Dependence of forced vital capacity manoeuvre on time course of preceding inspiration in patients with restrictive lung disease

Koulouris, Nikolaos; Rapakoulias, Panagiotis; Rassidakis, A.; Dimitroulis, J.; Gaga, Mina; Milic–Emili, J.; Jordanoglou, J.

doi:10.1183/09031936.97.10102366

Cited by 21 publications

(23 citation statements)

References 17 publications

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“…Since the previous volume and time history of a spontaneous tidal breath is necessarily different from that of a forced vital capacity (FVC) manoeuvre, it is axiomatic that comparison of tidal expiratory flow-volume with MEFV curves is problematic. In fact, there is not a single MEFV curve, but rather a family of different curves, which depend on the time-course of the inspiration preceding the FVC manoeuvre [15][16][17]. Therefore, comparison of tidal expiratory flow-volume and MEFV curves is incorrect.…”

Section: Conventional Techniquesmentioning

confidence: 99%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

European Respiratory Journal

220

168

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Fashions in ideas, like clothes, come and go. From approximately 1950From approximately -1980, physiological research was seen as the key discipline in understanding lung disease and was at the cutting edge of pulmonary science. Subsequently, its importance has been down played amid a widely accepted but unfounded assumption that we now have a perfect working understanding of the physiological behaviour of the respiratory system in health and disease. Although it seems improbable that completely new disciplines within respiratory physiology will emerge with fundamentally different ways of describing the mechanical or gas exchanging function of the lung, advances in computing and new observations in disease have highlighted previously unsuspected physiological abnormalities that have changed the way we view lung disease and the interface between disordered lung mechanics, symptomatology and disability. This is especially true for the two related physiological concepts of expiratory flow limitation and dynamic hyperinflation, which are now being taken from the physiological laboratory to the bedside with dramatic effect. Each arises from well-established theoretical and practical observations first made 40 yrs ago and now adapted to a range of settings, particularly in the field of obstructive lung disease. This review focuses on how these conditions are defined and assessed and what evidence there is that they might be important in lung disease.

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Section: Conventional Techniquesmentioning

confidence: 99%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

European Respiratory Journal

220

168

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“…Therefore, it is axiomatic that comparison of tidal with maximal flow-volume curves is problematic. In fact, there is not a single maximal flow-volume curve but rather a family of different curves, which depend on the time course of the inspiration preceding the FVC manoeuvre [35][36][37]. 4) Respiratory mechanics and time constant inequalities are different during the tidal and maximal expiratory efforts, again making comparisons of the two flow-volume curves problematic [38][39][40].…”

Section: Conventional (Hyatt's) Methodsmentioning

confidence: 99%

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Koulouris¹,

Hardavella²

2011

Eur Respir Rev

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Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as they do during the forced expiratory vital capacity manoeuvre, and this has been taken as an indicator of expiratory flow limitation at rest (EFLT). Therefore, EFLT, namely attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation, with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in Global Initiative for Chronic Obstructive Lung Disease III and IV stage), in whom the latter symptoms are common, but is not exclusive to COPD, since it can also be detected in other pulmonary and nonpulmonary diseases like asthma, acute respiratory distress syndrome, heart failure and obesity, etc. The existing up to date physiological techniques of assessing EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, noninvasive, practical and accurate new technique.

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“…Several previous studies showed that F maneuvers were associated with greater peak expiratory flows in both normal volunteers (D'Angelo et al 1993;Wanger et al 1996) and patients with various lung diseases (Braggion et al 1996;D'Angelo et al 1994;Koulouris et al 1997;Wanger et al 1996). Since the inter-maneuver differences in some measured pulmonary parameters could be as high as 40% (Braggion et al 1996;D'Angelo et al 1993D'Angelo et al , 1994Koulouris et al 1997;Wanger et al 1996), it was suggested that measurement of forced vital capacity should be standardized taking into consideration the speed of preceding inspiration (Braggion et al 1996;Wanger et al 1996).…”

Section: Discussionmentioning

confidence: 97%

Maximal dynamic expiratory pressures with fast and slow inspirations

2003

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Maximal dynamic expiratory pressures are higher when forced expiration is preceded by a fast inspiration to total lung capacity (TLC) than when preceded by a slow inspiration and a few seconds pause at TLC. We hypothesized that these pressure differences are due to the stretch-shorten cycle (SSC), which refers to enhancement of muscle force when a concentric muscle contraction is immediately preceded by an eccentric contraction. Seven volunteers [36 (2) years; mean (SEM)] performed maximal forced expirations against minimal resistance with fast (F) or slow (S) maneuvers. F maneuvers consisted of a fast inspiration to TLC followed immediately by a fast expiration, whereas S consisted of a slow inspiration to TLC and a 4- to 5-s pause at TLC prior to forced expiration. We measured esophageal pressure ( P(es)), peak expiratory flow rate (PEFR), and the EMG activity of the transversus abdominis (Tr) by means of intramuscular fine-wire electrodes. The subjects performed several runs of each maneuver in a random order, and runs with the greatest expiratory P(es) were analyzed. In comparison with S, F yielded greater P(es) [182 (15) versus 167 (15) cm H(2)O; P=0.003)] but similar PEFR [9.8 (0.7) versus 9.6 (0.7) l/s, P>0.05] and EMG activity of the Tr during forced expiration [221 (31) versus 208 (34) a.u., P>0.05]. Further analysis revealed significant EMG activity of Tr during end-inspiration (eccentric contraction) with F maneuvers only [73 (22) versus 32 (17) a.u., P<0.05]. We conclude that the ability of expiratory muscles to generate greater P(es) with F maneuvers is related to the sequence of an eccentric contraction, which is followed immediately by concentric contraction in a manner analogous to SSC described in skeletal muscles.

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Dependence of forced vital capacity manoeuvre on time course of preceding inspiration in patients with restrictive lung disease

Cited by 21 publications

References 17 publications

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Maximal dynamic expiratory pressures with fast and slow inspirations

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