Mechanistic interpretation of the slow bronchial clearance phase

Theoretical and experimental approaches to the deposition and clearance of ultrafine carcinogens in the human respiratory tract

INTRODUCTION

  Although inhaled ultrafine particles (UFPs) represent serious lung burdens and are thus responsible for a remarkable number of respiratory diseases (including cancer), only limited information on their deposition and clearance in the lung compartments is available. The study presented here tries to overcome this deficit by using a detailed theoretical approach to UFP behavior in the lungs.

METHODS

  The deposition model used in this context is based upon a stochastic lung geometry and the generation of single-particle trajectories in the tracheobronchial tree according to the random walk algorithm. Simulation of UFP clearance is conducted with the help of a multi-compartment model that considers cellular/non-cellular sites of temporary particle storage as separate compartments.

RESULTS

  As predicted by the models and confirmed by experimental findings, deposition of UFPs by Brownian motion takes place in both the upper and lower compartments of the respiratory tract. Alveolar accumulation of particulate mass increases proportionally with the inhalative flow rate. Clearance of UFPs is chiefly dominated by slow mechanisms with respective half-times ranging from several days to months.

DISCUSSION

  Modeling of UFP behavior in the respiratory tract represents an appropriate tool for forthcoming medical studies on this particle class, but it needs to be subjected to further refinements. •  As outlined by this study, alveolar deposition of UFPs, correlating with a noticeable risk of malignant transformations and cancer development, is determined by a number of factors, including effective particle size and velocity of particle transport in the conducting airways. •  With the help of appropriately validated models, respective predictions on the pulmonary burdens of UFP after short-term or long-term exposure can be made. In the case of subjects suffering from bronchial and/or alveolar UFP overloads, respective clearance approaches may be applied to simulate particle removal scenarios.

Theoretical approach to the hit probability of lung-cancer-sensitive epithelial cells by mineral fibers with various aspect ratios

BACKGROUND

  Inhalation of fibers may lead to the damage and, as a further consequence, to the malignant transformation of specific (most of all non-ciliated) cells of the bronchial and bronchiolar airway epithelium. In order to accurately estimate the cancer risk induced by inhaled fibers, hit probabilities of non-ciliated (secretory) cells by mineral fibers (asbestos and chrysotile) were computed.

METHODS

  Besides the use of a stochastic lung geometry and a particle transport/deposition model being based upon the random-walk algorithm, histological data of cell distributions in the human lungs were applied for the theoretical calculations. Diameters of computer-generated fibers ranged from 0.1 µm to 10 µm, whilst two values (3 and 100) were selected for the aspect ratios (ratios of fiber length to fiber diameter), thereby simulating the behavior of short and very long fibrous particles.

RESULTS

  According to the modeling results, the highest regional hit probabilities (up to 10%) are available for fibers with a diameter of 1.0 µm, whereby cells of the bronchiolar compartment represent a preferential target of these particles. For fibers with a diameter of 0.1 µm, bronchiolar hit probabilities reach 2-3%, whereas fibers with a diameter of 10 µm penetrate to the peripheral lung parts with only low amounts (<0.1%). A change of the inhalation conditions from sitting to light-work breathing enhances the extrathoracic and bronchial filtering of large particles (diameter ≥1 µm), whilst penetration of small particles towards distal lung airways is subject to a reinforcement. Further refinement of hit probabilities by considering single airway generations results in the circumstance that fibers with diameters ≤1.0 µm preferably collide with cancer-sensitive cells of airway generations 12-15. In contrast, fibers with a diameter of 10 µm mainly represent a hazard for cancer-sensitive cells being located in the uppermost airways. A change of breathing conditions both supports the effect of short fibers and enhances the filtering of long ones.

CONCLUSION

  Based upon the results of this contribution it can be concluded that highest cancer risk is generated by the inhalation of mineral fibers with diameters ≤1.0 µm, whereby fiber length has to be classified as a parameter with lower importance.

