Fast vs. slow exhalation before O2 inhalation alters subsequent phase III slope

1984 ◽  
Vol 56 (1) ◽  
pp. 52-56 ◽  
Author(s):  
T. S. Hurst ◽  
B. L. Graham ◽  
D. J. Cotton
Keyword(s):  
Total Lung Capacity ◽  
Normal Subjects ◽  
Phase Iii ◽  
Breath Holding ◽  
Small Airways ◽  
Residual Volume ◽  
Lung Capacity ◽  
Single Breath ◽  
Subsequent Phase ◽  
Phase Iii Slope

We studied 10 symptom-free lifetime non-smokers and 17 smokers all with normal pulmonary function studies. All subjects performed single-breath N2 washout tests by either exhaling slowly (“slow maneuver”) from end inspiration (EI) to residual volume (RV) or exhaling maximally (“fast maneuver”) from EI to RV. After either maneuver, subjects then slowly inhaled 100% O2 to total lung capacity (TLC) and without breath holding, exhaled slowly back to RV. In the nonsmokers seated upright phase III slope of single-breath N2 test (delta N2/l) was lower (P less than 0.01) for the fast vs. the slow maneuver, but this difference disappeared when the subjects repeated the maneuvers in the supine position. In contrast, delta N2/l was higher for the fast vs. the slow maneuver (P less than 0.01) in smokers seated upright. For the slow maneuver, delta N2/l was similar between smokers and nonsmokers but for the fast maneuvers delta N2/l was higher in smokers than nonsmokers (P less than 0.01). We suggest that the fast exhalation to RV decreases delta N2/l in normal subjects by decreasing apex-to-base differences in regional ratio of RV to TLC (RV/TLC) but increases delta N2/l in smokers, because regional RV/TLC increases distal to sites of small airways obstruction when the expiratory flow rate is increased.

Mode shift of an inhaled aerosol bolus is correlated with flow sequencing in the human lung

2002 ◽  
Vol 92 (3) ◽  
pp. 1232-1238 ◽  
Author(s):  
Christopher N. Mills ◽  
Chantal Darquenne ◽  
G. Kim Prisk
Keyword(s):  
Vital Capacity ◽  
Normal Subjects ◽  
Phase Iii ◽  
Mode Shift ◽  
Nitrogen Washout ◽  
Single Breath ◽  
Posture Change ◽  
Supine Posture ◽  
Residual Capacity ◽  
Phase Iii Slope

We studied the effects on aerosol bolus inhalations of small changes in convective inhomogeneity induced by posture change from upright to supine in nine normal subjects. Vital capacity single-breath nitrogen washout tests were used to determine ventilatory inhomogeneity change between postures. Relative to upright, supine phase III slope was increased 33 ± 11% (mean ± SE, P < 0.05) and phase IV height increased 25 ± 11% ( P < 0.05), consistent with an increase in convective inhomogeneity likely due to increases in flow sequencing. Subjects also performed 0.5-μm-particle bolus inhalations to penetration volumes (Vp) between 150 and 1,200 ml during a standardized inhalation from residual volume to 1 liter above upright functional residual capacity. Mode shift (MS) in supine posture was more mouthward than upright at all Vp, changing by 11.6 ml at Vp = 150 ml ( P < 0.05) and 38.4 ml at Vp = 1,200 ml ( P < 0.05). MS and phase III slope changes correlated positively at deeper Vp. Deposition did not change at any Vp, suggesting that deposition did not cause the MS change. We propose that the MS change results from increased sequencing in supine vs. upright posture.

scholarly journals Does the nitrogen single-breath washout test contribute to detecting pulmonary involvement in rheumatoid arthritis? A pilot study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Elizabeth Jauhar Cardoso Bessa ◽  
Felipe de Miranda Carbonieri Ribeiro ◽  
Geraldo da Rocha Castelar Pinheiro ◽  
Agnaldo José Lopes
Keyword(s):  
Rheumatoid Arthritis ◽  
Pulmonary Function Tests ◽  
Airway Disease ◽  
Pulmonary Involvement ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Lung Capacity ◽  
Single Breath ◽  
Small Airway Disease ◽  
Phase Iii Slope

