The anatomical basis for the sloping N2 plateau

Investigation of inert gas washout methods in a new numerical model based on an electrical analogy

Inert gas washout methods have been shown to detect pathological changes in the small airways that occur in the early stages of obstructive lung diseases such as asthma and COPD. Numerical lung models support the analysis of characteristic washout curves, but are limited in their ability to simulate the complexity of lung anatomy over an appropriate time period. Therefore, the interpretation of patient-specific washout data remains a challenge. A new numerical lung model is presented in which electrical components describe the anatomical and physiological characteristics of the lung as well as gas-specific properties. To verify that the model is able to reproduce characteristic washout curves, the phase 3 slopes (S3) of helium washouts are simulated using simple asymmetric lung anatomies consisting of two parallel connected lung units with volume ratios of1.25 0.75 ,1.50 0.50 , and1.75 0.25 and a total volume flow of 250 ml/s which are evaluated for asymmetries in both the convection- and diffusion-dominated zone of the lung. The results show that the model is able to reproduce the S3 for helium and thus the processes underlying the washout methods, so that electrical components can be used to model these methods. This approach could form the basis of a hardware-based real-time simulator.

Structure-function in smokers: when a small airways test really reflects the small airways

If multiple-breath washout (MBW)-derived acinar ventilation heterogeneity (Sacin) really represents peripheral units, the N2 phase-III of the first MBW exhalation should be curvilinear. This is essentially due to the superposed effect of gas diffusion and convection resulting in an equilibration of N2 concentrations between neighboring lung units throughout exhalation. We investigated this in smokers with computed tomography (CT)-proven functional small airway disease. Instantaneous N2-slopes were computed over 40-ms intervals throughout phase-III and normalized by mean phase-III N2 concentration. N2 phase-III (concave) curvilinearity was quantified as the rate at which the instantaneous N2-slope decreases past the phase-II peak over a 1-s interval; for a linear N2 phase-III unaffected by diffusion, this rate would amount to 0 L-1/s. N2 phase-III curvilinearity was obtained on the experimental curves and on existing model simulations of N2 curves from a normal peripheral lung model and one with missing terminal bronchioles (either 50% or 30% TB left). In 46 smokers [66 (±8) yr; 49 (±26) pack·yr] with CT-based evidence of peripheral lung destruction, instantaneous N2-slope decrease was compared between those with (fSAD+fEmphys) > 20% [-0.26 ± 0.14 (SD) L-1/s; n = 24] and those with (fSAD+fEmphys) < 20% [-0.16 ± 0.12 (SD) L-1/s; n = 22] (P = 0.014). Experimental values fell in the range predicted by a realistic peripheral lung model with progressive reduction of terminal bronchioles: values of instantaneous N2-slope decrease obtained from model simulations were -0.09 L-1/s (normal lung; 100% TB left), -0.17 L-1/s (normal lung 50% TB left), and -0.29 L-1/s (30% TB left). In smokers with CT-based evidence of functional small airway alterations, it is possible to demonstrate that Sacin really does represent the most peripheral airspaces.NEW & NOTEWORTHY In smokers with computed tomography-based evidence of functional small airway alterations by parametric response mapping, it is possible to demonstrate that the multiple-breath washout-derived Sacin, an index of acinar ventilation heterogeneity, actually does represent the most peripheral airspaces. This is done by verifying on experimental N2 washout curves of the first breath, N2 phase-III concavity predicted by the diffusion-convection interdependence model.

Model analysis of multiple breath nitrogen washout data: robustness to variations in breathing pattern

We recently developed a model-based method for analyzing multiple breath nitrogen washout data that does not require identification of Phase-III. In the present study, we assessed the effect of irregular breathing patterns on the intra-subject variabilities of the model parameters. Nitrogen fraction at the mouth was measured in 18 healthy and 20 asthmatic subjects during triplicate performances of multiple breath nitrogen washout, during controlled (target tidal volume 1 L at 8-12 breaths per minute) and free (unrestricted) breathing. The parameters S_cond, S_acin and functional residual capacity (FRC) were obtained by conventional analysis of the slope of Phase-III. Fitting the model to the washout data provided functional residual capacity (FRC_M), dead space volume (V_D), the coefficient of variation of regional specific ventilation ([Formula: see text]), and the model equivalent of S_acin (S_acin-M). Intra-participant coefficients of variation for the model parameters for both health and asthma were FRC_M < 5.2%, V_D < 5.4%, [Formula: see text] < 9.0%, and S_acin-M < 45.6% for controlled breathing, and FRC_M < 4.6%, V_D < 5.3%, [Formula: see text] < 13.2%, and S_acin-M < 103.2% for free breathing. The coefficients of variation limits for conventional parameters were FRC < 6.1%, with S_cond < 73.6% and S_acin < 49.2% for controlled breathing and S_cond < 35.0% and S_acin < 74.4% for free breathing. The model-fitting approach to multiple breath nitrogen washout analysis provides a measure of regional ventilation heterogeneity in [Formula: see text] that is less affected by irregularities in the breathing pattern than its corresponding Phase-III slope analysis parameter S_cond.

Investigation of tracer gas transport in a new numerical model of lung acini

Obstructive pulmonary diseases are associated with considerable morbidity. For an early diagnosis of these diseases, inert gas washouts can potentially be used. However, the complex interaction between lung anatomy and gas transport mechanisms complicates data analysis. In order to investigate this interaction, a numerical model, based on the finite difference method, consisting of two lung units connected in parallel, was developed to simulate the tracer gas transport within the human acinus. Firstly, the geometries of the units were varied and the diffusion coefficients (D) were kept constant. Secondly, D was changed and the geometry was kept constant. Furthermore, simple monoexponential growth functions were applied to evaluate the simulated data. In 109 of the 112 analyzed curves, monoexponential function matched simulated data with an accuracy of over 90%, potentially representing a suitable numerical tool to predict transport processes in further model extensions. For total flows greater than 5 × 10−4 ml/s, the exponential growth constants increased linearly with linear increasing flow to an accuracy of over 95%. The slopes of these linear trend lines of 1.23 µl−1 (D = 0.6 cm2/s), 1.69 µl−1 (D = 0.3 cm2/s), and 2.25 µl−1 (D = 0.1 cm2/s) indicated that gases with low D are more sensitive to changes in flows than gases with high D.

Graphical abstract

Prediction of COPD by the single-breath nitrogen test and various respiratory symptoms

Early identification of subjects running an increased risk of contracting COPD enables focus on individual preventive measures. The slope of the alveolar plateau of the single-breath nitrogen washout test (N2-slope) is a sensitive measure of small-airway dysfunction. However, its role remains unexplored in predicting hospital admission or death related to COPD, i.e. incident COPD events, in relation to the presence of various respiratory symptoms. A random population sample of 625 men, aged 50 (n=218) or 60 years (n=407), was followed for 38 years for incident COPD events. At baseline, a questionnaire on respiratory symptoms and smoking habits was collected, spirometry and the single-breath nitrogen test were performed, and the N2-slope was determined. Proportional hazard regression (Cox regression) analysis was used for the prediction model. The N2-slope improved the prediction of COPD events significantly beyond that of respiratory symptoms weighted all together and other covariates (hazard ratio 1.63, 95% CI 1.20-2.22; p<0.005), a prediction applicable to subjects without (p=0.001) and with (p<0.05) airway obstruction. Dyspnoea and wheezing were the most predictive symptoms. The combination of the N2-slope and number of respiratory symptoms notably resulted in an effective prediction of incident COPD events even in nonobstructive subjects, as evidenced by a predicted incidence of ∼70% and ∼90% for a very steep N2-slope combined with many respiratory symptoms in subject without and with airway obstruction, respectively. The alveolar N2-slope should be considered in the critical need for further research on early diagnosis of COPD.

