The influence of the bronchodilatation test on the duration of forced expiratory tracheal noises in young men

The diagnostic efficiency of estimating the duration of forced expiratory noises under the conditions of bronchial obstruction has been shown. The objective of this study was to analyze the response of the forced expiratory noise duration to the bronchodilatation test with the β₂-agonist in the age- and genderhomogenous group of healthy volunteers and bronchial asthma patients selected as a model of variable bronchial obstruction. Two hundred and sixty young men (16–25 years old) were examined. It was shown that the prevailing type of response in bronchial asthma patients with spirometry confirmed bronchial obstruction was shortened forced expiratory noises. Furthermore, the degree of the shortening considerably depended on the severity of the background bronchial obstruction. The absence of a statistically significant response of the forced expiratory noise duration dominated among healthy volunteers (nonsmokers as well as smokers) and bronchial asthma patients without a spirometry confirmed bronchial obstruction. However, the shortened response occurred much more frequently in bronchial asthma patients than in healthy volunteers. The high specificity (86%) of the response as shortened forced expiratory noises to the β₂-agonist may be useful for diagnostics.     

Dynamics of the duration of tracheal forced expiratory noises during long-term isolation in the Mars-500 experiment

The dynamics of the duration of tracheal forced expiratory noises in a group of volunteers were studied before, during, and after a 520-day confinement. The duration did not change in most volunteers. Two volunteers exhibited significant changes in the duration of tracheal sounds and some spirometric parameters. The increase in the duration of tracheal forced expiratory noises and the decrease in spirometric parameters reveal ventilation impairment of the obstructive type. Analysis of the duration of tracheal forced expiratory noise dynamics during prolonged confinement has proven to be a sensitive technique to test ventilation function changes.     

Relationship of tracheal size to maximal expiratory airflow and density dependence

Wave-speed theory predicts that maximal expiratory flow (MEF) at high lung volumes depends strongly on size of central airways. We tested this prediction by correlating MEF and tracheal cross-section area (T-XSA) in 15 (11 males, 4 females) healthy never-smoking volunteers. T-XSA was determined by planimetric analysis of contiguous 1-cm computerized tomographic scans of the intrathoracic trachea. We found a significant correlation between T-XSA at total lung capacity (TLC) and flow at 75% of vital capacity (V75) (r = 0.88, P less than 0.001). This contrasted to the correlation found between lung volume at TLC and V75 (r = 0.60). Density dependence of airflow (percent increase in V75 in air) was 35 +/- 17% and showed a significant inverse relationship to T-XSA (r = 0.70). These results confirm predictions of wave-speed theory and demonstrate the importance of cross-sectional area of central airways in determining MEF at high lung volumes. The large variability of MEF in normal individuals partly represents variations in tracheal size. Poor correlation between lung size and airway size suggests only a loose coupling between airways and lung parenchyma consistent with dysanaptic growth. Our findings indicate that changes in density dependence of airflow are not solely determined by the status of small airways and that differences in tracheal size contribute to its variability.     

Density dependence of forced expiratory flows in healthy infants and toddlers.

In older children and adults, density dependence (DD) of forced expiratory flow is present over the majority of the full flow-volume curve. In healthy subjects, DD occurs because the pressure drop from peripheral to central airways is primarily dependent on turbulence and convective acceleration rather than laminar resistance; however, an increase in peripheral resistance reduces DD. We measured DD of forced expiratory flow in 22 healthy infants to evaluate whether infants have low DD. Full forced expiratory maneuvers were obtained while the subjects breathed room air and then a mixture of 80% helium-20% oxygen. Flows at 50 and 75% of expired forced vital capacity (FVC) were measured, and the ratio of helium-oxygen to air flow was calculated (DD at 50 and 75% FVC). The mean (range) of DD at 50 and 75% FVC was 1.37 (1.22-1.54) and 1.23 (1.02-1.65), respectively, values similar to those reported in older children and adults. There were no significant relationships between DD and age. Our results suggest that infants, compared with older children and adults, have similar DD, a finding that suggests that infants do not have a greater ratio of peripheral-to-central airway resistance.     

Estimation of the mechanical parameters of the human respiratory system

A numerical algorithm has been developed for the estimation of the mechanical parameters of the human respiratory system. In order to estimate the pulmonary resistance and the dynamic pulmonary elastance, the transpulmonary pressure and the airflow at the mouth or nose are expanded in Chebyshev series. The nonlinear mathematical lung model and a set of measurements for airflow and pressure are then handled by the numerical technique. The lung model includes a component to account for turbulent flow in the larynx and trachea. This contribution presents an alternative method for lung parameter estimation and differs from most existing methods in that it does not need measurements for the tidal volume. It therefore eliminates the use of a body plethysmograph. The method may also find potential application to various other parameter identification problems.     