Abstract Objective There has been growing interest in studying small airway disease through measures of ventilation distribution, thanks to the resurgence of the nitrogen single-breath washout (N2SBW) test. Therefore, this study evaluated the contribution of the N2SBW test to the detection of pulmonary involvement in patients with rheumatoid arthritis (RA). Results Twenty-one patients with RA underwent clinical evaluation, pulmonary function tests (PFTs), including the N2SBW test, and computed tomography (CT). The main tomographic findings were air trapping and bronchiectasis (57.1% and 23.8% of cases, respectively). According to the phase III slope of the N2SBW (phase III slope), 11 and 10 patients had values < 120% predicted and > 120% predicted, respectively. Five patients with limited involvement on CT had a phase III slope > 120%. The residual volume/total lung capacity ratio was significantly different between patients with phase III slopes < 120% and > 120% (P = 0.024). Additionally, rheumatoid factor positivity was higher in patients with a phase III slope > 120% (P = 0.021). In patients with RA and airway disease on CT, the N2SBW test detects inhomogeneity in the ventilation distribution in approximately half of the cases, even in those with normal conventional PFT results.

Measurement of temporal changes in DLSBCO-3EQ from small alveolar samples in normal subjects

1994 ◽  
Vol 76 (4) ◽  
pp. 1494-1501 ◽  
Author(s):  
G. R. Soparkar ◽  
J. T. Mink ◽  
B. L. Graham ◽  
D. J. Cotton
Keyword(s):  
Hold Time ◽  
Normal Subjects ◽  
Gas Diffusion ◽  
Phase Iii ◽  
Mixing Efficiency ◽  
Breath Holding ◽  
Breath Hold ◽  
Inspiratory Capacity ◽  
Ventilation Inhomogeneity ◽  
Single Breath

The dynamic changes in CO concentration [CO] during a single breath could be influenced by topographic inhomogeneity in the lung or by peripheral inhomogeneity due to a gas mixing resistance in the gas phase of the lung or to serial gradients in gas diffusion. Ten healthy subjects performed single-breath maneuvers by slowly inhaling test gas from functional residual capacity to one-half inspiratory capacity and slowly exhaling to residual volume with target breath-hold times of 0, 1.5, 3, 6, and 9 s. We calculated the three-equation single-breath diffusing capacity of the lung for CO (DLSBCO-3EQ) from the mean [CO] in both the entire alveolar gas sample and in four successive equal alveolar gas samples. DLSBCO-3EQ from the entire alveolar gas sample was independent of breath-hold time. However, with 0 s of breath holding, from early alveolar gas samples DLSBCO-3EQ was reduced and from late alveolar gas samples it was increased. With increasing breath-hold time, DLSBCO-3EQ from the earliest alveolar gas sample rapidly increased, whereas from the last alveolar gas sample it rapidly decreased such that all values from the small alveolar gas samples approached DLSBCO-3EQ from the entire alveolar sample. These changes correlated with ventilation inhomogeneity, as measured by the phase III He concentration slope and the mixing efficiency, and were larger for maneuvers with inspired volumes to one-half inspiratory capacity vs. total lung capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Anomalous behavior of helium and sulfur hexafluoride during single-breath tests in sustained microgravity

1996 ◽  
Vol 80 (4) ◽  
pp. 1126-1132 ◽  
Author(s):  
G. K. Prisk ◽  
A. M. Lauzon ◽  
S. Verbanck ◽  
A. R. Elliot ◽  
H. J. Guy ◽  
...  
Keyword(s):  
Conformational Changes ◽  
Sulfur Hexafluoride ◽  
Anomalous Behavior ◽  
Phase Iii ◽  
Breath Holding ◽  
Breath Hold ◽  
Breath Tests ◽  
Single Breath ◽  
Lung Periphery ◽  
Phase Iii Slope

We performed single-breath wash-in tests for He and SF6 in four subjects exposed to 14 days of microgravity (microG) during the Spacelab flight Spacelab Life Sciences-2. Subjects inspired a vital capacity breath of 5% He-1.25% SF6-balance O2 and then exhaled to residual volume at 0.5l/s. The tests were also performed with a 10-s breath hold at the end of inspiration. Measurements were also made with the subjects standing and supine in 1 G. Phase III slope was measured after the dead-space washout and before the onset of airway closure. In all subjects in 1 G, whether standing or supine, phase III slope for SF6 was significantly steeper than that for He. However, in microG, the slopes became the same. Furthermore, after breath holding in microG, the SF6 slopes were significantly flatter than those for He. On return to 1 G, the changes were reversed, and there was no difference between preflight and postflight values. Because most of the phase III slope reflects events occurring in the acinar regions of the lung, the results suggest that microG causes conformational changes in the acini or changes in cardiogenic mixing in the lung periphery, but in either case the mechanism is unclear.