Modeling of the Transport and Exchange of a Gas Species in Lungs With an Asymmetric Branching Pattern. Application to Nitric Oxide

Over the years, various studies have been dedicated to the mathematical modeling of gas transport and exchange in the lungs. Indeed, the access to the distal region of the lungs with direct measurements is limited and, therefore, models are valuable tools to interpret clinical data and to give more insights into the phenomena taking place in the deepest part of the lungs. In this work, a new computational model of the transport and exchange of a gas species in the human lungs is proposed. It includes (i) a method to generate a lung geometry characterized by an asymmetric branching pattern, based on the values of several parameters that have to be given by the model user, and a method to possibly alter this geometry to mimic lung diseases, (ii) the calculation of the gas flow distribution in this geometry during inspiration or expiration (taking into account the increased resistance to the flow in airways where the flow is non-established), (iii) the evaluation of the exchange fluxes of the gaseous species of interest between the tissues composing the lungs and the lumen, and (iv) the computation of the concentration profile of the exchanged species in the lumen of the tracheobronchial tree. Even if the model is developed in a general framework, a particular attention is given to nitric oxide, as it is not only a gas species of clinical interest, but also a gas species that is both produced in the walls of the airways and consumed within the alveolar region of the lungs. First, the model is presented. Then, several features of the model, applied to lung geometry, gas flow and NO exchange and transport, are discussed, compared to existing works and notably used to give new insights into experimental data available in the literature, regarding diseases, such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease.

A simplified 4-parameter model of volumetric capnograms improves calculations of airway dead space and slope of Phase III

To evaluate a compact and easily interpretable 4-parameter model describing the shape of the volumetric capnogram, and the resulting estimates of anatomical dead space (VD_AW) and Phase III (alveolar plateau) slope (S_III). Data from of 8 mildly-endotoxemic pre-acute respiratory distress syndrome sheep were fitted to the proposed 4-parameter model (4p) and a previously established 7-parameter model (7p). Root mean square error (RMSE) and Akaike information criterion (AIC), as well as VD_AW and S_III derived from each model were compared. Confidence intervals for model's parameters, VD_AW and S_III were estimated with a jackknife approach. RMSE values were similar (4p: 1.13 ± 0.01 mmHg vs 7p: 1.14 ± 0.01 mmHg) in the 791 breath cycles tested. However, the 7p overfitted the curve and had worse AIC in more than 50% of the cycles (p < 0.001). The large number of degrees of freedom also resulted in larger between-animal range of confidence intervals for 7p (VD_AW: from 6.1 10^-12 to 34 ml, S_III: from 9.53 10^-7 to 1.80 mmHg/ml) as compared to 4p (VD_AW: from 0.019 to 0.15 ml, S_III: from 3.9 10^-4 to 0.011 mmHg/ml). Mean differences between VD_AW (2.1 ± 0.04 ml) and S_III (0.047 ± 0.004 mmHg/ml) from 7 and 4p were significant (p < 0.001), but within the observed cycle-by-cycle variability. The proposed 4-parameter model of the volumetric capnogram improves data fitting and estimation of VD_AW and S_III as compared to the 7-parameter model of reference. These advantages support the use of the 4-parameter model in future research and clinical applications.

A model-based approach to interpreting multibreath nitrogen washout data

The multibreath nitrogen washout (MBNW) test, as it is currently practiced, provides parameters of potential physiological significance that are derived from the relationship between the volume-normalized Phase III slope of the exhaled nitrogen fraction ([Formula: see text]) vs. the cumulative change in lung volume (V). Reliable evaluation of these parameters requires, however, that the subject breathe deeply and evenly, so that Phase III can be clearly identified in every breath. This places a burden on the test subject that may prove troublesome for young children and those with lung disease. Furthermore, the determination of the slope of Phase III requires that a decision be made as to when Phase II ends and Phase III begins. In an attempt to get around these methodological limitations, we develop here an alternative method of analysis based on a multicompartment model of the lung that accounts for the entire exhaled nitrogen profile, including Phases I, II, and III. Fitting this model to [Formula: see text] and V measured during a MBNW provides an estimate of the coefficient of variation of specific ventilation, as well as functional residual capacity, dead space volume, and a parameter that reflects structural asymmetry at the acinar level in the lung. In the present study, we demonstrate the potential utility of this modeling approach to the analysis of MBNW data. NEW & NOTEWORTHY The multibreath nitrogen washout test potentially provides important physiological information about regional ventilation heterogeneity throughout the lung, but the conventional analysis requires the subject to breathe deeply and regularly, which is not always practical. We have developed a model-based analysis method that avoids this limitation and that also provides measures of functional residual capacity and dead space volume, thereby expanding the applicability and scope of the method.

Computationally efficient analysis of particle transport and deposition in a human whole-lung-airway model. Part I: Theory and model validation

Computational predictions of aerosol transport and deposition in the human respiratory tract can assist in evaluating detrimental or therapeutic health effects when inhaling toxic particles or administering drugs. However, the sheer complexity of the human lung, featuring a total of 16 million tubular airways, prohibits detailed computer simulations of the fluid-particle dynamics for the entire respiratory system. Thus, in order to obtain useful and efficient particle deposition results, an alternative modeling approach is necessary where the whole-lung geometry is approximated and physiological boundary conditions are implemented to simulate breathing. In Part I, the present new whole-lung-airway model (WLAM) represents the actual lung geometry via a basic 3-D mouth-to-trachea configuration while all subsequent airways are lumped together, i.e., reduced to an exponentially expanding 1-D conduit. The diameter for each generation of the 1-D extension can be obtained on a subject-specific basis from the calculated total volume which represents each generation of the individual. The alveolar volume was added based on the approximate number of alveoli per generation. A wall-displacement boundary condition was applied at the bottom surface of the first-generation WLAM, so that any breathing pattern due to the negative alveolar pressure can be reproduced. Specifically, different inhalation/exhalation scenarios (rest, exercise, etc.) were implemented by controlling the wall/mesh displacements to simulate realistic breathing cycles in the WLAM. Total and regional particle deposition results agree with experimental lung deposition results. The outcomes provide critical insight to and quantitative results of aerosol deposition in human whole-lung airways with modest computational resources. Hence, the WLAM can be used in analyzing human exposure to toxic particulate matter or it can assist in estimating pharmacological effects of administered drug-aerosols. As a practical WLAM application, the transport and deposition of asthma drugs from a commercial dry-powder inhaler is discussed in Part II.

