title: Effect of preceding inspiratory speed and end-inspiratory pause on forced expiratory manoeuvre in healthy subjects and chronic obstructive pulmonary disease patients.
abstract: BACKGROUND
  Lower peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV(1)) have been consistently found after slow inspiration with end-inspiratory pause (EIP).
  
  
  OBJECTIVE
  It was the aim of this study to establish the respective influence of the speed of preceding inspiration (SPI) and EIP on the parameters obtained from the following expiratory forced vital capacity (FVC) manoeuvre.
  
  
  METHODS
  In 8 healthy subjects and 12 patients with chronic obstructive pulmonary disease (COPD), a number of inspirations with different SPI and EIP were performed. In the subsequent FVC manoeuvre, maximal expiratory flows, including PEF, and maximal expired volumes at different times, including FEV(1), were measured. For each FVC manoeuvre, peak expiratory time, expired volume at PEF (as % of FVC), flow limitation by the negative expiratory pressure technique and FVC were checked to be sure of achieving a similar expiratory effort and starting inflation lung volume.
  
  
  RESULTS
  The highest values of PEF and FEV(1) were found in normal subjects and COPD patients after fastest SPI without EIP (p < 0.001). In normal subjects, no significant PEF and FEV(1) changes during FVC manoeuvre were observed with different SPI, in the absence of EIP. In contrast, inspirations with slower SPI (inspiratory time >2 s) without EIP were followed by lower PEF in COPD patients (p < 0.05). As compared with inspirations without EIP, those with a presence of EIP were invariably followed by lower PEF and FEV(1), both in normal subjects and in COPD patients (p < 0.05).
  
  
  CONCLUSIONS
  The effect of SPI on subsequent PEF and FEV(1) is irrelevant in healthy subjects as well as in COPD patients, unless SPI is too slow (inspiratory time >2 s), while any EIP decreases these indices in all individuals.
authors.affiliation: Department of Medical and Surgical Sciences, University of Brescia, and 1st Medicina, Spedali Civili, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Boni
authors.forename: Stefania
authors.initials: S
authors.lastname: Chiari
authors.forename: Marco
authors.initials: M
authors.lastname: Trigiani
authors.forename: Diego
authors.initials: D
authors.lastname: Gatta
authors.forename: Laura
authors.initials: L
authors.lastname: Pini
authors.forename: Claudio
authors.initials: C
authors.lastname: Tantucci
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008448:Maximal Expiratory Flow Rate; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012119:Respiration