Deposition and cellular interaction of cancer-inducing particles in the human respiratory tract: Theoretical approaches and experimental data

Inhaled particles that are deposited on the epithelial surface of the human respiratory tract (HRT) may act as serious health hazards, in the worst case inducing the development of various types of lung cancer. In the past, several particle types, such as asbestos fibers, hard wood dust and cigarette smoke were identified and classified as human carcinogens. Due to their different physical and chemical properties these particles are characterized by remarkable discrepancies concerning their transport, deposition, and epithelial interaction in the HRT. In order to continuously increase the knowledge on carcinogenic particle behavior in the HRT, theoretical models describing single stages of particulate action in the lung airways were developed over the last few decades. With the help of these mathematical approaches physical characteristics of aerosolized drugs as well as protocols of inhalative therapies for the treatment of lung diseases could be significantly optimized. In addition, new experimental setups for the enlightenment of possible mechanisms underlying particle-lung interaction were, among other things, founded upon the results of theoretical computations. This review summarizes the efforts and advances of theoretical lung modeling from the early 1970s till today, thereby mainly directing the attention to the simulation of carcinogenic particle behavior in the HRT.

Bioaerosols in the lungs of subjects with different ages-Part 2: clearance modeling

BACKGROUND

The present contribution deals with theoretical aspects regarding biogenic particle clearance from various lung structures of probands with different ages (1, 5, 15, 20 y). With reference to part 1 of the study, particles varying in size and shape are subject to a detailed analysis. The main goal of the investigation consists in an increase of our knowledge concerning the clearance behaviour of bioparticles and its dependence upon various physiological and anatomical factors.

METHODS

Theoretical clearance of biogenic particles was subdivided into four main phases, namely fast bronchial clearance, slow bronchial clearance, fast alveolar clearance, and slow alveolar clearance. All of these phases were simulated by using a well validated stochastic modeling approach, where the main focus is set on the randomly varied particle mass transfer between main compartments of the human respiratory tract. Whilst effects of particle geometry on clearance were approximated by application of the projective-diameter concept, age dependence of the particle removal process was expressed by the experimentally proven relationship between bronchial mucus velocities and morphometry of the airway tree.

RESULTS

According to the results of the theoretical simulations efficiency of fast bronchial clearance, expressed by the 24-h-retention value, exhibits a negative correlation with proband's age, whereas the other clearance phases are characterized by a rather conservative behaviour among the different age categories. Highest clearance rates may be observed for very fine (<0.01 µm) and very coarse particles (>5 µm) preferentially deposited in the upper bronchial airways, whilst large particles accumulated in the alveoli may be stored there for several months to years.

CONCLUSIONS

The study comes to the conclusion that infants and children dispose of an enhanced bronchial clearance efficiency with respect to adolescents and adults, which results in a faster removal of particulate substances accumulated in the upper bronchial regions. Particles escaping from the natural filtering process in the upper airways and undergoing alveolar deposition are subject to identical clearance scenarios among the age groups and may represent remarkable health hazards.

Bioaerosols in the lungs of subjects with different ages-part 1: deposition modeling

BACKGROUND

In this contribution the inhalation and deposition of bioaerosols including particles with various shapes and sizes were investigated for probands with different ages (1, 5, 15 and 20 y). The study should help to increase our knowledge with regard to the behavior of variably shaped and sized particles in lungs being subject to different developmental stages.

METHODS

Simulation of particle transport and deposition in single structures of the respiratory tract was conducted by using a stochastic model of the tracheobronchial tree and well-validated analytical and empirical deposition formulae. Possible effects of particle geometry on deposition were taken into consideration by application of the aerodynamic diameter concept. Age-dependent lung morphometry and breathing parameters were computed by using appropriate scaling factors.

RESULTS

Theoretical simulations came to the result that bioparticle deposition in infants and children clearly differs from that in adolescents and adults insofar as the amount of deposited mass exhibits a positive correlation with age. Nose breathing results in higher extrathoracic deposition rates than mouth breathing and, as a consequence of that, lower particle amounts are enabled to enter the lung structures after passing the nasal airways. Under sitting breathing conditions highest alveolar deposition rates were calculated for particles adopting aerodynamic diameters of 10 nm and 4 µm, respectively.

CONCLUSIONS

The study comes to the conclusion that bioparticles have a lower chance to reach the alveoli in infants' and children's lungs, but show a higher alveolar deposition probability in the lungs of adolescents and adults. Despite of this circumstance also young subjects may increasingly suffer from biogenic particle burden, when they are subject to a long-term exposure to certain bioaerosols.