Airway gas exchange and exhaled biomarkers

During inspiration and expiration, gases traverse the conducting airways as they are transported between the environment and the alveolar region of the lungs. The term "conducting" airways is used broadly as the airway tree is thought largely to provide a conduit for the respiratory gases, oxygen and carbon dioxide. However, despite a significantly smaller surface area, and thicker barrier separating the gas phase from the blood when compared to the alveolar region, the airway tree can participate in gas exchange under special conditions such as high water solubility, high chemical reactivity, or production of the gas within the airway wall tissue. While these conditions do not apply to the respiratory gases, other gases demonstrate substantial exchange of the airways and are of particular importance to the inflammatory response of the lungs, the medical-legal field, occupational health, metabolic disorders, or protection of the delicate alveolar membrane. Given the significant structural differences between the airways and the alveolar region, the physical determinants that control airway gas exchange are unique and require different models (both experimental and mathematical) to explore. Our improved physiological understanding of airway gas exchange combined with improved analytical methods to detect trace compounds in the exhaled breath provides future opportunities to develop new exhaled biomarkers that are characteristic of pulmonary and systemic conditions.

Gas exchange under altered gravitational stress

Efficient gas exchange in the lung depends on the matching of ventilation and perfusion. However, the human lung is a readily deformable structure and as a result gravitational stresses generate gradients in both ventilation and perfusion. Nevertheless, the lung is capable of withstanding considerable change in the applied gravitational load before pulmonary gas exchange becomes impaired. The postural changes that are part of the everyday existence for most bipedal species are well tolerated, as is the removal of gravity (weightlessness). Increases in the applied gravitational load result only in a large impairment in pulmonary gas exchange above approximately three times that on the ground, at which point the matching of ventilation to perfusion is so impaired that efficient gas exchange is no longer possible. Much of the tolerance of the lung to alterations in gravitation stress comes from the fact that ventilation and perfusion are inextricably coupled. Deformations in the lung that alter ventilation necessarily alter perfusion, thus maintaining a degree of matching and minimizing the disruption in ventilation to perfusion ratio and thus gas exchange.

A functional mathematical model to simulate the single-breath nitrogen washout

A nonlinear dynamic model is proposed to reproduce and interpret the influence of pulmonary inhomogeneities on the single-breath nitrogen washout (SBNW) curve. The model is characterized by two parallel zones. In each zone, the upper airways are described by a Rohrer resistor. Intermediate airways are represented as a collapsible segment, the volume of which depends on transmural pressure. Smaller airways are described by a resistance which increases when transpulmonary pressure decreases. The respiratory region is modeled as a Voigt element. Three different conditions were simulated: a reference case, characterized by airway-parameter values for normal conditions, and two pathological states corresponding to different levels of disease. In the reference case, a straight line was a good approximation of SBNW phase III and the last point of departure of the nitrogen trace from this line unambiguously identified the onset of phase IV. The slope of phase III rose with disease severity (from a 1.1% increase in nitrogen concentration per 1000 ml of expired volume in the reference case to 3.6% and 7.7% in the pathological cases) and the distinction between phases III and IV became less evident. The results obtained indicate that the slope of phase III depends primarily on nitrogen-concentration differences between lung zones, as determined by different mechanical properties of the respiratory airways. In spite of the simplified representation of the lungs, the similarity of the simulation results to actual data suggests that the proposed model describes important physiological mechanisms underlying changes observed during SBNW in normal and pathological patients.

Respiratory system reactance is an independent determinant of asthma control

The mechanisms underlying not well-controlled (NWC) asthma remain poorly understood, but accumulating evidence points to peripheral airway dysfunction as a key contributor. The present study tests whether our recently described respiratory system reactance (Xrs) assessment of peripheral airway dysfunction reveals insight into poor asthma control. The aim of this study was to investigate the contribution of Xrs to asthma control. In 22 subjects with asthma, we measured Xrs (forced oscillation technique), spirometry, lung volumes, and ventilation heterogeneity (inert-gas washout), before and after bronchodilator administration. The relationship between Xrs and lung volume during a deflation maneuver yielded two parameters: the volume at which Xrs abruptly decreased (closing volume) and Xrs at this volume (Xrscrit). Lowered (more negative) Xrscrit reflects reduced apparent lung compliance at high lung volumes due, for example, to heterogeneous airway narrowing and unresolved airway closure or near closure above the critical lung volume. Asthma control was assessed via the 6-point Asthma Control Questionnaire (ACQ6). NWC asthma was defined as ACQ6 > 1.0. In 10 NWC and 12 well-controlled subjects, ACQ6 was strongly associated with postbronchodilator (post-BD) Xrscrit (R(2) = 0.43, P < 0.001), independent of all measured variables, and was a strong predictor of NWC asthma (receiver operator characteristic area = 0.94, P < 0.001). By contrast, Xrs measures at lower lung volumes were not associated with ACQ6. Xrscrit itself was significantly associated with measures of gas trapping and ventilation heterogeneity, thus confirming the link between Xrs and airway closure and heterogeneity. Residual airway dysfunction at high lung volumes assessed via Xrscrit is an independent contributor to asthma control.

Parenchymal mechanics, gas mixing, and the slope of phase III

A model of parenchymal mechanics is revisited with the objective of investigating the differences in parenchymal microstructure that underlie the differences in regional compliance that are inferred from gas-mixing studies. The stiffness of the elastic line elements that lie along the free edges of alveoli and form the boundary of the lumen of the alveolar duct is the dominant determinant of parenchymal compliance. Differences in alveolar size cause parallel shifts of the pressure-volume curve, but have little effect on compliance. However, alveolar size also affects the relation between surface tension and pressure during the breathing cycle. Thus regional differences in alveolar size generate regional differences in surface tension, and these drive Marangoni surface flows that equilibrate surface tension between neighboring acini. Surface tension relaxation introduces phase differences in regional volume oscillations and a dependence of expired gas concentration on expired volume. A particular example of different parenchymal properties in two neighboring acini is described, and gas exchange in this model is calculated. The efficiency of mixing and slope of phase III for the model agree well with published data. This model constitutes a new hypothesis concerning the origin of phase III.

Effect of regional lung inflation on ventilation heterogeneity at different length scales during mechanical ventilation of normal sheep lungs

Heterogeneous, small-airway diameters and alveolar derecruitment in poorly aerated regions of normal lungs could produce ventilation heterogeneity at those anatomic levels. We modeled the washout kinetics of (13)NN with positron emission tomography to examine how specific ventilation (sV) heterogeneity at different length scales is influenced by lung aeration. Three groups of anesthetized, supine sheep were studied: high tidal volume (Vt; 18.4 ± 4.2 ml/kg) and zero end-expiratory pressure (ZEEP) (n = 6); low Vt (9.2 ± 1.0 ml/kg) and ZEEP (n = 6); and low Vt (8.2 ± 0.2 ml/kg) and positive end-expiratory pressure (PEEP; 19 ± 1 cmH(2)O) (n = 4). We quantified fractional gas content with transmission scans, and sV with emission scans of infused (13)NN-saline. Voxel (13)NN-washout curves were fit with one- or two-compartment models to estimate sV. Total heterogeneity, measured as SD[log(10)(sV)], was divided into length-scale ranges by measuring changes in variance of log(10)(sV), resulting from progressive filtering of sV images. High-Vt ZEEP showed higher sV heterogeneity at <12- (P < 0.01), 12- to 36- (P < 0.01), and 36- to 60-mm (P < 0.05) length scales compared with low-Vt PEEP, with low-Vt ZEEP in between. Increased heterogeneity was associated with the emergence of low sV units in poorly aerated regions, with a high correlation (r = 0.95, P < 0.001) between total heterogeneity and the fraction of lung with slow washout. Regional mean fractional gas content was inversely correlated with regional sV heterogeneity at <12- (r = -0.67), 12- to 36- (r = -0.74), and >36-mm (r = -0.72) length scales (P < 0.001). We conclude that sV heterogeneity at length scales <60 mm increases in poorly aerated regions of mechanically ventilated normal lungs, likely due to heterogeneous small-airway narrowing and alveolar derecruitment. PEEP reduces sV heterogeneity by maintaining lung expansion and airway patency at those small length scales.