Density dependence of maximal expiratory flow before and during tracheal constriction in dogs

The effect of carbachol-induced central bronchoconstriction on density dependence of maximal expiratory flow (MEF) was assessed in five dogs. MEFs were measured on air and an 80% He-20% O2 mixture before and after local application of carbachol to the trachea. Airway pressures were measured using a pitot-static probe, from which central airway areas were estimated. At lower concentrations of carbachol the flow-limiting site remained in the trachea over most of the vital capacity (VC), and tracheal area and compliance decreased in all five dogs. In four dogs, decreases in choke point area predominated and produced decreases in flows. In one dog the increase in airway "stiffness" apparently offset the fall in area to account for an increase in MEF. Density dependence measured as the ratio of MEF on HeO2 to MEF on air at 50% of VC increased in all five dogs. Increases in density dependence appeared to be related to increases in airway stiffness at the choke point rather than decreases in gas-related airway pressure differences. Lower concentrations produced a localized decrease in tracheal area and extended the plateau of the flow-volume curve to lower lung volumes. Higher concentrations caused further reductions in tracheal area and greater longitudinal extension of bronchoconstriction, resulting in upstream movement of the site of flow limitation at higher lung volumes. Density dependence increased if the flow-limiting sites remained in the trachea at mid-VC but fell if the flow-limiting site had moved upstream by that volume.     

Acoustic and spirometry parameters of forced expiratory sounds during a five-day dry immersion

The dynamic studies of the parameters of forced expiration under the conditions of a five-day dry immersion involved seven healthy male subjects aged 20 to 25 years. During forced expiration, spirometry tests were performed simultaneously with tracheal sounds being recorded by a microphone. A number of parameters, including the acoustic duration of the forced-expiration tracheal sounds, the lungs’ forced vital capacity, the 1-s forced expiration volume, the peak expiratory flow, and time of achieving the peak expiratory flow, were recorded before dry immersion, on days 1 and 4 of immersion, and the next day after the termination of immersion. There was a significant decrease (by 8.4%) in the peak expiratory flow on day 1 of immersion; however, by day 4 of immersion, the peak expiratory flow increased by 8.9%, reaching its baseline values. The lungs’ forced vital capacity and the forced expiration volume during 1 second, on the average, did not change throughout the experiment. There was a significant increase (by 17%) in the duration of the forced expiration tracheal sounds after the immersion, which suggests an increase in respiratory resistance and needs further studies. A moderate negative correlation between the duration of the forced expiration tracheal sounds and Gensler’s index (r = ?0.63) was found, whereas the correlation with other spirometry parameters was weak or absent.     

Acoustic biomechanical relationships of human forced exhalation in bronchial obstruction

A statistically significant bidirectional influence of the incidence and degree of bronchial obstruction on the acoustic parameters of forced expiration and the spirometry/body plethysmography indicators of lung function has been revealed by means of nonparametric analysis of variance in a sample of 218 subjects. It has been shown that the acoustic band pass times and energies of forced expiratory tracheal noises coordinate with both tidal resistance and residual volume.     

Frequency dependence of forced oscillatory respiratory mechanics in horses with heaves

Young, S. S., D. Tesarowski, and L. Viel. Frequencydependence of forced oscillatory respiratory mechanics in horses withheaves. J. Appl. Physiol. 82(3):983-987, 1997.The effect of measurement frequency on respiratorymechanics was investigated in six horses with reversible allergicairway disease. Total respiratory impedance was measured at 1.5, 2.0, 3.0, and 5.0 Hz by using the forced oscillation technique with thehorses in remission, after acute antigenic challenge producing clinicalheaves, and with heaves but after the administration of 2 mg fenoterolby inhalation. The slopes of the magnitude(|Zrs|) and real part (R) of total respiratoryimpedance over the frequency range 1.5-3 Hz changed significantlyafter antigenic challenge and fenoterol. The ratio of R at 2 Hz to R at3 Hz, however, discriminated better among the three conditions.Compliance and resonant frequency (calculated by using a three-elementmodel) changed significantly after antigenic challenge and fenoterol,but inertance did not. We concluded that horses with heaves showedfrequency dependence of R and |Zrs| atfrequencies up to 3 Hz and that parameters derived from a three-element model were useful indicators of small airway obstruction in the horse.

