

Interfacial properties of pulmonary surfactant layers.

The composition of the pulmonary surfactant and the border conditions of normal human breathing are relevant to characterize the interfacial behavior of pulmonary layers. Based on experimental data methods are reviewed to investigate interfacial properties of artificial pulmonary layers and to explain the behavior and interfacial structures of the main components during compression and expansion of the layers observed by epifluorescence and scanning force microscopy. Terms like over-compression, collapse, and formation of the surfactant reservoir are discussed. Consequences for the viscoelastic surface rheological behavior of such layers are elucidated by surface pressure relaxation and harmonic oscillation experiments. Based on a generalized Volmer isotherm the interfacial phase transition is discussed for the hydrophobic surfactant proteins, SP-B and SP-C, as well as for the mixtures of dipalmitoylphosphatidylcholine (DPPC) with these proteins. The behavior of the layers depends on both the oligomerisation state and the secondary structure of the hydrophobic surfactant proteins, which are controlled by the preparation of the proteins. An example for the surface properties of bronchoalveolar porcine lung washings of uninjured, injured, and Curosurf treated lavage is discussed in the light of surface behavior. An outlook summarizes the present knowledge and the main future development in this field of surface science.

Relation between rheological properties and structural changes in monolayers of model lung surfactant under compression.

rSP-C surfactant monolayers spread on a native physiological model substrate show two plateau regions in the pi/A-isotherm. The first corresponds to the main phase transition in the monolayer from a LE to a LC phase. Its course is non-horizontal because of the complex composition of the lung surfactant. The second plateau, which is much more pronounced, cannot be attributed to a change of the phase state. Brewster angle microscopy images taken in this region show a sharp apparent decrease of the aggregation degree from the LE to the LC state. This process can be considered as a change in the monolayer orientation relative to the direction of the propagated light. Such a change can be the result of monolayer folding and formation of a thicker layer, which is supported by results of rheological measurements. The dilatation elasticity obtained from oscillating barrier and longitudinal wave measurements reveals a pure elastic behaviour with a steep increase in the second plateau region. Because of the insolubility of the pure lipid components, a possible explanation is squeezing protein components of rSP-C or its complexes with lipids out of the monolayer into the bulk.

Effects of oligomerization and secondary structure on the surface behavior of pulmonary surfactant proteins SP-B and SP-C.

The relationship among protein oligomerization, secondary structure at the interface, and the interfacial behavior was investigated for spread layers of native pulmonary surfactant associated proteins B and C. SP-B and SP-C were isolated either from butanol or chloroform/methanol lipid extracts that were obtained from sheep lung washings. The proteins were separated from other components by gel exclusion chromatography or by high performance liquid chromatography. SDS gel electrophoresis data indicate that the SP-B samples obtained using different solvents showed different oligomerization states of the protein. The CD and FTIR spectra of SP-B isolated from all extracts were consistent with a secondary structure dominated by alpha-helix. The CD and FTIR spectra of the first SP-C corresponded to an alpha-helical secondary structure and the spectra of the second SP-C corresponded to a mixture of alpha-helical and beta-sheet conformation. In contrast, the spectra of the third SP-C corresponded to antiparallel beta-sheets. The interfacial behavior was characterized by surface pressure/area (pi-A) isotherms. Differences in the oligomerization state of SP-B as well as in the secondary structure of SP-C all produce significant differences in the surface pressure/area isotherms. The molecular cross sections determined from the pi-A isotherms and from dynamic cycling experiments were 6 nm(2)/dimer molecule for SP-B and 1.15 nm(2)/molecule for SP-C in alpha-helical conformation and 1.05 nm(2)/molecule for SP-C in beta-sheet conformation. Both the oligomer ratio of SP-B and the secondary structure of SP-C strongly influence organization and behavior of these proteins in monolayer assemblies. In addition, alpha-helix --> beta-sheet conversion of SP-C occurs simply by an increase of the summary protein/lipid concentration in solution.