Tidal volume single breath washout of two tracer gases--a practical and promising lung function test

Background

Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI), which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM) and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW) of sulfur hexafluoride (SF₆) and helium (He) using an ultrasonic flowmeter (USFM).

Methods

The tracer gas mixture contained 5% SF₆ and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC), were determined in seven subjects performing three SBW 24 hours apart.

Results

USFM reliably measured MM during all SBW tests (n = 60). MM from USFM reflected SF₆ and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%.

Conclusion

The USFM accurately measured relative changes in SF₆ and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF₆ and He washout patterns during tidal breathing.

Quantifying proximal and distal sources of NO in asthma using a multicompartment model

Nitric oxide (NO) is detectable in exhaled breath and is thought to be a marker of lung inflammation. The multicompartment model of NO exchange in the lungs, which was previously introduced by our laboratory, considers parallel and serial heterogeneity in the proximal and distal regions and can simulate dynamic features of the NO exhalation profile, such as a sloping phase III region. Here, we present a detailed sensitivity analysis of the multicompartment model and then apply the model to a population of children with mild asthma. Latin hypercube sampling demonstrated that ventilation and structural parameters were not significant relative to NO production terms in determining the NO profile, thus reducing the number of free parameters from nine to five. Analysis of exhaled NO profiles at three flows (50, 100, and 200 ml/s) from 20 children (age 7-17 yr) with mild asthma representing a wide range of exhaled NO (4.9 ppb < fractional exhaled NO at 50 ml/s < 120 ppb) demonstrated that 90% of the children had a negative phase III slope. The multicompartment model could simulate the negative phase III slope by increasing the large airway NO flux and/or distal airway/alveolar concentration in the well-ventilated regions. In all subjects, the multicompartment model analysis improved the least-squares fit to the data relative to a single-path two-compartment model. We conclude that features of the NO exhalation profile that are commonly observed in mild asthma are more accurately simulated with the multicompartment model than with the two-compartment model. The negative phase III slope may be due to increased NO production in well-ventilated regions of the lungs.

Effect of heterogeneous ventilation and nitric oxide production on exhaled nitric oxide profiles

Elevated exhaled nitric oxide (NO) in the breath of asthmatic subjects is thought to be a noninvasive marker of lung inflammation. Asthma is also characterized by heterogeneous bronchoconstriction and inflammation, which impact the spatial distribution of ventilation in the lungs. Since exhaled NO arises from both airway and alveolar regions, and its level in exhaled breath depends strongly on flow, spatial heterogeneity in flow patterns and NO production may significantly affect the exhaled NO signal. To investigate the effect of these factors on exhaled NO profiles, we developed a multicompartment mathematical model of NO exchange using a trumpet-shaped central airway segment that bifurcates into two similarly shaped peripheral airway segments, each of which empties into an alveolar compartment. Heterogeneity in flow alone has only a minimal impact on the exhaled NO profile. In contrast, placing 70% of the total airway NO production in the central compartment or the distal poorly ventilated compartment can significantly increase (35%) or decrease (-10%) the plateau concentration, respectively. Reduced ventilation of the peripheral and acinar regions of the lungs with concomitant elevated NO production delays the rise of NO during exhalation, resulting in a positive phase III slope and reduced plateau concentration (-11%). These features compare favorably with experimentally observed profiles in exercise-induced asthma and cannot be simulated with single-path models. We conclude that variability in ventilation and NO production in asthmatic subjects impacts the shape of the exhaled NO profile and thus impacts the physiological interpretation.

Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test

BACKGROUND

Alveolar volume measured according to the American Thoracic Society-European Respiratory Society (ATS-ERS) guidelines during the single breath diffusion test can be underestimated when there is maldistribution of ventilation. Therefore, the alveolar volume calculated by taking into account the ATS-ERS guidelines was compared to the alveolar volume measured from sequentiallly collected samples of the expired volume in two groups of individuals: COPD patients and healthy individuals. The aim of this study was to investigate the effects of the maldistribution of ventilation on the real estimate of alveolar volume and to evaluate some indicators suggestive of the presence of maldistribution of ventilation.

METHODS

Thirty healthy individuals and fifty patients with moderate-severe COPD were studied. The alveolar volume was measured either according to the ATS-ERS guidelines or considering the whole expired volume subdivided into five quintiles. An index reflecting the non-uniformity of the distribution of ventilation was then derived (DeltaVA/VE).

RESULTS

Significant differences were found when comparing the two measurements and the alveolar volume by quintiles appeared to have increased progressively towards residual volume in healthy individuals and much more in COPD patients. Therefore, DeltaVA/VE resulted in an abnormal increase in COPD.

CONCLUSION

The results of our study suggest that the alveolar volume during the single breath diffusion test should be measured through the collection of a sample of expired volume which could be more representative of the overall gas composition, especially in the presence of uneven distribution of ventilation. Further studies aimed at clarifying the final effects of this way of calculating the alveolar volume on the measure of DLCO are needed. DeltaVA/VE is an index that can help assess the severity of inhomogeneity in COPD patients.

Multiple-breath washout in preschool children--FRC and ventilation inhomogeneity

The open-circuit multiple-breath inert gas washout method is used to measure functional residual capacity and also to quantify ventilation distribution. The technique is readily applicable in preschool children as it requires quiet tidal breathing. Guidelines for data collection and interpretation in this age group will shortly be published by the European Respiratory Society and the American Thoracic Society.

Airway closure in microgravity

Recent single breath washout (SBW) studies in microgravity and on the ground have suggested an important effect of airway closure on gas mixing in the human lung, reflected particularly in the phase III slope of vital capacity SBW and bolus tests. In order to explore this effect, we designed a SBW in which subjects inspired 2-l from residual volume (RV) starting with a 150 ml bolus of He and SF6. In an attempt to vary the pattern of airways closure configuration before the test, the experiments were conducted in 1G and in microgravity during parabolic flight allowing the pre-test expiration to RV to be either in microgravity or at 1.8 G, with the actual test gas inhalation performed entirely in microgravity. Contrary to our expectations, the measured phase III slope and phase IV height and volume obtained from seven subjects in microgravity were essentially identical irrespective of the gravity level during the pre-test expiration to RV. The results suggest that airway closure configuration at RV before the test inspiration has no apparent impact on phases III and IV generation.

Gas mixing efficiency from birth to adulthood measured by multiple-breath washout

Efficient mixing of inspired gas with the resident gas of the lung is an essential requirement of effective respiration. This review focuses on one method for quantifying ventilation inhomogeneity: the multiple-breath inert gas washout (MBW). MBW has been employed as a research tool in adults and school age children for more than 50 years. Modifications allowing data collection in infants and preschoolers have been described recently. Indices of overall ventilation inhomogeneity, such as the lung clearance index and moment ratios, are raised in many infants with lung disease of prematurity, and in young children with cystic fibrosis. These indices may be more sensitive than other lung function measures for the early detection of airway disease. We describe, for the first time, a development of the MBW analysis that allows calculation of acinar and conductive zone inhomogeneity indices in spontaneously breathing children. Although methodological and analytical issues remain, the future clinical and research applications of MBW justify accelerated research in this field.

