Aerosol bolus dispersion in the respiratory tract of children

Influence of alveolar mixing and multiple breaths of aerosol intake on particle deposition in the human lungs

Predictive dosimetry models play an important role in assessing health effect of inhaled particulate matter and in optimizing delivery of inhaled pharmaceutical aerosols. In this study, the commonly used 1D Multiple-Path Particle Dosimetry model (MPPD) was improved by including a mechanistically based model component for alveolar mixing of particles and by extending the model capabilities to account for multiple breaths of aerosol intake. These modifications increased the retained fraction of particles and consequently particle deposition predictions in the deep lung during tidal breathing. Comparison with an existing dataset (J. Aerosol Sci., 99:27-39, 2016) obtained under two breathing conditions referred to as slow and fast breathing showed significant differences in 1 μm particle deposition between predictions based on subject-specific breathing patterns and lung volume (slow: 30 ± 1%, fast: 21 ± 1%, (average ± standard deviation), N = 7) and measurements (slow: 43 ± 9%, fast: 30 ± 5%) when the prior version of MPPD (single breath and no mixing, J. Aerosol Sci., 151:105647, 2021) was used. Adding a mixing model and multiple breaths moved the predictions (slow: 34 ± 2%, fast:25 ± 2%) closer to the range of deposition measurements. For 2.9 μm particles, predictions from both the original (slow: 70 ± 2%, fast: 57 ± 2%) and the revised MPPD model (slow: 71 ± 2%, fast: 59 ± 3%) compared well with experiments (slow: 67 ± 8%, fast: 58 ± 10%). This was expected as suspended fraction of 2.9 μm particles was small and thus the addition of alveolar mixing and multi breath capability only slightly increased the retained fraction for particles of this size and greater. The revised 1D model improves dose predictions in the deep lung and support human risk assessment from exposure to airborne particles.

Regional Lung Deposition: In Vivo Data

The method section of this chapter on in vivo regional lung deposition highlights a nonradioactive method to measure regional deposition, which uses a photometer to quantify inhaled and exhaled particles and in that way is able to estimate the lung region from which the particles are exhaled and to what amount. The radioactive methods cover the measurement of clearance of the deposited particles as well as different imaging techniques to determine regional deposition. The result section reviews in vivo trials in human subjects. It also addresses different parameters that influence the regional deposition in the lungs: particle size, inhalation maneuver, carrier gas, disease, and inhalation device. All of these factors can affect regional deposition significantly. By choosing specific values of these parameters, it should be feasible to target different regions of the lungs for the therapy of different diseases.

Aerosol bolus dispersion in acinar airways--influence of gravity and airway asymmetry

The aerosol bolus technique can be used to estimate the degree of convective mixing in the lung; however, contributions of different lung compartments to measured dispersion cannot be differentiated unambiguously. To estimate dispersion in the distal lung, we studied the effect of gravity and airway asymmetry on the dispersion of 1 μm-diameter particle boluses in three-dimensional computational models of the lung periphery, ranging from a single alveolar sac to four-generation (g4) structures of bifurcating airways that deformed homogeneously during breathing. Boluses were introduced at the beginning of a 2-s inhalation, immediately followed by a 3-s exhalation. Dispersion was estimated by the half-width of the exhaled bolus. Dispersion was significantly affected by the spatial orientation of the models in normal gravity and was less in zero gravity than in normal gravity. Dispersion was strongly correlated with model volume in both normal and zero gravity. Predicted pulmonary dispersion based on a symmetric g4 acinar model was 391 ml and 238 ml under normal and zero gravity, respectively. These results accounted for a significant amount of dispersion measured experimentally. In zero gravity, predicted dispersion in a highly asymmetric model accounted for ∼20% of that obtained in a symmetric model with comparable volume and number of alveolated branches, whereas normal gravity dispersions were comparable in both models. These results suggest that gravitational sedimentation and not geometrical asymmetry is the dominant factor in aerosol dispersion in the lung periphery.

