Ventilation Heterogeneity in Asthma and COPD: The Value of the Poorly Communicating Fraction as the Ratio of Total Lung Capacity to Alveolar Volume

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Roberta Pisi ◽  
Marina Aiello ◽  
Luigino Calzetta ◽  
Annalisa Frizzelli ◽  
Veronica Alfieri ◽  
...  
Keyword(s):  
Total Lung Capacity ◽  
Airflow Obstruction ◽  
Diffusing Capacity ◽  
Body Plethysmography ◽  
Alveolar Volume ◽  
Asthmatic Patients ◽  
Lung Capacity ◽  
Copd Patients ◽  
Ventilation Heterogeneity ◽  
Patient Groups

<b><i>Background:</i></b> The ventilation heterogeneity (VH) is reliably assessed by the multiple-breath nitrogen washout (MBNW), which provides indices of conductive (<i>S</i><sub>cond</sub>) and acinar (<i>S</i><sub>acin</sub>) VH as well as the lung clearance index (LCI), an index of global VH. VH can be alternatively measured by the poorly communicating fraction (PCF), that is, the ratio of total lung capacity by body plethysmography to alveolar volume from the single-breath lung diffusing capacity measurement. <b><i>Objectives:</i></b> Our objective was to assess VH by PCF and MBNW in patients with asthma and with COPD and to compare PCF and MBNW parameters in both patient groups. <b><i>Method:</i></b> We studied 35 asthmatic patients and 45 patients with COPD. Each patient performed spirometry, body plethysmography, diffusing capacity, and MBNW test. <b><i>Results:</i></b> Compared to COPD patients, asthmatics showed a significantly lesser degree of airflow obstruction and lung hyperinflation. In asthmatic patients, both PCF and LCI and <i>S</i><sub>acin</sub> values were significantly lower than the corresponding ones of COPD patients. In addition, in both patient groups, PCF showed a positive correlation with LCI (<i>p</i> &#x3c; 0.05) and <i>S</i><sub>acin</sub> (<i>p</i> &#x3c; 0.05), but not with <i>S</i><sub>cond</sub>. Lastly, COPD patients with PCF &#x3e;30% were highly likely to have a value ≥2 of the mMRC dyspnea scale. <b><i>Conclusions:</i></b> These results showed that PCF, a readily measure derived from routine pulmonary function testing, can provide a comprehensive measure of both global and acinar VH in asthma and in COPD patients and can be considered as a comparable tool to the well-established MBNW technique.

scholarly journals Total lung capacity without plethysmography

2018 ◽  
Author(s):  
Ori Adam ◽  
Inon Cohen ◽  
Wai-Ki Yip ◽  
Robert J. Shiner ◽  
Peter Calverley ◽  
...  
Keyword(s):  
Total Lung Capacity ◽  
Airflow Obstruction ◽  
Heterogeneous Population ◽  
Repeated Measurements ◽  
Body Plethysmography ◽  
Individual Subject ◽  
Thoracic Imaging ◽  
Lung Inflation ◽  
Lung Capacity

ABSTRACTBackgroundAmong the most basic measures of respiratory function is the total lung capacity (TLC). TLC is the pulmonary gas volume at maximal lung inflation, which is the sum of the volume of gas that can be exhaled –the vital capacity (VC)– and the volume of gas that cannot –the residual volume (RV). Determination of VC requires only spirometry whereas determination of RV or TLC requires body plethysmography, gas dilution or washout, or thoracic imaging, each of which is more complex than spirometry, and none of which is suited to routine office practice, population screening, or community medicine. To fill this gap, we describe here a new approach to determine TLC without plethysmography.MethodsIn a heterogeneous population of 434 volunteers (265 male, 169 female; 201 healthy, 170 with airflow obstruction, and 63 with ventilatory restriction), we determined TLC in the standard fashion using conventional body plethysmography (TLCpleth). In the same individuals, we also determined TLC in a novel fashion using the MiniBox ™ (TLCMB). To obtain TLCMB, population-based data from traditional spirometry together with flow-interruption transients were subjected to data mining and machine-learning to create for each individual subject an unbiased statistical determination of TLC.ResultsFor the combined heterogeneous population, we found TLCpleth = 1.02TLCMB −0.091 L, adjusted r2=0.824. For the heterogeneous population as a whole, and for each subpopulation, TLCMB closely tracked TLCpleth. For 26 healthy subjects measured on different days, the coefficient of variation for repeated measurements in was 3.3% for TLCpleth versus 1.6% for TLCMB.ConclusionsThese results establish the validity and potential utility of a new method for rapid, accurate, and repeatable determination of TLC in a heterogeneous patient population, but without the need of a plethysmograph.

