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. 2005 Apr;60(4):288–292. doi: 10.1136/thx.2004.033589

Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery

A Sharafkhaneh 1, S Goodnight-White 1, T Officer 1, J Rodarte 1, A Boriek 1
PMCID: PMC1747381  PMID: 15790983

Abstract

Background: Thoracic gas compression (TGC) exerts a negative effect on forced expiratory flow. Lung resistance, effort during a forced expiratory manoeuvre, and absolute lung volume influence TGC. Lung volume reduction surgery (LVRS) reduces lung resistance and absolute lung volume. LVRS may therefore reduce TGC, and such a reduction might explain in part the improvement in forced expiratory flow with the surgery. A study was conducted to determine the effect of LVRS on TGC and the extent to which reduced TGC contributed to an improvement in forced expiratory volume in 1 second (FEV1) following LVRS.

Methods: The effect of LVRS on TGC was studied using prospectively collected lung mechanics data from 27 subjects with severe emphysema. Several parameters including FEV1, expiratory and inspiratory lung resistance (Rle and Rli), and lung volumes were measured at baseline and 6 months after surgery. Effort during the forced manoeuvre was measured using transpulmonary pressure. A novel method was used to estimate FEV1 corrected for the effect of TGC.

Results: At baseline the FEV1 corrected for gas compression (NFEV1) was significantly higher than FEV1 (p<0.0001). FEV1 increased significantly from baseline (p<0.005) while NFEV1 did not change following surgery (p>0.15). TGC decreased significantly with LVRS (p<0.05). Rle and maximum transpulmonary pressure (TPpeak) during the forced manoeuvre significantly predicted the reduction in TGC following the surgery (Rle: p<0.01; TPpeak: p<0.0001; adjusted R2 = 0.68). The improvement in FEV1 was associated with the reduction in TGC after surgery (p<0.0001, adjusted R2 = 0.58).

Conclusions: LVRS decreased TGC by improving expiratory flow limitation. In turn, the reduction in TGC decreased its negative effect on expiratory flow and therefore explained, in part, the improvement in FEV1 with LVRS in this cohort.

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Selected References

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  1. Black L. F., Hyatt R. E. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May;99(5):696–702. doi: 10.1164/arrd.1969.99.5.696. [DOI] [PubMed] [Google Scholar]
  2. Black L. F., Offord K., Hyatt R. E. Variability in the maximal expiratory flow volume curve in asymptomatic smokers and in nonsmokers. Am Rev Respir Dis. 1974 Sep;110(3):282–292. doi: 10.1164/arrd.1974.110.3.282. [DOI] [PubMed] [Google Scholar]
  3. Criner G. J., Cordova F. C., Furukawa S., Kuzma A. M., Travaline J. M., Leyenson V., O'Brien G. M. Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999 Dec;160(6):2018–2027. doi: 10.1164/ajrccm.160.6.9902117. [DOI] [PubMed] [Google Scholar]
  4. Dawson S. V., Elliott E. A. Wave-speed limitation on expiratory flow-a unifying concept. J Appl Physiol Respir Environ Exerc Physiol. 1977 Sep;43(3):498–515. doi: 10.1152/jappl.1977.43.3.498. [DOI] [PubMed] [Google Scholar]
  5. FRY D. L., HYATT R. E. Pulmonary mechanics. A unified analysis of the relationship between pressure, volume and gasflow in the lungs of normal and diseased human subjects. Am J Med. 1960 Oct;29:672–689. doi: 10.1016/0002-9343(60)90100-5. [DOI] [PubMed] [Google Scholar]
  6. Fessler Henry E., Scharf Steven M., Permutt Solbert. Improvement in spirometry following lung volume reduction surgery: application of a physiologic model. Am J Respir Crit Care Med. 2002 Jan 1;165(1):34–40. doi: 10.1164/ajrccm.165.1.2101149. [DOI] [PubMed] [Google Scholar]
  7. Gelb A. F., Brenner M., McKenna R. J., Jr, Zamel N., Fischel R., Epstein J. D. Lung function 12 months following emphysema resection. Chest. 1996 Dec;110(6):1407–1415. doi: 10.1378/chest.110.6.1407. [DOI] [PubMed] [Google Scholar]
  8. JAEGER M. J., OTIS A. B. MEASUREMENT OF AIRWAY RESISTANCE WITH A VOLUME DISPLACEMENT BODY PLETHYSMOGRAPH. J Appl Physiol. 1964 Jul;19:813–820. doi: 10.1152/jappl.1964.19.4.813. [DOI] [PubMed] [Google Scholar]
  9. Krowka M. J., Enright P. L., Rodarte J. R., Hyatt R. E. Effect of effort on measurement of forced expiratory volume in one second. Am Rev Respir Dis. 1987 Oct;136(4):829–833. doi: 10.1164/ajrccm/136.4.829. [DOI] [PubMed] [Google Scholar]
  10. Lambert R. K., Wilson T. A., Hyatt R. E., Rodarte J. R. A computational model for expiratory flow. J Appl Physiol Respir Environ Exerc Physiol. 1982 Jan;52(1):44–56. doi: 10.1152/jappl.1982.52.1.44. [DOI] [PubMed] [Google Scholar]
  11. Officer T. M., Pellegrino R., Brusasco V., Rodarte J. R. Measurement of pulmonary resistance and dynamic compliance with airway obstruction. J Appl Physiol (1985) 1998 Nov;85(5):1982–1988. doi: 10.1152/jappl.1998.85.5.1982. [DOI] [PubMed] [Google Scholar]
  12. Ramírez-Sarmiento A., Orozco-Levi M., Barreiro E., Méndez R., Ferrer A., Broquetas J., Gea J. Expiratory muscle endurance in chronic obstructive pulmonary disease. Thorax. 2002 Feb;57(2):132–136. doi: 10.1136/thorax.57.2.132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Rochester D. F., Braun N. M. Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1985 Jul;132(1):42–47. doi: 10.1164/arrd.1985.132.1.42. [DOI] [PubMed] [Google Scholar]
  14. Schlueter D. P., Immekus J., Stead W. W. Relationship between maximal inspiratory pressure and total lung capacity (coefficient of retraction) in normal subjects and in patients with emphysema, asthma, and diffuse pulmonary infiltration. Am Rev Respir Dis. 1967 Oct;96(4):656–665. doi: 10.1164/arrd.1967.96.4.656. [DOI] [PubMed] [Google Scholar]
  15. Sciurba F. C., Rogers R. M., Keenan R. J., Slivka W. A., Gorcsan J., 3rd, Ferson P. F., Holbert J. M., Brown M. L., Landreneau R. J. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med. 1996 Apr 25;334(17):1095–1099. doi: 10.1056/NEJM199604253341704. [DOI] [PubMed] [Google Scholar]
  16. Sharafkhaneh Amir, Officer Todd M., Goodnight-White Sheila, Rodarte Joseph R., Boriek Aladin M. Novel method for measuring effects of gas compression on expiratory flow. Am J Physiol Regul Integr Comp Physiol. 2004 Apr 29;287(2):R479–R484. doi: 10.1152/ajpregu.00573.2003. [DOI] [PubMed] [Google Scholar]

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