title: Virtual respiratory system in investigation of CPAP influence on optimal breathing frequency in obstructive lungs disease.
abstract: BACKGROUND
  Continuous Positive Airway Pressure (CPAP) is a commonly accepted method of spontaneous breathing support in obstructive lung disease. Previous work suggested that the cause of the CPAP efficacy in the obstructive lung disease localized in bronchi of middle order (OLDMO) is not as obvious as, for example, in the obstructive sleep apnea. Since CPAP reduces obstruction and the optimal breathing frequency (BF) depends on the obstruction level, it seems to be important to analyze the dependence of the optimal BF on CPAP.
  
  
  OBJECTIVE
  To analyze the support efficacy cause in OLDMO, esp. the relationship between the CPAP value and optimal BF.
  
  
  METHODS
  Investigations utilized previously built virtual respiratory system. Its most important factors: nonlinear lungs compliance and changeability of nonlinear airway resistance (Raw). Influence of BF and the CPAP value on the tidal volume and minute ventilation was analyzed for four exemplary virtual patients: healthy ("standard") and suffering from moderate, severe, and the very severe OLDMO (the other parameters, esp. respiratory muscles effort, were unchanged). Minute inspiratory work as a criterion of the BF optimization.
  
  
  RESULTS
  CPAP decreased Raw making breathing easier, however, it shifted the working point of the respiratory system towards the smaller lungs compliance making breathing harder. The final result depended on the Raw value: CPAP improved breathing of patients with the serious OLDMO while it worsened healthy person breathing. The optimal CPAP value depended on the Raw value. If a virtual patient suffering from the serious OLDMO was not supported with CPAP, he had to breathe with low frequency because minute ventilation did not rise with BF increase. The optimal BF depended on the CPAP value (the greater the value, the greater the frequency).
  
  
  CONCLUSIONS
  The CPAP efficacy depends on the level of OLDMO. CPAP is efficient in the severe OLDMO because it increases the optimal BF, which makes possible less energy-consuming breathing with frequency close to the normal one (greater BF means smaller tidal volume and thus smaller work against lungs compliance).
authors.affiliation: Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland. tgol@ibib.waw.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Golczewski
authors.forename: Marek
authors.initials: M
authors.lastname: Darowski