Thoracic gas compression during forced expiration in patients with emphysema, interstitial lung disease and obesity

BMC Pulmonary Medicine

Anssi RA Sovijärvi²  Hans-Jürgen Smith³  Tomi Wuorimaa²  Ulla Hodgson¹  Päivi L Piirilä² 

[1] Heart and Lung Center Helsinki, Helsinki University Central Hospital, Helsinki, Finland;Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, P.O.Box 340, Helsinki, HUS 00029, Finland;Research in Respiratory Diagnostics, Bahrendorfer Str. 3, Berlin 12555, Germany

关键词: Thoracic gas compression;    Obesity;    Interstitial lung disease;    Healthy control;    Flow plethysmography;    Emphysema;    Chronic obstructive pulmonary disease;   

Others  :  866508
DOI  :  10.1186/1471-2466-14-34

 received in 2013-06-05, accepted in 2014-02-24,  发布年份 2014

【 摘 要 】

Background

Dynamic gas compression during forced expiration has an influence on conventional flow-volume spirometry results. The extent of gas compression in different pulmonary disorders remains obscure. Utilizing a flow plethysmograph we determined the difference between thoracic and mouth flows during forced expiration as an indication of thoracic gas compression in subjects with different pulmonary diseases characterized by limitations in pulmonary mechanics.

Methods

Patients with emphysema (N = 16), interstitial lung disease (ILD) (N = 15), obesity (N = 15) and healthy controls (N = 16) were included. Compressed expiratory flow-volume curves (at mouth) and corresponding compression-free curves (thoracic) were recorded. Peak flow (PEF) and maximal flows at 75%, 50% and 25% of remaining forced vital capacity (MEF75, MEF50 and MEF25) were derived from both recordings. Their respective difference was assessed as an indicator of gas compression.

Results

In all groups, significant differences between thoracic and mouth flows were found at MEF50 (p < 0.01). In controls, a significant difference was also measured at MEF75 (p <0.005), in emphysema subjects, at PEF and MEF75 (p < 0.05, p < 0.005) and in obese subjects at MEF75 (p <0.005) and MEF25 (p < 0.01). ILD patients showed the lowest difference between thoracic and mouth flows at MEF75 relative to controls and emphysema patients (p < 0.005, p < 0.001). Obese subjects did not differ from controls, however, the difference between thoracic and mouth flows was significantly higher than in patients with emphysema at MEF50 (p < 0.001) and MEF25 (p < 0.005).

Conclusions

Alveolar gas compression distorts the forced expiratory flow volume curve in all studied groups at the middle fraction of forced expiratory flow. Consequently, mouth flows are underestimated and the reduction of flow measured at 75% and 50% of vital capacity is often considerable. However, gas compression profiles in stiff lungs, in patients with decreased elastic recoil in emphysema and in obesity differ; the difference between thoracic and mouth flows in forced expiration was minimal in ILD at the first part of forced expiration and was higher in obesity than in emphysema at the middle and last parts of forced expiration.

【 授权许可】

   
2014 Piirilä et al.; licensee BioMed Central Ltd.

【 图 表 】

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