Two hydrophobic protein fractions of ovine pulmonary surfactant: isolation, characterization, and biophysical activity.

Pulmonary surfactant contains two extremely hydrophobic proteins, SP-B and SP-C. We present a novel HPLC method for the preparation of these hydrophobic proteins. It is based on size-exclusion chromatography using the apolar stationary-phase butyl silica gel and isocratic elution with acidified chloroform/methanol. Samples for HPLC were prepared from sheep lung lavage fluid by centrifugation and extraction with chloroform/methanol. Amino acid analyses of the two protein fractions revealed sequences that are consistent with SP-B and SP-C, respectively. MALDI-TOF-MS analyses of the SP-B fraction showed one major peak of dimeric SP-B with m/z 17,361, and additional peaks of monomeric and oligomeric forms, which are predominantly even numbered. The SP-C fraction showed a peak at m/z 4200, consistent with the theoretical mass of the dipalmitoylated form of this protein. The biophysical activity of pure sheep SP-B and SP-C was evaluated by measuring the surface tension using axisymmetric drop shape analysis for captive bubbles. We found distinct surface pressure versus surface area isotherms of SP-B and SP-C indicating different biophysical activities for these surfactant proteins. The new preparative HPLC method is able to replace the established, time-consuming low-pressure liquid chromatography method for the isolation of SP-B and SP-C from lipids.

Interfacial behaviour and mechanical properties of spread lung surfactant protein/lipid layers.

The surface behaviour of spread dipalmitoyl phosphatidyl choline (DPPC), lung surfactant protein C (SP-C), and their mixtures were characterised using a captive bubble surfactometer. The surface tension was determined by using axisymmetric bubble shape analysis. Surface dilatational rheological behaviour was characterised by sinusoidal oscillation of the bubble volume and at frequencies 0.006-0.025 Hz. The pi/A isotherms of DPPC, SP-C, and their mixtures were described with a generalised equation of state. Monolayer cycling of mixed DPPC/SP-C layers yields isotherms with a plateau in the range of 50-53 mN/m. When the surface pressure becomes higher SP-C is squeezed out of the film, but it re-enters the film upon expansion. Surface dilatational elasticities of DPPC films had a maximum at about 30 mN/m. At higher surface pressures, the films became brittle and the elasticity decreased. A slightly pronounced maximum was found at a surface pressure exceeding 55 mN/m. The dilatational viscosity had two distinct maxima, corresponding with those in the elasticity curves, i.e. one before the minimum area demand, and one in the range of over-compression. This was explained by the formation of a second ordered complex structure in the range of film over-compression. SP-C films show continuously increasing dilatational elasticities and viscosities with a maximum at f approximately 0.02 Hz. Mixed monolayers, DPPC+2 mol% SP-C, had dilatational elasticities increasing with surface pressure. In contrast to DPPC alone, an elasticity maximum appeared in the range of the squeeze out plateau. The dilatational viscosity had two distinct maxima as observed for DPPC, whereas the maximum before the squeeze out plateau is very broad like that of SP-C. The viscosity decreased for frequencies higher 0.02 Hz favouring elastic properties of the film. Our data provide experimental evidence that SP-C mixed with DPPC yield higher elasticities and viscosities as compared with films formed by the single components. This behaviour is likely to support breathing cycles, especially for the turn from inspiration to expiration and vice versa.

Dynamic surface tension and surface rheology of biological liquids.

