Area under the inspiratory flow-volume curve (AIN): Proposed normative values

Abstract

Rationale Area under expiratory flow-volume curve (AEX) has been shown to be a valuable functional measurement in respiratory physiology. Area under inspiratory flow-volume loop (AIN) also shows promise in characterizing upper and/or lower airflow obstruction. Objectives we aimed here to develop normative reference values for AIN, able to ascertain deviations from normal. Methods We analyzed AIN in 4,980 spirometry tests recorded in non-smoking, healthy individuals in the Pulmonary Function Testing Laboratory. Results The mean (95% confidence interval, CI), standard deviation and median (25th-75th interquartile range) AIN were 16.05 (15.79–16.31), 9.08 and 14.72 (9.12–21.42) L2·sec-1, respectively. The mean (95% CI) and standard deviation of the best-trial measurements for square root of AIN (Sqrt AIN) were 3.84 (3.81–3.87) and 1.14; 4.15 (4.12–4.18) and 1.03 in men, and 2.68 (2.63–2.72) and 0.72 L·sec-1/2 in women. The mean (standard deviation) of pre- and post-bronchodilator Sqrt AIN were 3.71 (1.17) and 3.81 (1.19) L·sec-1/2, respectively. The mean (95% CI), standard deviation and lowest 5th percentile (lower limit of normal, LLN) of Sqrt AIN/Sqrt AEX (%) were 101.3 (100.82–101.88), 18.7, and 71.8%; stratified by gender, it was 102.2 (101.6–102.8), 18.6, and 72.8% in men, and 98 (96.9–99.2), 18.8, and 68.6% in women, respectively. Conclusions The availability of area under the inspiratory flow-volume curve (AIN) and the derived indices offers a promising opportunity to assess upper airway disease (e.g., involvement of larynx, trachea or major bronchi), especially because some of these measurements appear to be independent of age, race, height, and weight.