Semi-empirical stochastic model of aerosol bolus dispersion in the human lung

Aerosol bolus dispersion, that is, the broadening of an inhaled narrow aerosol bolus upon exhalation, was simulated by Monte Carlo methods using a stochastic, asymmetric morphometric model of the human lung. Physical mechanisms considered to contribute to bolus dispersion were (1) axial diffusion in conductive airways, approximated by effective diffusivities, (2) convective mixing at airway bifurcation sites, (3) differences in inspiratory and expiratory velocity profiles, (4) mixing with residual air in alveoli, and (5) inhomogeneous ventilation of the lung lobes due to asymmetric flow spitting at bifurcations and asymmetric and asynchronous filling of the five lung lobes. Theoretical predictions of the bolus dispersion model were compared to experimental data for 79 healthy volunteers, which provide detailed information on statistical bolus parameters (half-width, standard deviation, skewness, and mode shift) and total bolus deposition as a function of the depth of bolus penetration into the airway system. Predicted bolus dispersion and deposition data show excellent agreement with the published experimental data, suggesting that axial diffusion in conductive airways and convective mixing in alveoli, resulting in irreversible particle transport, are the major determinants of bolus dispersion. The variability and asymmetry of the branching airway network, leading to asymmetric flow splitting at airway bifurcations, greatly enhances the effect of irreversibility and the resulting dispersion of the inhaled bolus.

Lung volume is a determinant of aerosol bolus dispersion

The technique of inhaling a small volume element labeled with particles ("aerosol bolus") can be used to assess convective gas mixing in the lung. While a bolus undergoes mixing in the lung, particles are dispersed in an increasing volume of the respired air. However, determining factors of bolus dispersion are not yet completely understood. The present study tested the hypothesis that bolus dispersion is related, among others, to the total volume in which the bolus is allowed to mix--i.e., to the individual lung size. Bolus dispersion was measured in 32 anesthetized, mechanically ventilated dogs with total lung capacities (TLCs) of 1.1-2.5 L. Six-milliliter aerosol boluses were introduced at various preselected time-points during inspiration to probe different volumetric lung depths. Dispersion (SD) was determined by moment analysis of particle concentrations in the expired air. We found linear correlations between SD at a given lung depth and the individual end-inspiratory lung volume (V(L)). The relationship was tightest for boluses inhaled deepest into the lungs: SD(40) = 0.068 V(L) - 1.77, r(2) = 0.59. Normalizing SD to V(L) abolished this dependency and resulted in a considerable reduction of inter-individual variability as compared to the uncorrected measurements. These data indicate that lung size influences measurements of bolus dispersion. It therefore appears reasonable to apply a normalization procedure before interpreting the data. Apart from a reduction in measurement variability, this should help to separate the effects on bolus dispersion of altered lung volumes and altered mixing processes in diseased lungs.

Anatomic localization of 24- and 96-h particle retention in canine airways

Long-term retention of particles in airways is controversial. However, precise anatomic localization of the particles is not possible in people. In this study the anatomic location of retained particles after shallow bolus inhalation was determined in anesthetized, ventilated beagle dogs. Fifty 30-cm(3) boluses containing monodisperse 2.5-micron polystyrene particles (PSL) were delivered to a shallow lung depth of 81-129 cm(3). At 96 h before euthanasia, red fluorescent PSL were used; at 24 h, green fluorescent PSL and (99m)Tc-labeled PSL were used. Clearance of (99m)Tc-PSL was measured during the next 24 h. Sites of particle retention were determined in systematic, volume-weighted random samples of microwave-fixed lung tissue. Precise particle localization and distribution was analyzed by using gamma counting, conventional fluorescence microscopy, and confocal microscopy. Within 24 h after shallow bolus inhalation, 50-95% of the deposited (99m)Tc-PSL were cleared, but the remaining fraction was cleared slowly in all dogs, similar to previous human results. The three-dimensional deposition patterns showed particles across the entire cross-sectional plane of the lungs at the level of the carina. In these locations, 33 +/- 9.9% of the retained particles were found in small, nonrespiratory airways (0.3- to 1-mm diameter) and 49 +/- 10% of the particles in alveoli; the remaining fraction was found in larger airways. After 96 h, a similar pattern was found. These findings suggest that long-term retention in airways is at the bronchiolar level.