The paper presents results of dynamic and equilibrium surface tension measurements (using a maximum bubble pressure instrument) of serum and urine samples that were obtained from 80 healthy human of various sexes and ages. These data were compared with surface tension measurements of biological liquids obtained from patients suffering from malignant neoplasm of corpus uteri (n=5) and cervix uteri (n=31). In addition, surface dilatational rheology was determined on 32 samples using a drop shape method. The dilatational rheology data were compared with the dynamic surface tension data. Although some trends were found, no significant correlations exist between surface tension and rheology data and any of the disease states or stages. It is difficult to explain these findings in the framework of known mechanisms. However, our studies demonstrate that dynamic interface tensiometry of human biological liquids provide new insight into the biophysical behavior of these liquids, most likely reflecting compositional changes of them during ageing, the course of cancer and as a consequence of therapeutical interventions.

Pulmonary surfactant: functions, abnormalities and therapeutic options.

The first successful clinical pilot studies of surfactant replacement were published about 20 years ago as a logical extension of experimental studies showing beneficial effects in pre-term animals. The efficacy of this therapy for immature new-borns has been confirmed in various controlled trials and surfactant therapy is now part of the routine management of the infant respiratory distress syndrome. During the last decade there has been growing insight into the functional role of surfactant components and the mechanisms by which exogenous surfactant exerts its therapeutic effects on lung mechanics, gas exchange and host defence. Of particular interest in this context is the essential role that surfactant-associated proteins play in the surface tension-limiting ability of surfactant, as well as their contribution to pulmonary defence. Indications for surfactant replacement have widened in recent years and promising results have been obtained for adult conditions such as the acute respiratory distress syndrome (ARDS), pneumonia, chronic obstructive and allergic lung diseases. This review outlines the complexity of the surfactant system and describes its basic biophysics, physiology and biochemistry. Problems related to the development of exogenous surfactant preparations, the exploration of clinical targets for surfactant therapy and pathophysiological mechanisms interfering with surfactant function in various forms of lung disease will be discussed.

Polymorphisms of human SP-A, SP-B, and SP-D genes: association of SP-B Thr131Ile with ARDS.

An allele association study of 19 polymorphisms in surfactant proteins SP-A1, SP-A2, SP-B, and SP-D genes in acute respiratory distress syndrome (ARDS) was carried out. Trend-test analysis revealed differences (p < 0.05) in the frequency of alleles for some of the microsatellite markers flanking SP-B, and for one polymorphism (C/T) at nucleotide 1580 [C/T (1580)], within codon 131 (Thr131Ile) of the SP-B gene. The latter determines the presence or absence of a potential N-linked glycosylation site. Multivariate analysis revealed significant differences only for the C/T (1580) polymorphism. When the ARDS population was divided into subgroups, idiopathic (i.e., pneumonia, etc.) or exogenic (i.e., trauma, etc.), significant differences were observed for the C/T (1580), for the idiopathic ARDS group, and the frequency of the C/C genotype was increased in this group. Based on the odds ratio, the C allele may be viewed as a susceptibility factor for ARDS. Although the expression of both C and T alleles occurs in heterozygous individuals, it is currently not known whether these alleles correspond to similar levels of SP-B protein. These data suggest that SP-B or a linked gene contributes to susceptibility to ARDS.

Unilateral lung edema: effects on pulmonary gas exchange, hemodynamics, and pulmonary perfusion distribution.

Two types of unilateral lung edema in sheep were characterized regarding their effects on pulmonary gas exchange, hemodynamics, and distribution of pulmonary perfusion. One edema type was induced with aerosolized HCl (0.15 M, pH 1.0) and the other with NaCl (0.15 M, pH 7.4). Both aerosols were nebulized continuously for 4 h into left lungs. In HCl-treated animals, pulmonary gas exchange deteriorated [from a partial arterial O(2) pressure-to-inspired O(2) fraction ratio (Pa(O(2))/FI(O(2))) of 254 at baseline to 187 after 4 h HCl]. In addition, pulmonary artery pressure and total pulmonary vascular resistance increased (from 16 to 19 mmHg and from 133 to 154 dyn. s. cm(-5), respectively). In NaCl-treated animals, only the central venous pressure significantly increased (from 7 to 9 mmHg). Distribution of pulmonary perfusion (measured with fluorescent microspheres) changed differently in both groups. After HCl application, 6% more blood flow was directed to the treated lung, whereas, after NaCl, 5% more blood flow was directed to the untreated lung. HCl and NaCl treatment both induce an equivalent lung edema, but only HCl treatment is associated with gas exchange alteration and tissue damage. Redistribution of pulmonary perfusion maintains gas exchange during NaCl treatment and decreases it during HCl inhalation.