The Lung in Space

The lung is exquisitely sensitive to gravity, which induces gradients in ventilation, blood flow, and gas exchange. Studies of lungs in microgravity provide a means of elucidating the effects of gravity. They suggest a mechanism by which gravity serves to match ventilation to perfusion, making for a more efficient lung than anticipated. Despite predictions, lungs do not become edematous, and there is no disruption to, gas exchange in microgravity. Sleep disturbances in microgravity are not a result of respiratory-related events; obstructive sleep apnea is caused principally by the gravitational effects on the upper airways. In microgravity, lungs may be at greater risk to the effects of inhaled aerosols.

Unevenness of ventilation assessed by the expired CO(2) gas volume versus V(T) curve in asthmatic patients

Recently, we have shown that the expired CO2 gas volume versus tidal volume (VCO2-VT) curve is a useful tool for assessing unevenness of ventilation because it allows the separation of tidal volume into three functional compartments: (a) the CO2-free expired air (V0), (b) the transitional volume (Vtr), (c) the alveolar volume (VA) and the measurement of alveolar FCO2 during resting breathing in normal subjects and patients with COPD. In this paper, we have investigated whether changes pertaining to unevenness of ventilation taking place immediately after the administration of methacholine can be assessed using the VCO2-VT curve in asthmatic patients. The VCO2-VT curve was obtained during tidal breathing from 16 stable asthmatic patients who underwent a methacholine challenge test. It has been found that the Vtr, and hence Bohr's dead space (VD,Bohr = V0 + Vtr), over tidal volume ratios were significantly increased immediately after the methacholine administration, whilst the V0 over tidal volume ratio was not affected. The change of the above ratios was not related to the percentage decrease of FEV1.0 following methacholine administration.

Effect of 60 degrees head-down tilt on peripheral gas mixing in the human lung

The phase III slope of sulfur hexafluoride (SF6) in a single-breath washout (SBW) is greater than that of helium (He) under normal gravity (i.e., 1G), thus resulting in a positive SF6-He slope difference. In microgravity (microG), SF6-He slope difference is smaller because of a greater fall in the phase III slope of SF6 than He. We sought to determine whether increasing thoracic fluid volume using 60 degrees head-down tilt (HDT) in 1G would produce a similar effect to microG on phase III slopes of SF6 and He. Single-breath vital capacity (SBW) and multiple-breath washout (MBW) tests were performed before, during, and 60 min after 1 h of HDT. Compared with baseline (SF6 1.050 +/- 0.182%/l, He 0.670 +/- 0.172%/l), the SBW phase III slopes for both SF6 and He tended to decrease during HDT, reaching nadir at 30 min (SF6 0.609 +/- 0.211%/l, He 0.248 +/- 0.138%/l; P = 0.08 and P = 0.06, respectively). In contrast to microG, the magnitude of the phase III slope decrease was similar for both SF6 and He; therefore, no change in SF6-He slope difference was observed. MBW analysis revealed a decrease in normalized phase III slopes at all time points during HDT, for both SF6 (P < 0.01) and He (P < 0.01). This decrease was due to changes in the acinar, and not the conductive, component of the normalized phase III slope. These findings support the notion that changes in thoracic fluid volume alter ventilation distribution in the lung periphery but also demonstrate that the effect during HDT does not wholly mimic that observed in microG.

Tidal volume single-breath washin of SF6 and CH4 in transient microgravity

We performed tidal volume single-breath washins (SBW) by using tracers of different diffusivity and varied the time spent in microgravity (microG) before the start of the tests to look for time-dependent effects. SF(6) and CH(4) phase III slopes decreased by 35 and 26%, respectively, in microG compared with 1 G (P < 0.05), and the slope difference between gases disappeared. There was no effect of time in microG, suggesting that neither the hypergravity period preceding microG nor the time spent in microG affected gas mixing at volumes near functional residual capacity. In previous studies using SF(6) and He (Lauzon A-M, Prisk GK, Elliott AR, Verbanck S, Paiva M, and West JB. J Appl Physiol 82: 859-865, 1997), the vital capacity SBW showed an increase in slope difference between gases in transient microG, the opposite of the decrease in sustained microG. In contrast, tidal volume SBW showed a decrease in slope difference in both microG conditions. Because it is only the behavior of the more diffusive gas that differed between maneuvers and microG conditions, we speculate that, in the previous vital capacity SBW, the hypergravity period preceding the test in transient microG provoked conformational changes at low lung volumes near the acinar entrance.

Impact of axial diffusion on nitric oxide exchange in the lungs

Nitric oxide (NO) appears in the exhaled breath and is a potentially important clinical marker. The accepted model of NO gas exchange includes two compartments, representing the airway and alveolar region of the lungs, but neglects axial diffusion. We incorporated axial diffusion into a one-dimensional trumpet model of the lungs to assess the impact on NO exchange dynamics, particularly the impact on the estimation of flow-independent NO exchange parameters such as the airway diffusing capacity and the maximum flux of NO in the airways. Axial diffusion reduces exhaled NO concentrations because of diffusion of NO from the airways to the alveolar region of the lungs. The magnitude is inversely related to exhalation flow rate. To simulate experimental data from two different breathing maneuvers, NO airway diffusing capacity and maximum flux of NO in the airways needed to be increased approximately fourfold. These results depend strongly on the assumption of a significant production of NO in the small airways. We conclude that axial diffusion may decrease exhaled NO levels; however, more advanced knowledge of the longitudinal distribution of NO production and diffusion is needed to develop a complete understanding of the impact of axial diffusion.

Collateral gas transport by diffusion across tissue in the healthy, human lung; effects on dead space

The effects of collateral gas transport by diffusion across lung tissue on the Bohr and Fowler dead spaces were quantified for resting breathing conditions. The dead spaces (VD) of He, Xe and SF(6) were determined from expirograms obtained from the simultaneous washout of these test gases. The experiments were performed on seven healthy subjects. The contribution of collateral gas transport by diffusion on VD was obtained from the difference between VD(SF(6)) and VD(Xe). These two gases have comparable diffusion coefficients (D) in residual gas but in lung tissue D(Xe) is roughly 25 times larger than D(SF(6)) due to the higher solubility of Xe in aqueous tissues. The data showed that the reducing effect of collateral gas transport by diffusion on VD(Xe) amounts to about 2 ml for both the Bohr and the Fowler dead space. The smallness of this effect means that the alveolar ventilation for Xe hardly benefits from this additional mechanism of intrapulmonary gas mixing.

Microgravity and the lung

Although environmental physiologists are readily able to alter many aspects of the environment, it is not possible to remove the effects of gravity on Earth. During the past decade, a series of space flights were conducted in which comprehensive studies of the lung in microgravity (weightlessness) were performed. Stroke volume increases on initial exposure to microgravity and then decreases as circulating blood volume is reduced. Diffusing capacity increases markedly, due to increases in both pulmonary capillary blood volume and membrane diffusing capacity, likely due to more uniform pulmonary perfusion. Both ventilation and perfusion become more uniform throughout the lung, although much residual inhomogeneity remains. Despite the improvement in the distribution of both ventilation and perfusion, the range of the ventilation-to-perfusion ratio seen during a normal breath remains unaltered, possibly because of a spatial mismatch between ventilation and perfusion on a small scale. There are unexpected changes in the mixing of gas in the periphery of the lung, and evidence suggests that the intrinsic inhomogeneity of the lung exists at a scale of an acinus or a few acini. In addition, aerosol deposition in the alveolar region is unexpectedly high compared with existing models.

