Chest
Volume 88, Issue 5, November 1985, Pages 697-702
Journal home page for Chest

Clinical Investigations
Partial and Maximal Expiratory Flow-Volume Curves in Normal and Asthmatic Subjects Before and After Inhalation of Metaproterenol

https://doi.org/10.1378/chest.88.5.697Get rights and content

The effects of deep inspiration upon expiratory flow rates and response to inhaled metaproterenol were studied in normal and asthmatic subjects using partial (PEFV) and maximal (MEFV) expiratory flow volume curves. Routine pulmonary function tests and specific conductance were also measured. Prior to administration of metaproterenol, 18 of 24 normal subjects and 11 of 24 asthmatic subjects (p 0.05) had higher flow rates on MEFV than on PEFV curves. The 11 volume history responsive asthmatic subjects showed better lung function and more density-dependence of expiratory flow than the other 13 asthmatic subjects; furthermore, the effect of lung inflation was significantly larger in the volume history responsive asthmatic subjects than in the volume history responsive normal subjects. Responses to inhaled metaproterenol were much larger on PEFV than MEFV curves; nevertheless, differences between normal and asthmatic subjects in metaproterenol responsiveness were less using PEFV curves. Thus, the use of PEFV curve measurement did not facilitate the detection of individual asthmatic responses to inhaled metaproterenol.

Section snippets

Materials and Methods

Twenty four non-smoking normal subjects (13 men, 11 women) with mean age 33.3±9.5 were studied; the asthmatic group consisted of 24 subjects (12 men, 12 women) with mean age 30.5±11.4 (p=NS). Four of the asthmatic subjects were light smokers (>ten pack-years); all of these subjects had asthma prior to the onset of cigarette smoking. All subjects gave informed consent to participate in the study. The asthmatic subjects all had a history of episodic dyspnea or bronchospasm but were selected by

Routine Pulmonary Function Tests (Table 1)

In the asthmatic group, abnormalities ranged from mild to severe. Compared to the normal subjects, FEV1, percent predicted FEV1, FVC, SGaw,

max50, and RV were all significantly worse in the asthmatics. In addition, density-dependence of maximal expiratory flow (
max50) was substantially lower in the asthmatic than in normal subjects (p<0.001). Total lung capacity and DLco did not differ significantly between the two groups.

In both groups, FEV1, percent predicted FEV1, FVC, percent predicted FVC,

Discussion

A total lung capacity (TLC) volume history could affect flow rates through several mechanisms. Using the equal pressure point model,

=Pst/Rus, where Pst is lung elastic recoil pressure and Rus is upstream segment resistance.21 A deep inspiration is known to decrease Pst and thereby decrease the driving pressure for flow, as well as decrease external traction on the airways and airway diameter. Alternatively, a post inspiratory decrease in bronchomotor tone would decrease resistance. The net

ACKNOWLEDGMENTS

The authors thank R. Alfonso, Y. Franzen, and J. Lowe for technical assistance and R. Langenfeld and H. Buck for the typing of this manuscript.

References (29)

  • N Zamel et al.

    Partial and complete maximum expiratory flow-volume in asthmatics with spontaneous bronchospasm

    Chest

    (1983)
  • RD Fairshter et al.

    Large airway constriction in allergic rhinitis: response to inhalation of helium-oxygen

    J Allergy Clin Immunol

    (1979)
  • JA Nadel et al.

    Effect of a previous deep inspiration on airway resistance in man

    J Appl Physiol

    (1961)
  • M Green et al.

    Time dependence of flow volume curves

    J Appl Physiol

    (1974)
  • NE Brown et al.

    Airway response to inhaled histamine in asymptomatic smokers and nonsmokers

    J Appl Physiol

    (1977)
  • J Orehek et al.

    Bronchomotor effect of bronchoconstriction-induced deep inspirations in asthmatics

    Am Rev Respir Dis

    (1980)
  • G Gayrard et al.

    Bronchoconstrictor effects of a deep inspiration in patients with asthma

    Am Rev Respir Dis

    (1975)
  • JE Fish et al.

    Regulation of bronchomotor tone by lung inflation in asthmatic and non-asthmatic subjects

    J Appl Physiol

    (1981)
  • RD Fairshter

    Airway hysteresis in normal subjects and individuals with chronic airflow obstruction

    J Appl Physiol: Respir Environ Exer Physiol

    (1985)
  • WM Parham et al.