Studies on the application of dynamic surface tensiometry of serum and cerebrospinal liquid for diagnostics and monitoring of treatment in patients who have rheumatic, neurological or oncological diseases.

Human biological liquids comprise various surfactants, which adsorb at liquid interfaces and lead to a variation in surface tension. The adsorption processes involving low molecular weight surfactants, proteins and phospholipids play a vital role in the physiological functions of the human organism, especially if large surfaces are involved (e.g., gas exchange in lungs, metabolism of kidneys, liver and brain). Dynamic surface tensiometric studies of biological liquids like serum and cerebrospinal fluid provide surrogate parameters that reflect surface tension phenomena. We provide dynamic surface tension data of serum and cerebrospinal fluid that were collected from healthy volunteers and patients with rheumatic, neurological or oncological diseases. Our studies indicate that dynamic surface tension data are helpful for diagnostic purposes and for monitoring of therapeutic interventions.

cDNA cloning of ovine pulmonary SP-A, SP-B, and SP-C: isolation of two different sequences for SP-B.

Pulmonary surfactant promotes alveolar stability by lowering the surface tension at the air-liquid interface in the peripheral air spaces. The three surfactant proteins SP-A, SP-B, and SP-C contribute to dynamic surface properties involved during respiration. We have cloned and sequenced the complete cDNAs for ovine SP-A and SP-C and two distinct forms of ovine SP-B cDNAs. The nucleotide sequence of ovine SP-A cDNA consists of 1,901 bp and encodes a protein of 248 amino acids. Ovine SP-C cDNA contains 809 bp, predicting a protein of 190 amino acids. Ovine SP-B is encoded by two mRNA species, which differ by a 69-bp in-frame deletion in the region coding for the active airway protein. The larger SP-B cDNA comprises 1,660 bp, encoding a putative protein of 374 amino acids. With the sequences reported, a more complete analysis of surfactant regulation and the determination of their physiological function in vivo will be enabled.

Quantitative analysis of hydrophobic pulmonary surfactant proteins by high-performance liquid chromatography with light-scattering detection.

A new method for the separation and quantification of two hydrophobic lung surfactant proteins (SPs) is described. It is based on size-exclusion chromatography using the apolar stationary phase butyl silicagel with a pore size of 30 nm and isocratic elution with chloroform, methanol and trifluoroacetic acid. The samples were prepared from sheep lung lavage fluid by centrifugation and fractional extraction with butanol and chloroform-methanol. The chromatograms show three peaks in the elution order SP-B, SP-C and lipids. A small peak ahead of SP-B, which disappeared after reduction with 2-mercaptoethanol, was oligomeric SP-B. The response of the evaporative light-scattering detector was non-linear. For preparative high-performance liquid chromatography ultraviolet detection at 279 nm is recommended.

[Magnetic resonance imaging of the degree of pulmonary edema using a macromolecular contrast medium]. / Kernspintomographische Quantifizierung des Lungenödemgrades mit Hilfe eines makromolekularen Kontrastmittels.