     

Effect of expiratory loading on expiratory duration and pulmonary stretch receptor discharge

Slowly adapting pulmonary stretch receptors have been hypothesized to be the afferents mediating the vagally dependent, volume-related prolongation of expiratory time (TE) during expiratory loading. It has been further suggested that the vagal component of this prolongation of TE is due to the temporal summation of pulmonary stretch receptor (PSR) activity during expiratory loading. This hypothesis was tested in rabbits exposed to resistive and elastic single-breath expiratory loading while PSR's were simultaneously recorded. Both types of loads resulted in a decreased expired volume (VE) and increased expiratory duration (TE). The TE for resistive loads were significantly greater than for elastic loads for equivalent VE. Thus two different VE-TE relationships were found for resistive and elastic loads. When TE was plotted against the area under the expired volume trajectory, a single linear relationship was observed. PSR activity recorded during expiratory loading increased as VE decreased and TE increased. A single linear relationship resulted when the number of PSR spikes during the expiration was plotted against the associated TE for all types of loads. These findings demonstrate that the volume-related prolongation of TE with single-breath expiratory loads is associated with an increase in PSR discharge. These results support the hypothesis that the vagal component of load-dependent prolongation of TE is a function of both the temporal and spatial summation of PSR activity during the expiratory phase.     

Flow and volume dependence of respiratory mechanical properties studied by forced oscillation

The influence of inspiratory and expiratory flow magnitude, lung volume, and lung volume history on respiratory system properties was studied by measuring transfer impedances (4-30 Hz) in seven normal subjects during various constant flow maneuvers. The measured impedances were analyzed with a six-coefficient model including airway resistance (Raw) and inertance (Iaw), tissue resistance (Rti), inertance (Iti), and compliance (Cti), and alveolar gas compressibility. Increasing respiratory flow from 0.1 to 0.4 1/s was found to increase inspiratory and expiratory Raw by 63% and 32%, respectively, and to decrease Iaw, but did not change tissue properties. Raw, Iti, and Cti were larger and Rti was lower during expiration than during inspiration. Decreasing lung volume from 70 to 30% of vital capacity increased Raw by 80%. Cti was larger at functional residual capacity than at the volume extremes. Preceding the measurement by a full expiration rather than by a full inspiration increased Iaw by 15%. The data suggest that the determinants of Raw and Iaw are not identical, that airway hysteresis is larger than lung hysteresis, and that respiratory muscle activity influences tissue properties.     

Effect of compression pressure on forced expiratory flow in infants

The effect of the force of compression on expiratory flow was evaluated in 19 infants (2-13 mo of age) with respiratory illnesses of varying severity. An inflatable cuff was used to compress the chest and abdomen. Expiratory flow and volume, airway occlusion pressure, cuff pressure (Pc), and functional residual capacity were measured. Transmission of pressure from cuff to pleural space was assessed by a noninvasive occlusion technique. Close correlations (P less than 0.001) were found between Pc and the change in pleural pressure with cuff inflation (delta Ppl,c). Pressure transmission was found to vary between two cuffs of different design and between infants. Several forced expirations were then performed on each infant at various levels of delta Ppl,c. Infants with low maximal expiratory flows at low lung volumes required relatively gentle compression to achieve flow limitation and showed decreased flow for firmer compressions. Flow-volume curves in each infant tended to become more concave as delta Ppl,c increased. These findings underline the importance of knowledge of delta Ppl,c in interpreting expiratory flow-volume curves in infants.     

Influence of modified gas mixtures on the acoustic parameters of human forced exhalation

It was earlier demonstrated that the duration of tracheal noises of forced exhalation (FE) looks to be promising to determine adverse changes in the lung function after a dive. This study dealt with the parameters of tracheal expiratory noises (FE) as dependent of the composition of breathing gas mixtures. In the first type of experiments, 25 volunteers aged from 22 to 60 years carried out forced exhalation under a normal pressure of air or of an oxygen-helium or oxygen-krypton mixture. In the second type of experiments, six volunteers from 25 to 46 years of age performed forced exhalation with air in an altitude chamber under a normal pressure (0.1 MPa); the same subjects performed FE under an elevated pressure (0.263 MPa) while breathing air or an oxygen-helium mixture. In the first type of experiments, the total duration of tracheal FE noises in the frequency range 200?C2000 Hz and 200-Hz bands FE noises depended directly and linearly on the density of the gas mixture; this was not the case in the high-frequency band from 1400 to 2000 Hz. In the second type of experiments, the high-frequency durations and spectral energies of tracheal FE noises (1600?C2000 Hz) depended inversely and significantly on the adiabatic gas compressibility. In a simulated dive to a depth of 16.3 m (0.263 MPa), individual changes in the total duration of tracheal FE noises exceeded the diagnostic threshold of deterioration of the lung function in divers that was determined earlier under normal pressure.     

