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. 1973 Sep;52(9):2117–2128. doi: 10.1172/JCI107396

Contributions of Loss of Lung Recoil and of Enhanced Airways Collapsibility to the Airflow Obstruction of Chronic Bronchitis and Emphysema

D G Leaver 1, A E Tattersfield 1, N B Pride 1
PMCID: PMC333012  PMID: 4727452

Abstract

We investigated the contributions of intrinsic disease of the airways, loss of lung recoil and enhanced airway collapsibility to the airflow obstruction of 17 patients with chronic bronchitis and emphysema. Airways conductance at low flow (Gaw), maximum expiratory flow (V̇E, MAX) and static lung recoil pressure [Pst (l)] were measured at different lung volumes, and conductance-static recoil pressure and maximum flow-static recoil pressure curves constructed. Low values of ΔGaw/ΔPst (l) and ΔV̇E, max/ΔPst (l) were attributed to intrinsic airways disease. Airway collapsibility was assessed by comparing Gaw with upstream conductance on forced expiration and by the intercept of the maximum flow-static recoil curve on the static recoil pressure axis (Ptm′).

All patients had reduced Gaw at all volumes but in seven ΔGaw/ΔPst (l) was normal. On forced expiration, maximum flow in all patients was reduced more than could be accounted for by loss of lung recoil. ΔV̇E, MAX/ΔPst (l) was reduced in the patients in whom ΔGaw/Pst (l) was low. In contrast ΔV̇E, MAX/ΔPst (l) was normal in three and only slightly reduced in another three of the seven patients with normal ΔGaw/ΔPst (l). In these patients Gaw greatly exceeded upstream conductance and Ptm′ was increased.