Aerosol bolus dispersion and aerosol-derived airway morphometry: assessment of lung pathology and response to therapy, Part 1

review discusses the potential utility of two methods using inhaled aerosols to detect and diagnose lung disease and to evaluate the efficacy of therapy. Aerosol bolus dispersion measures convective gas mixing; aerosol-derived airway morphometry assesses the calibers of airway and airspaces. These two methods are discussed in terms of their ease of use (simplicity and acceptability) and current data regarding their validity, reproducibility, specificity, sensitivity, and detection of lung improvement with therapy. Part 1 of this review focuses upon aerosol bolus dispersion; Part 2(1) focuses upon aerosol-derived airway morphometry. Aerosol bolus dispersion has many features that make it clinically attractive. It is simple to administer and patients can successfully perform the maneuvers. It detects known alterations in the lungs. It is reproducible and has high specificity and sensitivity. However, every lung disease or condition known to be detected by aerosol bolus dispersion is also detected by spirometery, maximal expiratory flow-volume curves, or another conventional lung function test. This, aerosol bolus dispersion appears best reserved as a specialized method to supplement conventional lung function tests and to characterize convective gas transport.

Influence of intrinsic particle properties on the assessment of convective gas transport by aerosol bolus technique

Aerosol bolus measurements are increasingly being used in patients and healthy subjects to assess convective gas transport and mixing in the lungs. To investigate the extent to which intrinsic particle properties confound parameters derived for the assessment of intrapulmonary transport, bolus inhalation experiments were performed in six anesthetized, intubated, and mechanically ventilated beagle dogs using DEHS particles of 0.5, 1, or 2 microns diameter. Therefore, particle displacement by diffusion varied by a factor of two, settling velocity by a factor of 13, and particle inertia as inferred from the stopping distance by a factor of 16. By using a standardized breathing maneuver 6-mL boluses were inhaled into lung depths between 75 and 475 mL. Mode, half-width, and intrapulmonary particle deposition along with mean, standard deviation, and skewness of the particle concentration distributions in the expired air were determined. For all particle sizes studied particle deposition increased with increasing lung depth not exceeding 25% for 0.5-micron particles, but being 80% in deep lung regions for 2-micron particles. Whereas half-width and standard deviation exhibited only small differences between particle sizes (less than 20%), mode and mean of the exhaled bolus were clearly dependent on particle size, in particular for particles inhaled deep into the lung. No significant effects were detectable for the skewness. Hence, convective mixing assessed by half-width or standard deviation is only slightly dependent on particle size, but the estimate of convective bulk transport as inferred from the mean volume from which the bolus is exhaled is highly dependent on particle size. Yet, the intrinsic mobility of unit-density 0.5-micron particles was found to be small enough to consider these particles as ideal tracers for probing convective gas transport in the lungs.

Influence of gas composition on convective and diffusive intrapulmonary gas transport

The influence of gas composition on convective and diffusive gas transport in the lungs was assessed by studying the dispersion of combined particle and argon (Ar) boluses induced by the passage through the lungs filled with three different gas mixtures. Particles, as a "nondiffusing gas," served as a tracer for convective gas transport, while the significance of diffusive gas transport was inferred from the difference in the behavior of Ar and particles. The lungs of six anesthetized and mechanically ventilated beagle dogs were equilibrated with air or either of the test atmospheres, He-O2 or SF6-O2, where nitrogen was replaced by helium (He) or sulfur hexafluoride (SF6). Due to differences in gas density and gas viscosity Reynolds numbers varied by a factor of twelve and Ar diffusivity by a factor of four between He-O2 and SF6-O2, suggesting that both kinds of intrapulmonary gas transport, convection and diffusion, should be affected. Combined particle and Ar boluses were inhaled into various lung depths and the extent of gas transport was inferred from changes in bolus shape induced by the passage through the lungs. In air, convective bulk gas transport generally followed the symmetric first-in, last-out principle and acted at all tested lung depths. Within the conducting airways, gas transport to the lung periphery was primarily due to convection but beyond these airways diffusion became rapidly significant. Breathing test atmospheres affects intrapulmonary gas transport only slightly. The extent of convective mixing was increased by 4% in SF6-O2 (p < .01) and reduced by 5% in He-O2 (p < .01) as compared to air. The symmetry of convective lung filling and emptying was slightly disturbed. In SF6-O2 the mean of the exhaled bolus was shifted by 8% toward the lung periphery. In He-O2 it was shifted by 4% toward the airway opening. In both test atmospheres exhaled Ar boluses were similar, suggesting that diffusive gas transport overwhelms the small changes in convective gas transport. Hence, factors other than gas composition-related flow characteristics, e.g., nonreversibility of in- and expiratory flow profiles or features of lung geometry, are the major determinants of gas transport in the lungs.