Spatial visualization of theoretical nanoparticle deposition in the human respiratory tract

BACKGROUND

Although nanoparticles and their hazardous effects on human health are well elucidated meanwhile, inhalation and distribution of these materials in the human respiratory tract still represent partly enigmatic phenomena. Main objective of the present study was the detailed description of a mathematical method, with the help of which spatial distributions of nanoparticles deposited in the tracheobronchial tree may be visualized appropriately.

METHODS

The technique is founded on a stochastic model of the bronchial network, within which inhaled particles follow individual, randomly selected trajectories. The lengths of these random paths depend on the airway-specific deposition probabilities calculated for the particles and the duration of the breath cycle. Positions of the deposited material were determined by computation of the exact lengths of individual particle trajectories and the orientation of single path segments within a Cartesian coordinate system, where the z-direction corresponds with the trachea. For a better quantification of the particle distribution and its eventual comparison with experimental data particle coordinates were fitted into a voxel grid [1 voxel = (0.467 cm)(3)]. Particle deposition is chiefly controlled by diffusive processes, whereas deposition mechanisms associated with inertia or gravity play a subordinate role.

RESULTS

Deposition patterns were visualized for particles with sizes of 1, 10, and 100 nm. As clearly demonstrated by the results obtained from the modeling procedure, under normal breathing conditions 1-nm particles tend to deposit in the upper airways, whilst 10- and 100-nm particles are preferably accumulated in the airways of the central and peripheral lung. The particle dose deposited in the extrathoracic and thoracic airways within one breath cycle significantly declines with increasing particle size.

CONCLUSIONS

Based on the predictions presented in this study possible consequences of nanoparticle inhalation to the health of subjects increasingly exposed to these airborne materials were discussed.

A computer model for the simulation of nanoparticle deposition in the alveolar structures of the human lungs

BACKGROUND

According to epidemiological and experimental studies, inhalation of nanoparticles is commonly believed as a main trigger for several pulmonary dysfunctions and lung diseases. Concerning the transport and deposition of such nano-scale particles in the different structures of the human lungs, some essential questions are still in need of a clarification. Therefore, main objective of the study was the simulation of nanoparticle deposition in the alveolar region of the human respiratory tract (HRT).

METHODS

Respective factors describing the aerodynamic behavior of spherical and non-spherical particles in the inhaled air stream (i.e., Cunningham slip correction factors, dynamic shape factors, equivalent-volume diameters, aerodynamic diameters) were computed. Alveolar deposition of diverse nanomaterials according to several known mechanisms, among which Brownian diffusion and sedimentation play a superior role, was approximated by the use of empirical and analytical formulae. Deposition calculations were conducted with a currently developed program, termed NANODEP, which allows the variation of numerous input parameters with regard to particle geometry, lung morphometry, and aerosol inhalation.

RESULTS

Generally, alveolar deposition of nanoparticles concerned for this study varies between 0.1% and 12.4% during sitting breathing and between 2.0% and 20.1% during heavy-exercise breathing. Prolate particles (e.g., nanotubes) exhibit a significant increase in deposition, when their aspect ratio is enhanced. In contrast, deposition of oblate particles (e.g., nanoplatelets) is remarkably declined with any reduction of the aspect ratio.

CONCLUSIONS

The study clearly demonstrates that alveolar deposition of nanoparticles represents a topic certainly being of superior interest for physicists and respiratory physicians in future.

Theoretical deposition of nanotubes in the respiratory tract of children and adults

INTRODUCTION

Nanotubes are assumed to contribute to a significant exacerbation of asthma and to enhance the risk of profibrotic effects in lungs being affected by this injury. Therefore, deposition of nanotubes in the lungs of subjects with different ages was subject to a detailed theoretical investigation.

METHODS

Nanoparticle deposition was computed by application of well validated stochastic deposition model, including four main deposition forces (Brownian diffusion, inertial impaction, interception, gravitational settling). Nonspherical particle geometry was considered with the help of the aerodynamic diameter concept. Deposition was calculated for particles with diameters adopting values of 1, 10, and 100 nm as well as aspect ratios of 10, 50, and 100. Lungs of subjects with different ages were generated with the help of scaling factors and allometric functions. Inhalation was uniformly supposed to take place under non-strain conditions (sitting breathing conditions).

RESULTS

Total deposition of nanotubes is significantly increased with proceeding age, with deposition probability being negatively correlated with particle size (diameter and aspect ratio). Whilst extrathoracic deposition is subject to a slight decrease from infants to adults, bronchial/bronchiolar and alveolar depositions are exponentially increased.