Overall and peripheral inhomogeneity of ventilation in patients with stable cystic fibrosis

We studied distribution of ventilation in patients with cystic fibrosis (CF) who had not had an exacerbation for some time. Patients performed either the vital capacity nitrogen (N(2)) single-breath washout test (VC test) or a modified single-breath washout consisting of 1 L inspired from functional residual capacity (FRC test) of 90% oxygen (O(2)), 5% helium (He), and 5% sulfur hexafluoride (SF(6)). We computed the slopes of phase III of N(2) concentration from the VC test (S(N2) (VC)) and the phase III slopes of the He (S(He)): The SF(6) (S(SF6)), and curves from the FRC test. S(N2) (VC) may be regarded as an index of overall ventilation and the difference (S(SF6) - S(He)) as an index of peripheral ventilation. Three groups were studied: CF, 28 CF patients (8-36 years of age); normal controls (NC), 33 normal nonsmokers (9-55 years of age); and a smoking group (SG), 42 non-CF smoking patients (39-79 years of age). Compared to the NC group, S(N2) (VC) is increased in the CF group, reflecting an overall ventilation impairment. There is no difference in S(N2) (VC) between the CF group and the SG group, suggesting that S(N2), though sensitive, is nonspecific. Compared to both NC and SG groups, (S(SF6) - S(He)) is decreased in the CF group, being on the average negative. This may imply that there is a peripheral impairment in the distribution of ventilation that originates in terminal and respiratory bronchioles. Negative (S(SF6) - S(He)) is statistically associated with the youngest CF patients, suggesting that terminal and respiratory bronchiolar involvement is linked to early stages of the disease. In older CF patients, (S(SF6) - S(He)) is more often positive, suggesting that even more distal airways, such as alveolar ducts, become involved in peripheral inhomogeneity of ventilation.

Effect of alveolar volume and sequential filling on the diffusing capacity of the lungs: I. theory

The diffusing capacity, DL, is a critical physiological parameter of the lung used to assess gas exchange clinically. Most models developed to analyze experimental data from a single breath maneuver have assumed a well-mixed or uniform alveolar region, including the clinically accepted Jones-Meade method. In addition, all previous models have assumed a constant DL, which is independent of alveolar volume, VA. In contrast, experimental data provide evidence for a non-uniform alveolar region coupled with sequential filling of the lung. In addition, although the DL for carbon monoxide is a weak function of VA, the DL of nitric oxide depends strongly on VA. We have developed a new mathematical model of the single breath maneuver that considers both a variable degree of sequential filling and a variable DL. Our model predicts that the Jones-Meade method overestimates DL when the exhaled gas sample is collected late in the exhalation, but underestimates DL if the exhaled gas sample is collected early in the exhalation phase due to the effect of sequential filling. Utilizing a prolonged constant exhalation method, or a three-equation method, will also produce erroneous predictions of DL. We conclude that current methods may introduce significant error in the estimation of DL by ignoring the sequential filling of the lung, and the dependence of DL on VA.

Ventilation heterogeneity does not change following pulmonary microembolism

By using the multiple-breath helium washout technique, ventilation heterogeneity (VH) after embolic injury in the lung can be quantitatively partitioned into the conductive and acinar components. Total VH, represented by the normalized slope of the phase III alveolar plateau, Sn(III (total)), was studied for 120 min in three groups of anesthetized and paralyzed mongrel dogs. Group 1 (n = 3) received only normal saline and served as controls. Group 2 (n = 4) received repeated infusions of polystyrene beads (250 microm) into the right atrium at 10, 40, 80, and 120 min. Group 3 (n = 3) was similarly treated, except that the embolic beads used were 1,000 microm in diameter. The data show that, despite repeated embolic injury by polystyrene beads of different diameters, there was no significant increase in total VH. The acinar component of Sn(III), which represents VH in the distal airways, accounts for over 90% of the total VH. The conductive component of Sn(III), which represents VH between larger conductive airways, remains relatively constant and a minor component. We conclude that pulmonary microembolism does not result in significant redistribution of ventilation.

A two-compartment model of pulmonary nitric oxide exchange dynamics

The relatively recent detection of nitric oxide (NO) in the exhaled breath has prompted a great deal of experimentation in an effort to understand the pulmonary exchange dynamics. There has been very little progress in theoretical studies to assist in the interpretation of the experimental results. We have developed a two-compartment model of the lungs in an effort to explain several fundamental experimental observations. The model consists of a nonexpansile compartment representing the conducting airways and an expansile compartment representing the alveolar region of the lungs. Each compartment is surrounded by a layer of tissue that is capable of producing and consuming NO. Beyond the tissue barrier in each compartment is a layer of blood representing the bronchial circulation or the pulmonary circulation, which are both considered an infinite sink for NO. All parameters were estimated from data in the literature, including the production rates of NO in the tissue layers, which were estimated from experimental plots of the elimination rate of NO at end exhalation (ENO) vs. the exhalation flow rate (VE). The model is able to simulate the shape of the NO exhalation profile and to successfully simulate the following experimental features of endogenous NO exchange: 1) an inverse relationship between exhaled NO concentration and VE, 2) the dynamic relationship between the phase III slope and VE, and 3) the positive relationship between ENO and VE. The model predicts that these relationships can be explained by significant contributions of NO in the exhaled breath from the nonexpansile airways and the expansile alveoli. In addition, the model predicts that the relationship between ENO and VE can be used as an index of the relative contributions of the airways and the alveoli to exhaled NO.

Single-exhalation profiles of NO and CO2 in humans: effect of dynamically changing flow rate

Endogenous production of nitric oxide (NO) in the human lungs has many important pathophysiological roles and can be detected in the exhaled breath. An understanding of the factors that dictate the shape of the NO exhalation profile is fundamental to our understanding of normal and diseased lung function. We collected single-exhalation profiles of NO and CO2 from normal human subjects after inhalation of ambient air (approximately 15 parts/billion) and examined the effect of a 15-s breath hold and exhalation flow rate (VE) on the following features of the NO profile: 1) series dead space, 2) average concentration in phase III with respect to time and volume, 3) normalized slope of phase III with respect to time and volume, and 4) elimination rate at end exhalation. The dead space is approximately 50% smaller for NO than for CO2 and is substantially reduced after a breath hold. The concentration of exhaled NO is inversely related to VE, but the average NO concentration with respect to time has a stronger inverse relationship than that with respect to volume. The normalized slope of phase III NO with respect to time and that with respect to volume are negative at a constant VE but can be made to change signs if the flow rate continuously decreases during the exhalation. In addition, NO elimination at end exhalation vs. VE produces a nonzero intercept and slope that are subject dependent and can be used to quantitate the relative contribution of the airways and the alveoli to exhaled NO. We conclude that exhaled NO has an airway and an alveolar source.

