• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.486-494
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• 2000

Background : The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to $M_3$ muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal $M_2$ muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these $M_2$, muscarinic receptors act as autoreceptors. Loss of function of these $M_2$ receptors, as it occurs in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of $M_2$ muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. Method : We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test ($PC_{20}$<16mg/ml). Methacholine provocation tests were performed twice on separate days allowing for an interval of one week. In the second test, pretreatment with the $M_2$ muscarinic receptor agonist pilocarpine($180{\mu}g$) through inhalation was performed be fore the routine procedures. Results : Eleven subjects with mild asthma and eight subjects with moderate asthma showed significant increase of $PC_{20}$ from 5.30$\pm$5.23mg/ml(mean$\pm$SD) to 20.82$\pm$22.56mg/ml(p=0.004) and from 2.79$\pm$1.51mg/ml to 4.67$\pm$3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of $PC_{20}$ from l.76$\pm$1.50mg/ml to 3.18$\pm$4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. Conclusion : In subjects with mild and moderate asthma, function of $M_2$ muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. ηlese results suggest that function of $M_2$ muscarinic receptors is different according to severity of asthma.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.21-24
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• 2011

Xerostomia is subjective feeling of dry mouth, a symptom that may or may not be accompanied by hyposalivation, an objective decrease in salivary flow. There are many causes induced xerostomia like drugs, salivary gland diseases, radiation therapy to the head and neck region, Sjogren syndrome, emotional stress etc. Insufficient salivary flow creates complications with oral candidiasis, dental caries, periodontitis, halitosis, dysgeusia. So finally, these complications lead to an overall decline in quality of life. Managements of xerostomia are eliminating or alterating the etiologic factors, relieving symptoms, preventing or correcting the consequences of salivary dysfunction, treating underlying disease and stimulating salivation. One of the salivation stimulation agents studied to treat xerostomia was the pilocarpine muscarinic agonist. Pilocarpine is one of salivation stimulants, a parasympathomimetic drug and non-selective muscarinic receptor agonist. Systemic pilocarpine has been used to stimulate salivary secretion. But systemic administration of pilocarpine has limitations such as increased risk of side effects and contraindications. Side effects of systemic pilocarpine administration are sweating, urinary and gastrointestinal disturbance, risk of cardiovascular and pulmonary disorders. This drug must be used carefully by patients with controlled asthma, chronic bronchitis, pulmonary or cardiac disease. Patient with acute asthma, narrow angle glaucoma, iritis should not use pilocarpine. Like this, systemic pilocarpine has many limitations. So, many investigators also have looked at the effectiveness of topical pilocarpine. Here we present patients with xerostomia which was relieved by pilocarpine mouthwash.

• Journal of Oral Medicine and Pain
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• v.37 no.2
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• pp.107-112
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• 2012

Orofacial movement disorders (OMD) are uncontrolled movement of the muscles involving the face, tongue, lip and mandible. Due to variable oral and lingual muscles affected, the patients with OMD are interfered with the appropriate performance such as chewing, swallowing and talking. In this study, there are 4 OMD cases with oral dryness that saliva flow rate is decreased or not. The symptoms are improved after oral administration of pilocarpine to 4 patients with OMD. Therefore, we suggest that objective or subjective oral dryness could be etiologic factor in OMD and pilocarpine could be regarded as medication for OMD.

• Journal of Oral Medicine and Pain
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• v.19 no.2
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• pp.25-45
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• 1994

The purposes of this study were to investigate the effect of pilocarpine-containing chewing gum for the treatment of xerostomia and to compare the effect of pilocarpine-containing chewing gum with that of pilocarpine oral administration. The 20 subjective and objective xerostomic patients were included in this study and divided into 3 groups. Five subjects were included in gum base chewing group, 10 in pilocarpine-containing gum chewing, and 5 in pilocarpine oral administration. The author measured unstimulated whole salivary flow rate, stimulated parotid salivary flow rate, pH of resting whole saliva, viscosity of stimulated whole saliva, and subjective symptoms and discomforts using VAS(visual analogue scale) at the beginning of the experiment. And the author investigated the changes of these factors at 1, 2, 3, and 4 week after. The obtained results were as follows : 1. There were significant increases in the unstimulated whole salivary flow rate in pilocarpine-containing gum chewing and pilocarpine oral administration groups. But there was no significant difference between pilocarpine-containing gum chewing and pilocarpine oral administration groups. 2. There was a significant increase in the stimulated parotid salivary flow rate in pilocarpine- containing gum chewing group. But there was no significant difference between pilocarpine- containing gum chewing and pilocarpine oral administration groups. 3. The change of salivary pH showed the increasing pattern in all groups. But there was no significant difference among groups. 4. There were no significant changes in the values of salivary viscosity in all groups through the experimental period. 5. There were significant decreases of VAS(visual analogue scale) in the degree of subjective symptoms and discomforts in pilocarpine-containing gum chewing and pilocarpine oral administration groups. But there was no significant difference between pilocarpine- containing gum chewing and pilocarpine oral administration groups.

• Journal of Oral Medicine and Pain
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• v.24 no.4
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• pp.347-359
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• 1999

The purpose of this study was to investigate the effect of pilocarpine containing chewing gum on anti-microbial components in whole saliva of xerostomic patients, The objective xerostomic patients were instructed to use 5mg-pilocarpine containing chewing gum for 20minutes three times per day, and the author measured the flow rates of unstimulated whole saliva and stimulated whole saliva at the beginning the treatment, 1,2,3, and 4 weeks after. The concentration and flow rate of anti-microbial components in whole saliva were quantitated by enzyme-linked immunosorbent assay(ELISA). The obtained results were as follows: 1. There were significant increase in the unstimulated and stimulated whole salivary flow rate after using pilocarpine-containing chewing gum in xerostomic patients. 2. The concentrations of IgA in the unstimulated and stimulated whole saliva showed increasing pattern but, no significant changes, arid the flow rates of IgA in the unstimulated and stimulated whole saliva showed significant increase after using pilocarpine-containing chewing gum in xerostomic patients. 3. The concentrations of IgM in the unstimulated and stimulated whole saliva showed increasing pattern but, no significant changes, and the flow rates of IgM in the unstimulated and stimulated whole saliva showed significant increase after using pilocarpine-containing chewing gum in xerostomic patients. 4. The concentrations of lactoferrin in the unstimulated and stimulated whole saliva showed no significant changes, and the flow rates of lactoferrin in the unstimulated and stimulated whole saliva showed significant increase after using pilocarpine-containing chewing gum in xerostomic patients. 5. The concentrations of lysozyme in the unstimulated and stimulated whole saliva showed no significant changes, and the flow rates of lysozyme in the unstimulated whole saliva showed significant increase, but in stimulated whole saliva showed no significant changes after using pilocarpine-containing chewing gum in xerostomic patients.