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Relationship between airway narrowing, patchy ventilation and lung mechanics in asthmatics

¹ Depts of Anesthesia and Critical Care, ³ Medicine (Pulmonary and Critical Care Unit and Clinical Epidemiology Unit), Massachusetts General Hospital, ² Dept of Biomedical Engineering, Boston University, and ⁴ Harvard Medical School, Boston, MA, USA.

CORRESPONDENCE: J. G. Venegas, Dept of Anesthesia and Critical Care (CLN-237F), Massachusetts General Hospital, Boston, 02114 MA, USA. E-mail: jvenegas{at}partners.org

Keywords: Airway obstruction, constriction, elastance, heterogeneous, oscillatory, resistance

Received: August 29, 2006
Accepted February 28, 2007

Bronchoconstriction in asthma results in patchy ventilation forming ventilation defects (VDefs). Patchy ventilation is clinically important because it affects obstructive symptoms and impairs both gas exchange and the distribution of inhaled medications. The current study combined functional imaging, oscillatory mechanics and theoretical modelling to test whether the degrees of constriction of airways feeding those units outside VDefs were related to the extent of VDefs in bronchoconstricted asthmatic subjects.

Positron emission tomography was used to quantify the regional distribution of ventilation and oscillatory mechanics were measured in asthmatic subjects before and after bronchoconstriction. For each subject, ventilation data was mapped into an anatomically based lung model that was used to evaluate whether airway constriction patterns, consistent with the imaging data, were capable of matching the measured changes in airflow obstruction.

The degree and heterogeneity of constriction of the airways feeding alveolar units outside VDefs was similar among the subjects studied despite large inter-subject variability in airflow obstruction and the extent of the ventilation defects. Analysis of the data amongst the subjects showed an inverse relationship between the reduction in mean airway conductance, measured in the breathing frequency range during bronchoconstriction, and the fraction of lung involved in ventilation defects.

The current data supports the concept that patchy ventilation is an expression of the integrated system and not just the sum of independent responses of individual airways.

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