Ventilation inhomogeneity in oleic acid-induced pulmonary edema

Oleic acid causes permeability pulmonary edema in the lung, resulting in impairment of gas-exchange and ventilation-perfusion heterogeneity and mismatch. Previous studies have shown that by using the multiple-breath helium washout (MBHW) technique, ventilation inhomogeneity (VI) can be quantitatively partitioned into two components, i.e., convective-dependent inhomogeneity (cdi) and diffusive-convective-dependent inhomogeneity (dcdi). Changes in VI, as represented by the normalized slope of the phase III alveolar plateau, were studied for 120 min in five anesthetized mongrel dogs that were ventilated under paralysis by a constant-flow linear motor ventilator. These animals received oleic acid (0.1 mg/kg) infusion into the right atrium at t = 0. MBHWs were done in duplicate for 18 breaths every 40 min afterward. Three other dogs that received only normal saline served as controls. The data show that, after oleic acid infusion, dcdi, which represents VI in peripheral airways, is responsible for the increasing total VI as lung water accumulates progressively over time. The cdi, which represents VI between larger conductive airways, remains relatively constant throughout. This observation can be explained by increases in the heterogeneity of tissue compliance in the periphery, distal airway closure, or by decreases in ventilation through collateral channels.

Paradoxical helium and sulfur hexafluoride single-breath washouts in short-term vs. sustained microgravity

During single-breath washouts in normal gravity (1 G), the phase III slope of sulfur hexafluoride (SF6) is steeper than that of helium (He). Two mechanisms can account for this: 1) the higher diffusivity of He enhances its homogeneous distribution; and 2) the lower diffusivity of SF6 results in a more peripheral location of the diffusion front, where airway asymmetry is larger. These mechanisms were thought to be gravity independent. However, we showed during the Spacelab Life Sciences-2 spaceflight that in sustained microgravity (microG) the SF6-to-He slope difference is abolished. We repeated the protocol during short periods (27 s) of microG (parabolic flights). The subjects performed a vital-capacity inspiration and expiration of a gas containing 5% He-1.25% SF6-balance O2. As in sustained microG, the phase III slopes of He and SF6 decreased. However, during short-term microG, the SF6-to-He slope difference increased from 0.17 +/- 0.03%/l in 1 G to 0.29 +/- 0.06%/l in microG, respectively. This is contrary to sustained microG, in which the SF6-to-He slope difference decreased from 0.25 +/- 0.03%/l in 1 G to -0.01 +/- 0.06%/l in microG. The increase in phase III slope difference in short-term microG was caused by a larger decrease of He phase III slope compared with that in sustained microG. This suggests that changes in peripheral gas mixing seen in sustained microG are mainly due to alterations in the diffusive-convective inhomogeneity of He that require > 27 s of microG to occur. Changes in pulmonary blood volume distribution or cardiogenic mixing may explain the differences between the results found in short-term and sustained microG.

Effects of age on closing volume during head-out water immersion

Previous studies during head-out immersion have shown closing volume (CV) to either increase or remain unchanged. We hypothesized that these inconclusive results might be related to differences in the ages of the subjects tested. To elucidate this we studied single-breath argon washout tests performed by a younger group (n = 8, age 23-26) and an older group (n = 8, age 40-54) of males every 5 min during 30 min of seated, thermoneutral head-out immersion. No temporal changes in CV during immersion were observed in either group, therefore values within each group during immersion were combined. In the younger group, CV increased 77% (dry, 0.26 +/- 0.11 L; wet, 0.46 +/- 0.10 L; delta = 0.20 L) (P < 0.001) but remained less than the tidal breathing range upper limit [expiratory reserve volume + tidal volume (ERV + VT)]. In the older group, CV increased 34% (dry, 0.83 +/- 0.29 L; wet, 1.11 +/- 0.19 L; delta = 0.28 L) (P < 0.05) and was not different from ERV + VT. The absolute increase in CV during immersion did not differ between the groups. ERV decreased during immersion in both groups and was lower in the older than younger group (P < 0.001). Alveolar plateau (phase III) slope became steeper in the younger (P < 0.001) but not in the older group. We conclude that during immersion: (1) The absolute increase in CV is independent of age, and (2) in subjects over 40, CV approaches the highest lung volumes reached during tidal breathing.(ABSTRACT TRUNCATED AT 250 WORDS)

Microemboli reduce phase III slopes of CO2 and invert phase III slopes of infused SF6

We investigated the effect of increasing doses of intravenously infused glass microspheres (mean diameter 125 microns) on gas exchange in anesthetized, heparinized, mechanically ventilated goats (VT = 16-18 ml/kg). Breath-by-breath CO2 expirograms were collected using a computerized system (Study A) during the infusion of a total of 15 g of microspheres. We found a 50% decrease in extravascular lung water by indicator dilution with a corresponding doubling of alveolar dead space (VDalv). Airways deadspace (VDaw) decreased by 13 ml (10%) and mean normalized phase III slope for CO2 decreased from 0.23 to -0.08 L-1 becoming negative in 3 of 5 animals. In a second study (Study B), simultaneous breath-by-breath CO2 and infused SF6 expirograms were collected using an infrared CO2 analyzer and a mass spectrometer. Under baseline conditions VDaw for CO2 was smaller than for SF6 and the ratio of the phase III slope for SF6 to the phase III slope for CO2 was 1.39. Following embolization there were no differences in VDaw between the two gases, however, the phase III slope for CO2 became either slightly negative or extremely flat, while the phase III slope for SF6 became negative in 73% of the breaths (-0.17 L-1, P < 0.05). Negative phase III slopes have been predicted by a single path model when blood flow is confined to the most mouthward generations of the acinus (Schwardt et al., Ann. Biomed. Engin, 19: 679-697, 1991). The agreement between the numerical model and the experimental data is consistent with a serial distribution of blood flow within the acinus.

Sensitivity of CO2 washout to changes in acinar structure in a single-path model of lung airways

A numerical solution of the convection-diffusion equation with an alveolar source term in a single-path model (SPM) of the lung airways simulates steady state CO2 washout. The SPM is used to examine the effects of independent changes in physiologic and acinar structure parameters on the slope and height of Phase III of the single-breath CO2 washout curve. The parameters investigated include tidal volume, breathing frequency, total cardiac output, pulmonary arterial CO2 tension, functional residual capacity, pulmonary bloodflow distribution, alveolar volume, total acinar airway cross sectional area, and gas-phase molecular diffusivity. Reduced tidal volume causes significant steepening of Phase III, which agrees well with experimental data. Simulations with a fixed frequency and tidal volume show that changes in blood-flow distribution, model airway cross section, and gas diffusivity strongly affect the slope of Phase III while changes in cardiac output and in pulmonary arterial CO2 tension strongly affect the height of Phase III. The paper also discusses differing explanations for the slope of Phase III, including sequential emptying, stratified inhomogeneity, and the issue of asymmetry, in the context of the SPM.

A combined parallel and series distribution model of inspired inert gases

The distribution within the lungs of inspired gas has been demonstrated to be uneven by the technique of the external counting of inspired radioactive gas (Milic-Emili et al. (1966) J. Appl. Physiol. 21: 749-759). The contribution of this regional distribution to the slope of the alveolar plateau observed at the lips from an inspired gas marker has been debated, particularly the part played by incomplete diffusive mixing (Sikand et al. (1966) J. Appl. Physiol. 21: 1331-1337). We have repeated the experiments of Sikand, obtaining similar results, by inspiring 1.9 L of 79% argon and 21% oxygen from functional residual capacity, with a subsequent expiration to residual volume, after various breath-holding times. The opposing views of the above authors (parallel versus series inhomogeneities) are here used to develop a model in which the lung is divided into seven regions from apex to base, each region being allocated a compliance curve (polynomial equation of third order) after that of Milic-Emili. Each model region then receives a volume of inspired gas according to its compliance and its regional dead space. This dead space has been allocated on the basis of increasing path lengths of inspired gas from the apex to the base. Beyond the front of this dead space, the mixing of gas is taken to be exponential with respect to expired volume and a curve is then allocated to this alveolar region. The model thus contains both parallel (inter-regional) and series (intra-regional) components. Following a simulated expiration of these seven regions, the model expired curve so obtained is in close agreement with the experimental data, both in respect of shape and of the quantity of tracer contained within it in the range of 0.75-4.5 L of expired gas. We therefore conclude that inter-regional factors are the principal determinant of the last 2.5 L of the expired gas tracer curve and that intra-regional components play a significant role in the first 1.25 L. The model is also applicable to any other inhaled inert gas.