Influence of changed gas media on acoustic parameters of human forced exhalation

In previous study it was shown that duration of tracheal forced expiratory noises is promising to reveal negative changes of lung function after dive. The objective is a study of parameters of tracheal forced expiratory noises in changed gas media. The first experiment involved 25 volunteers (22-60 years), performed forced exhalation under normal pressure with air, oxygen-helium and oxygen-krypton mixtures. The second experiment in the chamber involved 6 volunteers (25-46 years), which performed forced exhalation with air under normal pressure (0.1 MPa), and under elevated pressure 0.263 MPa with air and oxygen-helium mixture. In the first experiment the direct linear dependence on gas density was found for forced expiratory noises common duration in the band of 200-2000 Hz and for its durations in narrow 200-Hz bands, excluding high frequency range 1400-2000 Hz. In the second experiment a significant reversed dependence of high frequency durations and spectral energies in 200-Hz bands (1600-2000 Hz) on adiabatic gas compressibility. Individual dynamics of common duration of tracheal forced expiratory noises under model dive of 16.3 m (0.263 MPa) is more then the diagnostic threshold of this parameter for lung function decrease, previously obtained for divers under normal pressure.     

Estimation of alveolar pressure during forced oscillation of the respiratory system.

A method for obtaining a continuous estimate of alveolar pressure (PAlv) during periodic flow is described; it was developed to improve the precision of measurements of airway and respiratory tissue impedance using the improved resolution of relatively high-frequency (approximately 5 Hz) singlas. The respiratory system was modulated with a piston pump, and lung volume and the volume change due to compression and expansion of alveolar gas were measured plethysmorgraphically; these signals and an analog divider were used to obtain a continuous solution of Boyle's law during flow. The plethysmorgraph was of the "flow" type; with it volume changes at frequencies up to 10 Hz and with rates of change up to 6 l/s were measured without amplitude or phase distortion. The method permits control of frequency and flow amplitude during PAlv measurement and calibration of PAlv in the absence of an active chest wall. However, it is technically complex.     

Effect of aerobic training on forced expiratory airflow in exercising asthmatic humans

Pulmonary function after exercise was evaluated in 22 asthmatic subjects before and after a 36-session training sequence of aerobic exercise. Training did not change pulmonary function values, except for a small increase in maximal voluntary ventilation (P less than 0.02), which was attributed to respiratory muscle training. After aerobic training, both external work at a given heart rate and peak O2 consumption increased by 30 and 15%, respectively. At the same minute ventilation (VE), immediate postexercise forced expiratory airflow was higher after training (P less than 0.02), and reduction in forced expiratory airflow during the first 9 min postexercise was less after training (P less than 0.01). The posttraining airflow response to the pretraining work load was, as expected, less than the pretraining response (P less than 0.02). Although the difference in maximal-to-minimal airflow at the same VE was similar before and after training, the airflow increase accounted for 50% of the response after training compared with 16% of the pretraining response. Furthermore the strong negative correlation (P less than 0.01) between maximal and minimal airflow both pre- and posttraining indicates that exercise-induced bronchospasm (EIB) severity is, in part, determined by the degree of exercise-induced bronchodilation. We conclude that aerobic training significantly increases exercise-induced bronchodilation and diminishes EIB.     

Flow simulation in the human upper respiratory tract

Computer simulations of airflow patterns within the human upper respiratory tract (URT) are presented. The URT model includes airways of the head (nasal and oral), throat (pharyngeal and laryngeal), and lungs (trachea and main bronchi). The head and throat morphology was based on a cast of a medical school teaching model; tracheobronchial airways were defined mathematically. A body-fitted three-dimensional curvilinear grid system and a multiblock method were employed to graphically represent the surface geometries of the respective airways and to generate the corresponding mesh for computational fluid dynamics simulations. Our results suggest that for a prescribed phase of breath (i.e., inspiration or expiration), convective respiratory airflow patterns are highly dependent on flow rate values. Moreover, velocity profiles were quite different during inhalation and exhalation, both in terms of the sizes, strengths, and locations of localized features such as recirculation zones and air jets. Pressure losses during inhalation were 30-35% higher than for exhalation and were proportional to the square of the flow rate. Because particles are entrained and transported within airstreams, these results may have important applications to the targeted delivery of inhaled drugs.