A simple method to detect expiratory flow limitation during spontaneous breathing.
Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as during a forced expiratory vital capacity manoeuvre, and this has been taken as indicating flow limitation at rest. To obtain such curves, a body plethysmograph and the patient's co-operation are required. We propose a simple technique which does not entail these requirements. It consists in applying negative pressure at the mouth during a tidal expiration (NEP). Patients in whom NEP elicits an increase in flow throughout the expiration are not flow-limited. In contrast, patients in whom application of NEP does not elicit an increase in flow during most or part of the tidal expiration are considered as flow-limited. Using this technique, 26 stable COPD patients were studied sitting and supine. Eleven patients were flow-limited both seated and supine, eight were flow-limited only when supine, and seven were not flow-limited either seated or supine. Only 5 of 19 patients who were flow-limited seated and/or supine had severe ventilatory impairment (forced expiratory volume in one second (FEV1) < 40% predicted). We conclude that the NEP technique provides a simple, rapid, and reliable method for detection of expiratory flow limitation in spontaneously breathing subjects, which does not require the patient's co-operation, and can be applied in different body positions both at rest and during muscular exercise. Our results also indicate a high prevalence of flow limitation in COPD patients at rest, particularly when supine.
Koulouris
N G
NG
Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.
Valta
P
P
Lavoie
A
A
Corbeil
C
C
Chassé
M
M
Braidy
J
J
Milic-Emili
J
J
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D011187:Posture; D012123:Pulmonary Ventilation / Q000502:physiology*; D012129:Respiratory Function Tests / Q000379:methods; D015656:Respiratory Mechanics / Q000502:physiology; D016683:Supine Position