Alveolar sacs and the expirograms of He and SF6: a model study

In 1975, Hansen and Ampaya described alveolated outpouchings in the walls of the acinar ducts, which were observed in all airway generations within the acini. These structures were called alveolar sacs, and they appear to contain the larger fraction (56%) of the acinar volume. The total depth of an alveolar sac including its alveoli (approximately 0.32 mm) is comparable to the mean length of an acinar duct (0.18 to 0.97 mm). Therefore, the alveolar sacs contribute to the asymmetric morphology of the acini. In this paper we investigate the impact of this aspect of the alveolar sacs on the shape of the expirograms of He and SF6. To that end, single-breath washout experiments were simulated with two different mathematical lung models. The one model is an airway model in which the alveolar sacs are modelled explicitly by separate compartments. The expirograms obtained with this model are compared to those obtained with a conventional axisymmetric airway model which is used as a reference model. In this model the volumes of the alveolar sacs are added to those of the acinar ducts; i.e., both air spaces are represented by the same compartments. The washout of He and SF6 was simulated for three different breathing maneuvers corresponding to ventilatory conditions at rest and at exercise. Comparison of the expirograms obtained with the two models showed no differences between their shapes when identical dimensions are used for the lengths and cross sections of the alveolar ducts in the two models. We conclude that the contribution of the alveolar sacs to the asymmetric morphologic structure of the acini has no consequences for the shape of the expirograms of He and SF6.

Sloping alveolar plateaus of He and SF6 measured in excised cat lungs ventilated at constant volume by pressure changes

Single-breath washout experiments with He and SF6 were performed in excised cat lungs placed in a closed, liquid-filled reservoir, where lung volume was clamped by the surrounding liquid and breathing was accomplished by hyperbaric pressure changes (pressure breathing) produced by a piston pump. Under these conditions the flow into each lung unit was assumed to be proportional to its volume, and sequential filling and emptying of lung units by convection probably did not occur. Thus, implicitly, gravity-dependent patterns of sequential filling and emptying of lung regions were also excluded. Different lung volumes (VL = 50%, 75%, 100% TLC, where TLC is total lung capacity), tidal volumes (VT = 21%, 34%, 47% TLC) and durations of post-inspiratory apnea (tA = 0,1,2,4,8 sec) were applied. The expirograms showed that the slopes of the alveolar plateau (S) were significantly positive for both He and SF6. For tA = 0 sec SHe ranged from 8.7 to 62.8% and SSF6 ranged from 24.4 to 87.8% (S is expressed in % per unit VE/TLC, where VE is expired volume). The ratio SSF6/SHe was larger than unity for each combination of VL and VT. Further, for tA = 0 sec both SHe and SSF6 showed a tendency to decrease with increasing VL and with increasing VT. For tA = 8 sec both SHe and SSF6 were close to zero. Additional single-breath washout experiments were performed with the same cat lungs by applying normal breathing where lung volume was not clamped and asynchronous unequal ventilation might have occurred. For comparable values of VL and VT, there were no clear differences between the slopes obtained at normal breathing and those obtained at pressure breathing. We conclude that asynchronous unequal ventilation plays only a minor role in the sloping alveolar plateau during normal breathing, and that the mechanism underlying the sloping alveolar plateau is diffusion dependent.

A simple method for correcting single breath total lung capacity for underestimation

The single breath method underestimates total lung capacity by comparison with the multiple breath method (TLCmb) because of inhomogeneity of ventilation distribution. This study proposes a simple correction for the single breath TLC (TLCsb), using inert gas phase III slope to account for the effects of uneven ventilation distribution. A model of a non-uniform lung ventilation was designed, composed of a serial dead space and two alveolar compartments arranged in parallel, whose relative ventilations were determined from the phase III plateau. Before correction TLCsb was 104-44% of TLCmb in 64 subjects (17 with diffuse interstitial disease, 42 with chronic obstructive pulmonary disease, and five healthy subjects). The limit of acceptability for the correction (TLCcorr) was determined from the 95% confidence interval of TLCsb/TLCmb in the healthy subjects. The correction resulted in a significant increase in TLCsb (p less than 0.004). TLCcorr remained under the limit of acceptability for only 12 patients with emphysema, and all 12 showed a large improvement in the TLC estimate. The presence of poorly ventilated zones during a single breath in these patients may explain this partial correction.

The sloping alveolar plateau of tracer gases washed out from mixed venous blood in man

We have investigated the slope of the alveolar plateau for inert tracer gases that were washed out from mixed venous blood. Two pairs of tracer gases were used (He, SF6) and (C2H2, Freon 22). The gases of each pair share almost the same blood-gas partition coefficient but they have different diffusive properties in the gas phase. The experiments were performed in healthy subjects at rest and at three levels of exercise (75, 150, 225 W). Each experiment started with the alveolar washin of the tracer gases by adding these gases to inspired air. This washin was continued for several minutes in order to dissolve sufficient amounts of the tracer gases in the body tissues. Subsequently, the tracer gases were washed out. In this paper, the slopes of the alveolar plateaus are defined as the relative increase of the concentration per second. Steeper slopes were found for the heavier gases (SF6 and Freon 22) in comparison with those for the lighter gases of the two pairs (He and C2H2). This finding may be ascribed to the contribution of diffusion-limited gas mixing in the lung to the slope of the alveolar plateau. For each gas, the slope for the first expiration during washout (alveolar washout) was considerably smaller than that for the later part of washout (mixed venous washout), and the difference amounts to about 56% and 76% of the slope during mixed venous washout at rest and at the highest level of exercise, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Preinspiratory lung volume dependence of the slope of the alveolar plateau

Nine healthy subjects performed He-SF6 single-breath washouts. The inspired gas contained 90% O2, 5% He and 5% SF6 and the slope of the alveolar plateau for N2, He and SF6 was computed. Each subject performed three times in the seated position four different maneuvers: inspiration of both 1 L and a full inspiration from a preinspiratory lung volume (PILV) equal to residual volume (RV) + 1 L and RV + 2 L. The main experimental observation was that for an inspired volume of 1 L, the slopes decreased by approximately a factor of 2 when PILV increased from RV + 1 L to RV + 2 L, the He-SF6 slope difference decreasing significantly more. Previous results can be explained if intraregional parallel units play an important role in the genesis of the alveolar plateau. Furthermore, comparisons with simulations of a multibranch-point model of the acinus suggest that those units are, at least in part, intra-acinar and that the acini do not expand homogeneously. The present work also suggests that the more informative maneuver to obtain data reflecting acinar behavior from single-breath washouts, consists in an inspiration not larger than 1 L from a PILV situated between functional residual capacity and closing volume.