PURPOSE: Development and experimental validation of a method tor the quantification of pulmonary oedema by measurement of total lung water and intravascular lung water and by calculation of extravascular lung water. MATERIAL AND METHODS: Isolated sheep lung preparations with unilateral pulmonary oedema were perfused (pulsatile pump) and examined under ventilatory arrest and during ventilation. Total lung water was calculated from proton density obtained from a multi-spin echo sequence and gravimetrically (reference method). Pulmonary intravascular volume was calculated from signal intensity histograms obtained from 3D-TOF MR-angiograms before and after application of the macromolecular contrast medium gadolinium-DTPA-polylysine. The reference method was a dye-dilution technique. Extravascular lung water was calculated as the difference between total lung water and pulmonary intravascular volume. RESULTS: Under ventilatory arrest, the magnetic resonance technique for the measurement of extravascular lung water correlated well with the reference technique (r = 0.89, n = 42 lungs). In 10 lungs the correlation coefficients were r = 0.95 (ventilatory arrest) and r = 0.92 (ventilated lungs). CONCLUSION: The results demonstrate that magnetic resonance imaging enhanced by a macromolecular contrast medium may be applicable for quantification of pulmonary oedema.

Quantitative analysis of pulmonary surfactant phospholipids by high-performance liquid chromatography and light-scattering detection.

An improved high-performance liquid chromatographic method for the separation and quantitation of nine phospholipid classes is described. It is based on normal-phase chromatography with silica gel as stationary phase and a binary gradient with mixtures of chloroform, methanol and water as mobile phase. The response of the evaporative light-scattering detector was non-linear. Peak areas were proportional to the power 1.7 of the masses. Phospholipids in lung lavage samples were enriched by liquid extraction prior to HPLC analysis. The described method is a rapid and accurate procedure for the quantitative analysis of phospholipid classes in biological samples.

Surfactant protein A modulates release of reactive oxygen species from alveolar macrophages.

The production and release of reactive oxygen species (the respiratory burst) is a common metabolic pathway linked to several macrophage-related reactions. The most abundant surfactant protein A (SP-A) binds to alveolar macrophages (AM) through a specific surface receptor with high affinity. Because such binding might initiate or modulate the respiratory burst, we wanted to know whether and how SP-A affects the oxygen radical release from AM. To answer these questions, we measured the release of reactive oxygen species from rat AM under various in vitro conditions using enhanced chemiluminescence systems. We prepared SP-A from pulmonary surfactant isolated either from silica-treated rats or adult dogs. Resident AM were harvested from pathogen-free Wistar rats by lung lavage. Adhered and nonadhered AM were assessed on protein-free or protein-coated surfaces of 96-well microtiter plates. On protein-free surfaces, the sole addition of SP-A failed to induce measurable oxygen radical release from 2 x 10(5) adhered or nonadhered AM, while zymosan opsonized with SP-A induced a marked increase over control. On protein-coated surfaces, AM respond differently depending on the coated protein: on SP-A-coated surfaces, a dose-dependent enhancement of oxygen radical release with a mean effective concentration of approximately 1.15 micrograms/ml was found. No such enhancement was seen on plates coated with similar amounts of either human fibronectin or collagen, and the enhancement with serum albumin was not dose related. Our data demonstrate that SP-A only enhances oxygen radical release from AM if SP-A is fixed to zymosan or the surface of the reaction vial in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Host defence capacities of pulmonary surfactant: evidence for 'non-surfactant' functions of the surfactant system.