DISCUSSION AND CONCLUSIONS

Due to an increase of nanotube deposition with proceeding age infants and children enjoy a certain protection from excessive particle exposure. This circumstance mostly reprieves their lungs from injuries induced by this sort of particles.

Nanotubes in the human respiratory tract - Deposition modeling

Deposition of inhaled single-wall carbon nanotubes (SWCNT) and multi-wall carbon nanotubes (MWCNT) in the respiratory tract was theoretically investigated for various age groups (infants, children, adolescents, and adults). Additionally, possible effects of the inhalative flow rate on nanotube deposition were simulated for adult lungs. Theoretical computations were based on the aerodynamic diameter concept and the assumption of particles being randomly transported through a stochastic (close-to-realistic) lung structure. Deposition of nanotubes was calculated by application of well validated empirical deposition formulae, thereby considering Browian motion, inertial impaction, interception, and sedimentation as main deposition mechanisms acting on the particles. Results of the simulations clearly show that for a given inhalation scenario (sitting breathing) total, bronchial, and acinar nanotube deposition increase with subject's age, whereas extrathoracic deposition is characterized by a decrease from younger to older subjects. According to the data provided by the model, MWCNT, whose aerodynamic diameters exceed those of SWCNT by one order of magnitude, are deposited in specific respiratory compartments to a lower extent than SWCNT. A change of the physical state from sitting to heavy work results in a common decline of bronchial and extrathoracic deposition of nanotubes. Total deposition is slightly increased for SWCNT and moderately decreased for MWCNT, whereas acinar deposition is significantly increased for SWCNT and decreased for MWCNT. Based on the results of this contribution it may be concluded that SWCNT bear a higher potential as health hazards than MWCNT, because they are accumulated in sensitive lung regions with higher doses than MWCNT.

Clearance of carbon nanotubes in the human respiratory tract-a theoretical approach

INTRODUCTION

Theoretical knowledge of carbon nanotube clearance in the human respiratory tract represents an essential contribution to the risk assessment of artificial airborne nanomaterials. Thus, single phases of nanotube clearance were simulated with the help of a theoretical model.

METHODS

In this study, clearance of single-walled carbon nanotubes (SWCNT) and multi-walled carbon nanotubes (MWCNT) was simulated by using a validated mathematical approach that includes all clearance mechanisms known hitherto. Fast mucociliary clearance is approximated by a steady-state steady-flow mucus model, whereas slow clearance mechanisms are modeled by definition of related clearance half-times.

RESULTS

Clearance may be subdivided into three phases, including fast bronchial clearance (mucociliary escalator), slow bronchial clearance (particle uptake by airway macrophages, transcytosis), and alveolar clearance (phagocytosis by alveolar macrophages, endocytosis by alveolar epithelium). According to the clearance model used in this study, mucociliary clearance is completed within the first 24 h after exposure, whereas slow bronchial clearance is characterized by a half-time of 5 d. Alveolar clearance is marked by half-times >100 d. As a result of their different deposition patterns, SWCNT and MWCNT show some discrepancies with regard to their clearance insofar as long SWCNT reside significantly longer in the lungs than MWCNT. This circumstance is among other expressed by higher 24-h, 10-d, and 100-d retentions computed for SWCNT compared to MWCNT.

DISCUSSION AND CONCLUSIONS

Due to their partly high residence times in distal lung regions, carbon nanotubes may bear the potential to act as triggers of inflammatory reactions or fibrotic modifications of the lung structure. Further they may also induce malignant transformations of lung cells, resulting in the development of lung tumours.

Theoretical models of carcinogenic particle deposition and clearance in children's lungs

INTRODUCTION

Deposition and clearance of carcinogenic particles in the lungs of subjects belonging to four different age groups (infants, children, adolescents, and adults) were theoretically investigated. The study is thought to contribute to the improvement of our knowledge concerning the behaviour of inhaled particles in lungs that may be attributed to different stages of development.

METHODS

Particle deposition and clearance were simulated by using a well established stochastic lung model, allowing the generation of nearly realistic scenarios. For the computation of particle deposition all main deposition forces were considered. Additionally, any influences on particle behaviour due to particle geometry were covered by using the aerodynamic diameter concept. Particle clearance was simulated by defining both a fast mucociliary clearance phase and a slow bronchial/alveolar clearance phase, the latter of which is based on previously published models and suggestions.