Previous volume history of the lung and regional distribution of residual volume

1981 ◽  
Vol 51 (2) ◽  
pp. 313-316 ◽  
Author(s):  
F. Ruff ◽  
R. R. Martin ◽  
J. Milic-Emili
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Regional Distribution ◽  
Breath Hold ◽  
Small Airways ◽  
Residual Volume ◽  
Lung Capacity ◽  
Lower Lung ◽  
History Of ◽  
Collateral Ventilation

By use of 133Xe, the regional distribution of residual volume (RV) was measured in six seated healthy men, following a fast vital capacity (VC) expiration a) without and b) with a breath hold at residual volume of approximately 30 s and c) following a slow (greater than 30 s) VC expiration from total lung capacity (TLC) without a breath hold at RV. After the breath hold at RV, regional RV/TLC in the lower lung zones decreased significantly compared wih results obtained with fast expiratory VC and no breath hold at RV. At lung top the opposite was true. The distribution of regional RV/TLC was the same following the slow VC expiration with no breath hold at RV as with the fast expiration with the breath hold at RV. The different regional distribution of RV in b and c relative to a was probably due mainly to collateral ventilation, i.e., during the breath hold at RV and the slow expiration some of the gas that was trapped in the dependent lung zones behind closed airways escaped into the upper regions of the lung where the small airways had remained patent, leading to increased expansion of upper alveoli.

Airway distensibility in healthy and asthmatic subjects: effect of lung volume history

2000 ◽  
Vol 88 (4) ◽  
pp. 1413-1420 ◽  
Author(s):  
David Peter Johns ◽  
John Wilson ◽  
Richard Harding ◽  
E. Haydn Walters
Keyword(s):  
Lung Volume ◽  
Total Lung Capacity ◽  
Normal Subjects ◽  
Residual Volume ◽  
Tidal Breathing ◽  
Lung Capacity ◽  
Mild Asthmatic ◽  
The Relationship ◽  
Asthmatic Group ◽  
Volume History

Anatomic dead space (Vd) is known to increase with end-inspiratory lung volume (EILV), and the gradient of the relationship has been proposed as an index of airway distensibility (ΔVd). The aims of this study were to apply a rapid method for measuring ΔVd and to determine whether it was affected by lung volume history. Vd of 16 healthy and 16 mildly asthmatic subjects was measured at a number of known EILVs by using a tidal breathing, CO2-washout method. The effect of lung volume history was assessed by using three tidal breathing regimens: 1) three discrete EILVs (low/medium/high; LMH); 2) progressively decreasing EILVs from total lung capacity (TLC; TLC-RV); and 3) progressively increasing EILVs from residual volume (RV; RV-TLC). ΔVd was lower in the asthmatic group for the LMH (25.3 ± 2.24 vs. 21.2 ± 1.66 ml/l, means ± SE) and TLC-RV (24.3 ± 1.69 vs. 18.7 ± 1.16 ml/l) regimens. There was a trend for a lower ΔVd in the asthmatic group for the RV-TLC regimen (23.3 ± 2.19 vs. 18.8 ± 1.68 ml/l). There was no difference in ΔVd between groups. In conclusion, mild asthmatic subjects have stiffer airways than normal subjects, and this is not obviously affected by lung volume history.

Comparison between total lung capacity and residual volume values obtained by pletysmography and single breath methods with methane

2006 ◽  
Vol 12 (6) ◽  
pp. 659-667
Author(s):  
Ricardo Marques Dias ◽  
Fernando Hauaji Chacur ◽  
Sonia Regina da Silva Carvalho ◽  
André Luís Mancini ◽  
Geraldo A. Capuchino
Keyword(s):  
Total Lung Capacity ◽  
Residual Volume ◽  
Lung Capacity ◽  
Single Breath

Pulmonary Function Abnormalities in Thalassemia Patients on a Hypertransfusion Program

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 1013-1017
Author(s):  
Thomas G. Keens ◽  
Margaret H. O'Neal ◽  
Jorge A. Ortega ◽  
Carol B. Hyman ◽  
Arnold C.G. Platzker
Keyword(s):  
Carbon Monoxide ◽  
Pulmonary Function ◽  
Total Lung Capacity ◽  
Small Airway ◽  
Phase Iii ◽  
Diffusing Capacity ◽  
Lung Capacity ◽  
Nitrogen Washout ◽  
Single Breath ◽  
Expiratory Flow