The most well characterized function of pulmonary surfactant is its ability to reduce surface tension at the alveolar air-liquid interface, thereby preventing lung collapse. However, several lines of evidence suggest that surfactant may also have 'non-surfactant' functions: specific components of surfactant (proteins and phospholipids) may interact with different alveolar cells, inhaled particles and micro-organisms modulating pulmonary host defence systems. SP-A, the most abundant surfactant protein, binds to alveolar macrophages via a specific surface receptor with high affinity [128]. Such binding effects the release of reactive oxygen species from resident alveolar macrophages if SP-A is properly presented to the target cell. SP-A also stimulates chemotaxis of alveolar macrophages [142], and serves as an opsonin in the phagocytosis of herpes simplex virus [161] Candida tropicalis [138] and various bacteria [137]. In addition, SP-A enhances the uptake of particles by monocytes and culture-derived macrophages [140] and improves bacterial killing. SP-D, another hydrophobic surfactant-associated protein, might interact with alveolar macrophages as well, stimulating the release of oxygen radicals [148], while for the hydrophilic surfactant proteins SP-B and SP-C no macrophage interactions have been described so far. SP-A and SP-D are members of the so-called 'collectins', pattern recognition molecules involved in first line defence. While some surfactant proteins appear to stimulate certain macrophage defence functions, surfactant phospholipids seem to inhibit those of lymphocytes. Suppressed lymphocyte functions include lymphoproliferation in response to mitogens and alloantigens, B cell immunoglobulin production and natural killer cell cytotoxicity. Concerning surfactant's phospholipid composition phosphatidylglycerol is more suppressive than phosphatidylcholine on a molar basis [38]. Bovine surfactant has an immunosuppressive effect on the development of hypersensitivity pneumonitis in a guinea pig model [150]. Despite these interesting observations, several important questions concerning the interactions of surfactant components with pulmonary host defence systems remain unanswered. Sufficient host defence in the lungs works through various humoral-cellular systems in conjunction with the specific anatomy of the airways and the gas exchange surface--how does the surfactant system fit into this network? Surfactant and alveolar cells are both altered during lung injury--is there a relationship between alveolar cells from RDS patients and the endogenous surfactant isolated from such patients? How does exogenous surfactant as used for substitution therapy modulate the defence system of the host? Some of those artificial surfactants have been shown to inhibit the endotoxin-alveolar macrophages, PMNs and monocytes including IL-1, IL-6 and TNF [139,152].(ABSTRACT TRUNCATED AT 400 WORDS)

Gd-DTPA-polylysine-enhanced pulmonary time-of-flight MR angiography.

The enhancing effect of gadolinium diethylenetriaminepentaacetic acid (DTPA) polylysine (a macromolecular paramagnetic contrast agent) in time-of-flight magnetic resonance (MR) angiography of isolated perfused sheep lungs was studied. Unilateral lung damage was induced with hydrochloric acid in eight sheep. The heart and lungs were removed from the thoracic cavity, and after cannulation of the trachea and both ventricles, pulsatile perfusion and ventilation were initiated. The heart-lung preparations were placed in the head coil of a 1.5-T imager. Time-of-flight pulmonary MR angiography was performed during respiratory arrest, before and after administration of 0.02 mmol/kg Gd-DTPA-polylysine. On the postcontrast angiograms, the signal intensity increased by 120% in pulmonary arteries (P < .01). The contrast-to-noise ratio between pulmonary arteries and parenchyma increased significantly (P < .01). The number of visualized generations of pulmonary artery branches increased from four to six in normal lungs and from three to five in edematous lungs. Low-dose Gd-DTPA-polylysine significantly improves the conspicuity of the pulmonary vascular tree in time-of-flight pulmonary MR angiography.

Inhaled nitric oxide: its effects on pulmonary circulation and airway smooth muscle cells.

Nitric oxide (NO), an endothelium-derived relaxing factor synthesized from L-arginine by the enzyme NO synthase, has been identified as an important, short-acting, endogenous vasodilator. In patients with pulmonary hypertension, inhaling a low dose of NO as a gaseous vasodilator has been shown to induce selective vasodilation in ventilated lung areas. It achieves this without the disadvantages attributed to systemically infused vasodilators e.g. systemic vasodilation and an increase in pulmonary right-to-left shunt with a consecutive fall in PaO2. Thus, inhaled NO reduces pulmonary hypertension in the severe adult respiratory distress syndrome and in persistent pulmonary hypertension of the newborn, and improves arterial oxygenation by redistributing pulmonary blood flow away from the shunt and towards areas with almost normal ventilation/perfusion ratios. The bronchodilatory effect of NO may be an alternative therapy for treating asthma and bronchospasm.