The effect of conductive ventilation heterogeneity on diffusing capacity measurement

2008 ◽  
Vol 104 (4) ◽  
pp. 1094-1100 ◽  
Author(s):  
Sylvia Verbanck ◽  
Daniel Schuermans ◽  
Sophie Van Malderen ◽  
Walter Vincken ◽  
Bruce Thompson
Keyword(s):  
Carbon Monoxide ◽  
Vital Capacity ◽  
Experimental Situation ◽  
Normal Subjects ◽  
Diffusing Capacity ◽  
Capacity Measurement ◽  
Alveolar Volume ◽  
Estimation Errors ◽  
Single Breath ◽  
Ventilation Heterogeneity

It has long been assumed that the ventilation heterogeneity associated with lung disease could, in itself, affect the measurement of carbon monoxide transfer factor. The aim of this study was to investigate the potential estimation errors of carbon monoxide diffusing capacity (DlCO) measurement that are specifically due to conductive ventilation heterogeneity, i.e., due to a combination of ventilation heterogeneity and flow asynchrony between lung units larger than acini. We induced conductive airway ventilation heterogeneity in 35 never-smoker normal subjects by histamine provocation and related the resulting changes in conductive ventilation heterogeneity (derived from the multiple-breath washout test) to corresponding changes in diffusing capacity, alveolar volume, and inspired vital capacity (derived from the single-breath DlCO method). Average conductive ventilation heterogeneity doubled ( P < 0.001), whereas DlCO decreased by 6% ( P < 0.001), with no correlation between individual data ( P > 0.1). Average inspired vital capacity and alveolar volume both decreased significantly by, respectively, 6 and 3%, and the individual changes in alveolar volume and in conductive ventilation heterogeneity were correlated ( r = −0.46; P = 0.006). These findings can be brought in agreement with recent modeling work, where specific ventilation heterogeneity resulting from different distributions of either inspired volume or end-expiratory lung volume have been shown to affect DlCO estimation errors in opposite ways. Even in the presence of flow asynchrony, these errors appear to largely cancel out in our experimental situation of histamine-induced conductive ventilation heterogeneity. Finally, we also predicted which alternative combination of specific ventilation heterogeneity and flow asynchrony could affect DlCO estimate in a more substantial fashion in diseased lungs, irrespective of any diffusion-dependent effects.

scholarly journals Patterns of regional lung physiology in cystic fibrosis using ventilation magnetic resonance imaging and multiple-breath washout

2018 ◽  
Vol 52 (5) ◽  
pp. 1800821 ◽  
Author(s):  
Laurie J. Smith ◽  
Guilhem J. Collier ◽  
Helen Marshall ◽  
Paul J.C. Hughes ◽  
Alberto M. Biancardi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cystic Fibrosis ◽  
Total Lung Capacity ◽  
Resonance Imaging ◽  
Ventilation Distribution ◽  
Lung Clearance ◽  
Lung Capacity ◽  
Lung Clearance Index ◽  
Ventilation Heterogeneity ◽  
Multiple Breath Washout

Hyperpolarised helium-3 (3He) ventilation magnetic resonance imaging (MRI) and multiple-breath washout (MBW) are sensitive methods for detecting lung disease in cystic fibrosis (CF). We aimed to explore their relationship across a broad range of CF disease severity and patient age, as well as assess the effect of inhaled lung volume on ventilation distribution.32 children and adults with CF underwent MBW and 3He-MRI at a lung volume of end-inspiratory tidal volume (EIVT). In addition, 28 patients performed 3He-MRI at total lung capacity. 3He-MRI scans were quantitatively analysed for ventilation defect percentage (VDP), ventilation heterogeneity index (VHI) and the number and size of individual contiguous ventilation defects. From MBW, the lung clearance index, convection-dependent ventilation heterogeneity (Scond) and convection–diffusion-dependent ventilation heterogeneity (Sacin) were calculated.VDP and VHI at EIVT strongly correlated with lung clearance index (r=0.89 and r=0.88, respectively), Sacin (r=0.84 and r=0.82, respectively) and forced expiratory volume in 1 s (FEV1) (r=−0.79 and r=−0.78, respectively). Two distinct 3He-MRI patterns were highlighted: patients with abnormal FEV1 had significantly (p<0.001) larger, but fewer, contiguous defects than those with normal FEV1, who tended to have numerous small volume defects. These two MRI patterns were delineated by a VDP of ∼10%. At total lung capacity, when compared to EIVT, VDP and VHI reduced in all subjects (p<0.001), demonstrating improved ventilation distribution and regions of volume-reversible and nonreversible ventilation abnormalities.

