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A simple method to detect expiratory flow limitation during spontaneous breathing

NG Koulouris, P Valta, A Lavoie, C Corbeil, M Chasse, J Braidy, J Milic-Emili
European Respiratory Journal 1995 8: 306-313; DOI:
NG Koulouris
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P Valta
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A Lavoie
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C Corbeil
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M Chasse
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J Braidy
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J Milic-Emili
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Abstract

Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as during a forced expiratory vital capacity manoeuvre, and this has been taken as indicating flow limitation at rest. To obtain such curves, a body plethysmograph and the patient's co-operation are required. We propose a simple technique which does not entail these requirements. It consists in applying negative pressure at the mouth during a tidal expiration (NEP). Patients in whom NEP elicits an increase in flow throughout the expiration are not flow-limited. In contrast, patients in whom application of NEP does not elicit an increase in flow during most or part of the tidal expiration are considered as flow-limited. Using this technique, 26 stable COPD patients were studied sitting and supine. Eleven patients were flow-limited both seated and supine, eight were flow-limited only when supine, and seven were not flow-limited either seated or supine. Only 5 of 19 patients who were flow-limited seated and/or supine had severe ventilatory impairment (forced expiratory volume in one second (FEV1) < 40% predicted). We conclude that the NEP technique provides a simple, rapid, and reliable method for detection of expiratory flow limitation in spontaneously breathing subjects, which does not require the patient's co-operation, and can be applied in different body positions both at rest and during muscular exercise. Our results also indicate a high prevalence of flow limitation in COPD patients at rest, particularly when supine.

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A simple method to detect expiratory flow limitation during spontaneous breathing
NG Koulouris, P Valta, A Lavoie, C Corbeil, M Chasse, J Braidy, J Milic-Emili
European Respiratory Journal Feb 1995, 8 (2) 306-313;

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A simple method to detect expiratory flow limitation during spontaneous breathing
NG Koulouris, P Valta, A Lavoie, C Corbeil, M Chasse, J Braidy, J Milic-Emili
European Respiratory Journal Feb 1995, 8 (2) 306-313;
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