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Treatment of Asthma: The long-acting beta-2-agonists pp 91–107Cite as

Development of β2-receptors in infancy and childhood

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Summary

At birth, intraalveolar fluid is rapidly displaced by air and excessive interstitial fluid is absorbed into the vascular system. This removal of fluid and surfactant release are presumed to be linked to pulmonary β-adrenergic stimulation. Administration of β-blockers to fetal lambs was shown to abolish the increase in surfactant release that normally accompanies labour and delivery. Similar observations have been reported in fetal rabbits. Little is known about the development of receptors in humans. Indirect evidence from functional studies in human babies suggest similar changes although the ontogeny of human pulmonary receptors remains largely unknown. During gestation both neural and non-neural receptor types change. With advancing gestational age the number of intrapulmonary β-adrenergic receptors increases nearly tenfold between the 15th gestational week and term. Receptor distribution shows a predominance in alveolar walls, bronchiolar and bronchial walls and in airway smooth muscle. It has been shown both in vitro and in vivo that exogenous glucocorticoid increases pulmonary β-receptors. Thus, glucocorticoids may be responsible for the increased pulmonary β-receptor concentration in late gestation. Glucocorticoids may increase β-adrenergic reponsiveness by both changes in receptor concentration and coupling of receptor occupancy to response.

Postnatally, several early studies failed to find bronchodilator responses to nebulized β2-agonists in infancy. It was therefore believed for many years that β-agonists were ineffective in this age group. Recent well designed studies have however shown significant bronchodilator effects and protection against bronchoconstricting agents. Clinical improvements were shown both for infants treated with β2-agents alone or in combination with steroids. Methodological aspects may be one reason for discrepancies between older and more recent data concerning bronchodilatation. It therefore seems that infants have functioning β2-receptors from birth and that stimulation of these receptors produces the same effect as in older children. Clinically, the response is often quite small and interindividual differences are seen. Preschool children show the same response to β2-adrenergic agents as do schoolchildren.

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Authors and Affiliations

  1. Department of Paediatric and Adolescent Medicine, Wilhelminenspital, Montleartstrasse 37, A-1171, Vienna, Austria

    Manfred Götz MD (Professor of Paediatrics, Head)

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  1. Manfred Götz MD
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  1. 2. Medizinische Abteilung mit Lungenkrankheiten und Tuberkulose, Wilhelminenspital, Wien, Österreich

    Friedrich Kummer

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© 1998 Springer-Verlag/Wien

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Götz, M. (1998). Development of β2-receptors in infancy and childhood. In: Kummer, F. (eds) Treatment of Asthma: The long-acting beta-2-agonists. Springer, Vienna. https://doi.org/10.1007/978-3-7091-7513-2_6

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  • DOI: https://doi.org/10.1007/978-3-7091-7513-2_6

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-83124-3

  • Online ISBN: 978-3-7091-7513-2

  • eBook Packages: Springer Book Archive

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