RESULTS

As clearly provided by the modelling computations, lung deposition of particles with aerodynamic diameters ranging from 1 nm to 10 µm may significantly differ between the studied age groups. Whilst in infants and children most particles are accumulated in the extrathoracic region and in the upper bronchi, in adolescents and adults high percentages of inhaled particular substances may also reach the lower bronchi and alveoli. Although mucus velocities are significantly lower in young subjects compared to the older ones, fast clearance is more efficient in small lungs due to the shorter clearance paths that have to be passed. Slow clearance is commonly characterized by insignificant discrepancies between the age groups.

CONCLUSIONS

From the study presented here it may be concluded that particle behaviour in infants' and children's lungs has to be regarded in a different light with respect to that in adolescents and adults. Although young subjects possess natural mechanisms of protecting their lungs from hazardous aerosols (e.g., expressed by breathing behaviour and lung size), they are much more sensitive to any particle exposure, since particle concentrations per lung tissue area may reach alarming values within a short period of inhalation.

Radioactivity and lung cancer-mathematical models of radionuclide deposition in the human lungs

The human respiratory tract is regarded as pathway for radionuclides and other hazardous airborne materials to enter the body. Radioactive particles inhaled and deposited in the lungs cause an irradiation of bronchial/alveolar tissues. At the worst, this results in a malignant cellular transformation and, as a consequence of that, the development of lung cancer. In general, naturally occurring radionuclides (e.g., (222)Rn, (40)K) are attached to so-called carrier aerosols. The aerodynamic diameters of such radioactively labeled particles generally vary between several nanometers (ultrafine particles) and few micrometers, whereby highest particle fractions adopt sizes around 100 nm. Theoretical simulations of radioactive particle deposition in the human lungs were based on a stochastic lung geometry and a particle transport/deposition model using the random-walk algorithm. Further a polydisperse carrier aerosol (diameter: 1 nm-10 µm, ρ ≈ 1 g cm(-3)) with irregularly shaped particles and the effect of breathing characteristics and certain respiratory parameters on the transport of radioactive particles to bronchial/alveolar tissues were considered. As clearly shown by the results of deposition modeling, distribution patterns of radiation doses mainly depend on the size of the carrier aerosol. Ultrafine (< 10 nm) and large (> 2 µm) aerosol particles are preferentially deposited in the extrathoracic and upper bronchial region, whereas aerosol particles with intermediate size (10 nm-2 µm) may penetrate to deeper lung regions, causing an enhanced damage of the alveolar tissue by the attached radionuclides.

An advanced stochastic model for mucociliary particle clearance in cystic fibrosis lungs

BACKGROUND

A mathematical model describing mucociliary clearance in cystic fibrosis (CF) patients and its development with progressing course of the disease was developed. The approach should support the prediction of the disease state on the basis of measured bronchial clearance efficiencies.

METHODS

The approach is based on the assumption of a steady-state steady-flow mucus transport through the tracheobronchial tree which enables the determination of airway generation-specific mucus velocities by using a measured tracheal mucus velocity and a realistic morphometric dataset of the human lung. Architecture of the tracheobronchial tree was approximated by a stochastic model, reflecting the intra-subject variability of geometric parameters within a given lung generation.

RESULTS

As predicted by the appropriately validated mathematical approach, mucociliary clearance efficiency in CF patients is partly significantly decreased with respect to healthy controls. 24-h retention of patients with mild CF (FEV(1) >70% of predicted) is reduced by 10% compared to healthy subjects, whilst 24-h retention of patients with moderate to severe CF (FEV(1) <70% of predicted) differs by 25% from that of the healthy controls. These discrepancies are further enhanced with continuation of the clearance process.

CONCLUSIONS

The theoretical results lead to the conclusion that CF patients have a higher risk of inhaled particle accumulation and related particle overload in specific lung compartments than healthy subjects.