    Analysis of time course and magnitude of lung inflation effects on airway tone: relation to airway reactivity

    Am Rev Respir Dis

    (1983)
  • LG Melissinos et al.

    Time dependence of maximum flow as an index of non-uniform emptying

    J Appl Physiol: Respirat Environ Exer Physiol

    (1979)
  • ER McFadden et al.

    Acute effects of inhaled isoproterenol on the mechanical characteristics of the lungs in normal man

    J Clin Invest

    (1970)
  • RR Parry et al.

    Partial and full flow volume curves before and after isoproterenol in patients

    Am Rev Respir Dis

    (1976)
  • PF Barnes et al.

    Partial flow-volume curves to measure bronchodilator dose-response curves in normal humans

    J Appl Physiol: Respirat Environ Exer Physiol

    (1981)
  • Cited by (23)

    • Alternative functional criteria to assess airflow-limitation reversibility in asthma

      2015, Revista Portuguesa de Pneumologia
      Citation Excerpt :

      Airway obstruction reversibility is still a controversial topic also because there is still a lack of consensus on which variables should be used to express bronchodilator response. In fact, despite the general use of FEV1 or FVC criteria, some studies have concluded that changes in these measurements can frequently underestimate significant responses to bronchodilator in both adults and children.5–12 On the other hand, when reversibility is expressed by the percentage increase in FEV1, it shows bronchodilator responses more frequently in the most severely obstructed patients.13,14

    • Assessment of acute bronchodilator effects from specific airway resistance changes in stable COPD patients

      2014, Respiratory Physiology and Neurobiology
      Citation Excerpt :

      While the need for the evaluation of novel procedures for acute bronchodilator reversibility testing has been stressed in the most recent review article on reversibility in COPD (Hanania et al., 2011), no alternatives to current criteria seem to have been taken into consideration, although there are indications that plethysmography and/or impulse oscillometry might better reflect bronchodilation in COPD patients (Borrill et al., 2004). In COPD patients, bronchodilators should significantly improve lung function and relieve respiratory symptoms to the extent that they decrease airway resistance during tidal breathing, thus preventing or reducing dynamic hyperinflation and increasing inspiratory capacity (IC) (Barnes et al., 1981; Berry and Fairshter, 1985; Pellegrino et al., 1998). Because in these patients the disease affects more the small than the large airways, another favorable effect of reducing bronchomotor tone could be the decrease of airway closing pressure, leading to a fall in the residual volume (RV) and increase in the vital capacity (VC).

    • Acute bronchodilator responsiveness in bronchiolitis obliterans syndrome following hematopoietic stem cell transplantation

      2011, Chest
      Citation Excerpt :

      Based on the results from a previous study30 in obstructed patients who did not meet the FEV1 criteria for reversibility, it seems reasonable to assume that a part change of this magnitude may exceed the within-session spontaneous variability of this index even in BOS. Analogous with observations in COPD,11 an explanation for part to increase, even in the absence of change in FEV1, after a bronchodilator is the bronchoconstrictor effect of full-lung inflation,11,13 which is accentuated after bronchodilators.39 That this also may be the case in the present study is suggested by the findings of a prebronchodilator max/part ratio < 1 and its positive postbronchodilator decrease.

    • Inspiratory capacity and decrease in lung hyperinflation with albuterol in COPD

      2002, Chest
      Citation Excerpt :

      Forced expiratory flows were measured at least in triplicate during a forced expiration initiated from end-tidal inspiration and terminated to RV (partial forced expiratory maneuver) and from TLC to RV (maximum forced expiratory maneuver) soon after taking a maximum and fast inspiration. The reason for measuring partial flow is that it is more sensitive than maximal flows to detect changes in airway caliber after bronchodilatation than maximal flows.6,7,12,13 The same measurements were repeated 20 min after inhalation of albuterol, 200 μg, by a metered-dose inhaler with spacer device during a full inspiratory maneuver from RV.

    View all citing articles on Scopus

    Manuscript received January 17; revision accepted May 8.

    Recipient of NHLBI Pulmonary Adacemic Award HL 00529.

    View full text