Pulmonary function tests were performed in 12 thalassemia patients on a hypertransfusion program (age 18.4 ± 2.6 SEM years) to determine the presence of any abnormalities of lung function. These included spirometry, expiratory flow rates, body plethysmography, single-breath nitrogen washout, single breath carbon monoxide diffusing capacity, and arterial blood gases. Only one patient had normal pulmonary function. Arterial hypoxemia was present in ten of 12 patients at rest. The total lung capacity (TLC) was normal. The residual volume was abnormally increased in five of 12 patients. The slope of phase III of single breath nitrogen washout curve was abnormal in five of 12 patients, but the closing volume was normal. The maximal expiratory flow rate at 60% total lung capacity was decreased in four of 12 patients, suggesting the presence of small airway disease. The single breath carbon monoxide diffusing capacity was normal in all patients. These pulmonary function abnormalities did not correlate with age or the cumulative amount of iron via blood transfused. The small airway obstruction, hyperinflation; and hypoxemia observed in thalassemia patients on a hypertransfusion program may result from the basic disease, iron deposition in the lungs, or other factors.

Postural effects on lung volumes and asynchronous ventilation in anesthetized horses

1980 ◽  
Vol 48 (1) ◽  
pp. 97-103 ◽  
Author(s):  
P. R. Sorenson ◽  
N. E. Robinson
Keyword(s):  
Lung Volume ◽  
Phase Iii ◽  
Lung Volumes ◽  
Lung Capacity ◽  
Single Breath ◽  
Supine Posture ◽  
Residual Capacity ◽  
Phase Iii Slope ◽  
Average Body ◽  
Prone Posture

Quasi-static pressure-volume curves and single-breath nitrogen washouts were performed simultaneously on eight anesthetized horses (average body wt = 485 kg) in left lateral, right lateral, prone, and supine postures (sequence randomized). The shift from prone to lateral or supine posture decreased expiratory reserve volume (ERV), vital capacity (VC), residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC); RV and FRC expressed as %TLC were unchanged, suggesting that in the lateral and supine postures a significant portion of the lung volume was not recruited by VC maneuvers. Phase III slope increased from 0.13 %N2/l in prone horses to 0.34 %N2/l in the lateral and supine positions. The onset of phase IV was not significantly different from FRC in the prone or laterally recombent animal, but exceeded FRC in the supine horse. The sequence of body positions had no effect on any of our results indicating that all changes in lung volumes and regional asynchronous ventilation c;n be reversed by placing the horse in the prone posture. The reduction in lung volume and increased asynchronous ventilation in the lateral and supine horse suggests that impaired gas exchange in anesthetized horses is predominantly related to posture, and not general anesthesia.

Effect of airway closure on ventilation distribution

1989 ◽  
Vol 66 (6) ◽  
pp. 2511-2515 ◽  
Author(s):  
A. B. Crawford ◽  
D. J. Cotton ◽  
M. Paiva ◽  
L. A. Engel
Keyword(s):  
Normal Subjects ◽  
Phase Iii ◽  
Mixing Efficiency ◽  
Breath Holding ◽  
Airway Closure ◽  
Ventilation Distribution ◽  
Residual Capacity ◽  
Lung Periphery ◽  
Phase Iii Slope ◽  
Volume Range

We examined the effect of airway closure on ventilation distribution during tidal breathing in six normal subjects. Each subject performed multiple-breath N2 washouts (MBNW) at tidal volumes of 1 liter over a range of preinspiratory lung volumes (PILV) from functional residual capacity (FRC) to just above residual volume. All subjects performed washouts at PILV below their measured closing capacity. In addition five of the subjects performed MBNW at PILV below closing capacity with end-inspiratory breath holds of 2 or 5 s. We measured the following two independent indexes of ventilation maldistribution: 1) the normalized phase III slope of the final breaths of the washout (Snf) and 2) the alveolar mixing efficiency of those breaths of the washout where 80–90% of the initial N2 had been cleared. Between a mean PILV of 0.28 liter above closing capacity and that 0.31 liter below closing capacity, mean Snf increased by 132% (P less than 0.005). Over the same volume range, mean alveolar mixing efficiency decreased by 3.3% (P less than 0.05). Breath holding at PILV below closing capacity resulted in marked and consistent decreases in Snf and increases in alveolar mixing efficiency. Whereas inhomogeneity of ventilation decreases with lung volume when all airways are patent (J. Appl. Physiol. 66: 2502–2510, 1989), airway closure increases ventilation inequality, and this is substantially reduced by short end-inspiratory breath holds. These findings suggest that the predominant determinant of ventilation distribution below closing capacity is the inhomogeneous closure of airways subtending regions in the lung periphery that are close together.

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