Elastic properties of the lung in acute induced asthma

1983 ◽  
Vol 54 (1) ◽  
pp. 152-158 ◽  
Author(s):  
D. Rodenstein ◽  
D. C. Stanescu
Keyword(s):  
Lung Volume ◽  
Static Pressure ◽  
Total Lung Capacity ◽  
Esophageal Pressure ◽  
Elastic Recoil ◽  
Rapid Loss ◽  
Asthmatic Patients ◽  
Clear Cut ◽  
Lung Capacity ◽  
Significant Change

In acute induced asthma, plethysmographic total lung capacity (TLCm) was reported to increase and lung elastic recoil [Pst(L)] to decrease. The increase in TLC is spurious (J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 52: 939–954, 1982), so that the rapid loss in Pst(L) could be due to errors in lung volume. We studied seven asthmatic patients before and during an induced bronchospasm. TLC was derived simultaneously from mouth and esophageal pressure vs. plethysmographic volume plots (TLCm and TLCes, respectively). Before bronchospasm, TLCm and TLCes were similar. During bronchospasm average TLCm increased, from 7.30 +/- 1.34 (SD) to 8.12 +/- 1.49 liters (P less than 0.001), whereas TLCes did not (P greater than 0.60). Static pressure-volume curves, derived from TLCes (P-Ves), were superimposed on prechallenge curves or only slightly shifted to the left, whereas those derived from TLCm (P-Vm) showed a clear-cut parallel shift to the left. At 70% of control TLC there was no significant change in Pst(L) measured from P-Ves curves (7.3 +/- 3.1 cmH2O before bronchospasm; 6.7 +/- 2.3 cmH2O during bronchospasm, P greater than 0.10), whereas Pst(L) measured from P-Vm curves decreased from 7.3 +/- 3.1 to 5.1 +/- 2.4 cmH2O (P less than 0.01). No significant change in Pst(L) at TLC was observed during bronchospasm. We conclude that in our patients acute decrease in Pst(L) during induced asthma was artifactual, secondary to lung volume overestimation by body plethysmography.

Voluntary activation of the human diaphragm in health and disease

1998 ◽  
Vol 85 (6) ◽  
pp. 2146-2158 ◽  
Author(s):  
Christer Sinderby ◽  
Jennifer Beck ◽  
Jadranka Spahija ◽  
Jan Weinberg ◽  
Alex Grassino
Keyword(s):  
Healthy Subjects ◽  
Total Lung Capacity ◽  
Voluntary Activation ◽  
Chronic Obstructive ◽  
Quiet Breathing ◽  
Obstructive Pulmonary Disease ◽  
Transdiaphragmatic Pressure ◽  
Lung Capacity ◽  
Copd Patients ◽  
Crural Diaphragm

Intersubject comparison of the crural diaphragm electromyogram, as measured by an esophageal electrode, requires a reliable means for normalizing the signal. The present study set out 1) to evaluate which voluntary respiratory maneuvers provide high and reproducible diaphragm electromyogram root-mean-square (RMS) values and 2) to determine the relative diaphragm activation and mechanical and ventilatory outputs during breathing at rest in healthy subjects ( n = 5), in patients with severe chronic obstructive pulmonary disease (COPD, n = 5), and in restrictive patients with prior polio infection (PPI, n = 6). In all groups, mean voluntary maximal RMS values were higher during inspiration to total lung capacity than during sniff inhalation through the nose ( P = 0.035, ANOVA). The RMS (percentage of voluntary maximal RMS) during quiet breathing was 8% in healthy subjects, 43% in COPD patients, and 45% in PPI patients. Despite the large difference in relative RMS ( P = 0.012), there were no differences in mean transdiaphragmatic pressure ( P= 0.977) and tidal volumes ( P = 0.426). We conclude that voluntary maximal RMS is reliably obtained during an inspiration to total lung capacity but a sniff inhalation could be a useful complementary maneuver. Severe COPD and PPI patients breathing at rest are characterized by increased diaphragm activation with no change in diaphragm pressure generation.

Effects of irradiation of chest on pulmonary function in man

1961 ◽  
Vol 16 (2) ◽  
pp. 331-338 ◽  
Author(s):  
C. Emirgil ◽  
H. O. Heinemann
Keyword(s):  
Pulmonary Function ◽  
Total Lung Capacity ◽  
Work Of Breathing ◽  
Diffusing Capacity ◽  
Progressive Reduction ◽  
Inspiratory Capacity ◽  
Carcinoma Of The Breast ◽  
Lung Volumes ◽  
Lung Capacity ◽  
Arterial Blood

Fifteen patients, free from cardiac and pulmonary disease, but receiving radiotherapy for carcinoma of the breast or carcinoma of the lung, were studied to determine the effect of irradiation on pulmonary function. Lung volumes, the distribution of inspired air, the levels of gases in the arterial blood, the diffusing capacity of the lung, and the mechanics of breathing were measured before and at varying intervals after the completion of radiotherapy. The results showed: early and progressive reduction of inspiratory capacity (IC) and residual volume (RV), decreasing the total lung capacity (TLC) without changing the RV/TLC ratio; unchanged distribution of inspired air; mild hypoxemia at rest; reduced diffusing capacity of the lung for carbon monoxide; and an early and progressive decrease in pulmonary compliance. These observations indicate that irradiation of the chest is complicated by a decrease in lung volumes, an impairment of the diffusing capacity, and an increase in the work of breathing. Submitted on September 6, 1960

Sign in / Sign up

Export Citation Format

Share Document