Effect of particle size on slow particle clearance from the bronchial tree

The Human Respiratory Tract Model of the International Commission on Radiological Protection assumes that a fraction of particles deposited in the bronchial tree clears slowly, this fraction decreasing with increasing particle geometric diameter. To test this assumption, volunteers inhaled 5-microm aerodynamic diameter 111In-polystyrene and 198Au-gold particles simultaneously, as a 'bolus' at the end of each breath to minimize alveolar deposition. Because of the different densities (1.05 versus 19.3 g cm3), geometric diameters were about 5 and 1.2 microm, respectively, and corresponding predicted slowly cleared fractions were about 10% and 50%. However, lung retention of the 2 particles was similar in each subject. Retention at 24 hours, as a percentage of initial lung deposit (mean +/- SD) was 34 +/- 12 for polystyrene and 31 +/- 11 for the gold particles.

Stochastic modeling predictions for the clearance of insoluble particles from the tracheobronchial tree of the human lung

Bronchial clearance of deposited particles was simulated using a stochastic model of the tracheobronchial tree. The clearance model introduced in this study considers (1) a continuous decrease of the mucus thickness from the trachea to the terminal bronchioles according to a linear or an exponential function, (2) the possibility of mucus discontinuities, which are mainly found in intermediate and distal airways of the tracheobronchial compartment, (3) mucus production in proximal airways, (4) a slow bronchial clearance phase due to the capture of a defined particle fraction f (s) in the periciliary sol phase, and (5) an eventual delay of the mucociliary transport at carinal ridges of airway bifurcations. Based on the concept of mucus volume conservation in single bifurcations, a reduction of the thickness of the mucus blanket from proximal to distal airways causes a significant increase of the mucus velocities in small ciliated airways compared to other stochastic modeling predictions assuming a constant thickness of the mucus layer throughout the conducting airways. This effect is further enhanced by the consideration of mucus discontinuities. In contrast, the ability of bronchial airways to produce a certain volume of mucus has a decreasing effect on the mucus velocities. In all generated clearance velocity models, mucociliary clearance is completely terminated within 24 h after exposure, consistent with the experimental evidence. Implementation of a slow bronchial clearance phase predicts a long-term retention fraction, which is fully cleared from the lung after several weeks. For 1-microm MMAD particles, 24-h retention varies between 0.42 and 0.52, in line with the suggestions of the ICRP. Mucus delay at carinal ridges only affects short-term clearance by increasing the retained particle fraction at a given time, while long-term retention is not influenced.

A multi-compartment model for slow bronchial clearance of insoluble particles--extension of the ICRP human respiratory tract models

To incorporate the various mechanisms that are presently assumed to be responsible for the experimentally observed slow bronchial clearance into the HRTM, a multi-compartment model was developed to simulate the clearance of insoluble particles in the tracheobronchial tree of the human lung. The new model considers specific mass transfer paths that may play an important role for slow bronchial clearance. These include the accumulation of particulate mass in the periciliary sol layer, phagocytosis of stored particles by airway macrophages and uptake of deposited mass by epithelial cells. Besides the gel layer representing fast mucociliary clearance, all cellular and non-cellular units involved in the slow clearance process are described by respective compartments that are connected by specific transfer rates. The gastrointestinal tract and lymph nodes are included into the model as final accumulation compartments, to which mass is transferred via the airway route and the transepithelial path. Predicted retention curves correspond well with previously published data.

Stochastic model of particle clearance in human bronchial airways

A stochastic bronchial clearance model, based on a stochastic morphometric model of the human bronchial tree, has been developed, which simulates the combined action of fast and slow bronchial clearance mechanisms by Monte Carlo methods. To model fast bronchial clearance, mucus velocities in individual airways were based on a correlation between mucus velocity and airway diameter, considering conservation of mucus flow. In addition, mucus transport was assumed to be delayed at bronchial bifurcation zones. The size dependence of the slow bronchial clearance phase was considered by a linear relationship between the slow bronchial clearance fraction, f(s), and the geometric particle diameter, derived from bolus inhalation experiments. Potential variations of f(s) from proximal to distal airway generations were simulated by five different scenarios, which allocated slow bronchial clearance to successively peripheral bronchial regions. Alveolar clearance, which contributes only to longterm particle retention, was modeled by transfer rates supplied by the ICRP respiratory tract model. To test the different components of the clearance model, modeling predictions were compared with experimental retention data from bolus inhalation experiments, using various particle sizes and bolus front depths, as well as from slow inhalation experiments, with a flow rate of only 0.045 L sec(-1). The overall good agreement between modeling results and experimental data indicate that the present model correctly predicts bronchial clearance, suggesting that slow bronchial clearance mechanisms are most effective in smaller bronchial airways.