We conclude that loss of lung recoil could account for the reduction in resting airways dimensions in 7 of the 17 patients. Enhanced airway collapsibility commonly contributed to reduction in maximum flow. In three patients the airflow obstruction could be entirely accounted for by loss of lung recoil and enhanced airway collapsibility.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BUTLER J., CARO C. G., ALCALA R., DUBOIS A. B. Physiological factors affecting airway resistance in normal subjects and in patients with obstructive respiratory disease. J Clin Invest. 1960 Apr;39:584–591. doi: 10.1172/JCI104071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Black L. F., Hyatt R. E., Stubbs S. E. Mechanism of expiratory airflow limitation in chronic obstructive pulmonary disease associated with 1 -antitrypsin deficiency. Am Rev Respir Dis. 1972 Jun;105(6):891–899. doi: 10.1164/arrd.1972.105.6.891. [DOI] [PubMed] [Google Scholar]
  3. Burrows B., Fletcher C. M., Heard B. E., Jones N. L., Wootliff J. S. The emphysematous and bronchial types of chronic airways obstruction. A clinicopathological study of patients in London and Chicago. Lancet. 1966 Apr 16;1(7442):830–835. doi: 10.1016/s0140-6736(66)90181-4. [DOI] [PubMed] [Google Scholar]
  4. Christie R. V. THE ELASTIC PROPERTIES OF THE EMPHYSEMATOUS LUNG AND THEIR CLINICAL SIGNIFICANCE. J Clin Invest. 1934 Mar;13(2):295–321. doi: 10.1172/JCI100588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. DAYMAN H. Mechanics of airflow in health and in emphysema. J Clin Invest. 1951 Nov;30(11):1175–1190. doi: 10.1172/JCI102537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. DUBOIS A. B., BOTELHO S. Y., BEDELL G. N., MARSHALL R., COMROE J. H., Jr A rapid plethysmographic method for measuring thoracic gas volume: a comparison with a nitrogen washout method for measuring functional residual capacity in normal subjects. J Clin Invest. 1956 Mar;35(3):322–326. doi: 10.1172/JCI103281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DUBOIS A. B., BOTELHO S. Y., COMROE J. H., Jr A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease. J Clin Invest. 1956 Mar;35(3):327–335. doi: 10.1172/JCI103282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Desmeules M., Peslin R., Saraiva C., Uffholtz H., Sadoul P. Propriétés statiques et dynamiques pulmonaires dans la bronchite chronique et l'emphysème. Bull Physiopathol Respir (Nancy) 1971 Mar-Apr;7(2):395–411. [PubMed] [Google Scholar]
  9. Duffell G. M., Marcus J. H., Ingram R. H., Jr Limitation of expiratory flow in chronic obstructive pulmonary disease. Relation of clinical characteristics, pathophysiological type, and mechanisms. Ann Intern Med. 1970 Mar;72(3):365–374. doi: 10.7326/0003-4819-72-3-365. [DOI] [PubMed] [Google Scholar]
  10. FRASER R. G. Measurements of the calibre of human bronchi in three phases of respiration by cinebronchography. J Can Assoc Radiol. 1961 Dec;12:102–112. [PubMed] [Google Scholar]
  11. 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]
  12. Grimby G., Takishima T., Graham W., Macklem P., Mead J. Frequency dependence of flow resistance in patients with obstructive lung disease. J Clin Invest. 1968 Jun;47(6):1455–1465. doi: 10.1172/JCI105837. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. HYATT R. E., SCHILDER D. P., FRY D. L. Relationship between maximum expiratory flow and degree of lung inflation. J Appl Physiol. 1958 Nov;13(3):331–336. doi: 10.1152/jappl.1958.13.3.331. [DOI] [PubMed] [Google Scholar]
  14. Hogg J. C., Macklem P. T., Thurlbeck W. M. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med. 1968 Jun 20;278(25):1355–1360. doi: 10.1056/NEJM196806202782501. [DOI] [PubMed] [Google Scholar]
  15. Hughes J. M., Hoppin F. G., Jr, Mead J. Effect of lung inflation on bronchial length and diameter in excised lungs. J Appl Physiol. 1972 Jan;32(1):25–35. doi: 10.1152/jappl.1972.32.1.25. [DOI] [PubMed] [Google Scholar]
  16. Hyatt R. E., Flath R. E. Influence of lung parenchyma on pressure-diameter behavior of dog bronchi. J Appl Physiol. 1966 Sep;21(5):1448–1452. doi: 10.1152/jappl.1966.21.5.1448. [DOI] [PubMed] [Google Scholar]
  17. Jonson B. Pulmonary mechanics in patients with pulmonary disease, studied with the flow regulator method. Scand J Clin Lab Invest. 1970 Jun;25(4):375–390. doi: 10.3109/00365517009046218. [DOI] [PubMed] [Google Scholar]
  18. Jordanoglou J., Pride N. B. A comparison of maximum inspiratory and expiratory flow in health and in lung disease. Thorax. 1968 Jan;23(1):38–45. doi: 10.1136/thx.23.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Leaver D. G., Tattersfield A. E., Pride N. B. Factors contributing to airflow obstruction in patients with chronic bronchitis and emphysema. Bull Physiopathol Respir (Nancy) 1971 Mar-Apr;7(2):479–487. [PubMed] [Google Scholar]
  20. MACKLEM P. T., FRASER R. G., BROWN W. G. BRONCHIAL PRESSURE MEASUREMENTS IN EMPHYSEMA AND BRONCHITIS. J Clin Invest. 1965 Jun;44:897–905. doi: 10.1172/JCI105206. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. MILIC-EMILI J., MEAD J., TURNER J. M., GLAUSER E. M. IMPROVED TECHNIQUE FOR ESTIMATING PLEURAL PRESSURE FROM ESOPHAGEAL BALLOONS. J Appl Physiol. 1964 Mar;19:207–211. doi: 10.1152/jappl.1964.19.2.207. [DOI] [PubMed] [Google Scholar]
  22. Macklem P. T., Wilson N. J. Measurement of intrabronchial pressure in man. J Appl Physiol. 1965 Jul;20(4):653–663. doi: 10.1152/jappl.1965.20.4.653. [DOI] [PubMed] [Google Scholar]
  23. Mead J., Takishima T., Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970 May;28(5):596–608. doi: 10.1152/jappl.1970.28.5.596. [DOI] [PubMed] [Google Scholar]
  24. Mead J., Turner J. M., Macklem P. T., Little J. B. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol. 1967 Jan;22(1):95–108. doi: 10.1152/jappl.1967.22.1.95. [DOI] [PubMed] [Google Scholar]
  25. Penman R. W., O'Neill R. P., Begley L. Lung elastic recoil and airway resistnce as factors limiting forced expiratory flow. Am Rev Respir Dis. 1970 Apr;101(4):528–535. doi: 10.1164/arrd.1970.101.4.528. [DOI] [PubMed] [Google Scholar]
  26. Pride N. B., Permutt S., Riley R. L., Bromberger-Barnea B. Determinants of maximal expiratory flow from the lungs. J Appl Physiol. 1967 Nov;23(5):646–662. doi: 10.1152/jappl.1967.23.5.646. [DOI] [PubMed] [Google Scholar]
  27. Stevens P. M., Orman B. F., Graves G., Jr Contributions of lung recoil and airway resistance to forced expiratory flow limitation. Am Rev Respir Dis. 1969 Jul;100(1):54–62. doi: 10.1164/arrd.1969.100.1.54. [DOI] [PubMed] [Google Scholar]
  28. Stubbs S. E., Hyatt R. E. Effect of increased lung recoil pressure on maximal expiratory flow in normal subjects. J Appl Physiol. 1972 Mar;32(3):325–331. doi: 10.1152/jappl.1972.32.3.325. [DOI] [PubMed] [Google Scholar]
  29. WRIGHT R. R. Bronchial atrophy and collapse in chronic obstructive pulmonary emphysema. Am J Pathol. 1960 Jul;37:63–77. [PMC free article] [PubMed] [Google Scholar]
  30. Zapletal A., Motoyama E. K., Van De Woestijne K. P., Hunt V. R., Bouhuys A. Maximum expiratory flow-volume curves and airway conductance in children and adolescents. J Appl Physiol. 1969 Mar;26(3):308–316. doi: 10.1152/jappl.1969.26.3.308. [DOI] [PubMed] [Google Scholar]

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