PT  - JOURNAL ARTICLE
AU  - Koulouris, NG
AU  - Valta, P
AU  - Lavoie, A
AU  - Corbeil, C
AU  - Chasse, M
AU  - Braidy, J
AU  - Milic-Emili, J
TI  - A simple method to detect expiratory flow limitation during spontaneous breathing
AID  - 10.1183/09031936.95.08020306
DP  - 1995 Feb 01
TA  - European Respiratory Journal
PG  - 306--313
VI  - 8
IP  - 2
4099  - https://publications.ersnet.org//content/8/2/306.short
4100  - https://publications.ersnet.org//content/8/2/306.full
SO  - Eur Respir J1995 Feb 01; 8
AB  - 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.