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Pressure‐Flow Relationships in the Lungs

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Abstract

The sections in this article are:

1 Historical Perspectives
2 Physical Basis of Airway Resistance
2.1 General Principles
2.2 Predictions of Inspiratory Pressure Drop
2.3 Predictions of Expiratory Pressure Drop
2.4 Validity of the Quasi‐Steady Assumption for Pressure‐Flow Relationships for Oscillatory Flow
3 Resistance in Normal Subjects
3.1 Physiological Factors Influencing Measurements
3.2 Central Versus Peripheral Airway Contribution to Lower Pulmonary Resistance
3.3 Tissue Viscance
3.4 Inertance
3.5 Frequency Dependence
3.6 Techniques for Measuring Resistance
4 Concluding Remarks
Figure 1. Figure 1.

Measurement of pulmonary resistance showing airflow rate (P.T. denotes pneumotachograph) and both static (Pl.stat) and dynamic (Pl.dyn) components of pleural pressure during breathing. Zero pressure level for pleural pressure denoted by 0L; Ph. indicates pleural pressure points at instants of zero flow. Resistance is pressure difference between Pl.dyn and Pl.stat divided by simultaneous airflow rate.

From von Neergaard and Wirz 73
Figure 2. Figure 2.

Mouth pressure (dark line) with the zero pressure and airflow levels (OL) and airflow rate (lighter line, P. T. denotes pneumotachograph). V. Dr. indicates mouth pressure during occlusion. Note that during occlusion, airflow drops to zero and mouth pressure falls during inspiration or rises during expiration. Airway resistance was thought to be represented by ratio of mouth pressure to airflow rate either just before or after occlusion. See AIRWAY RESISTANCE, p. 289, for criticism of the authors' interpretation.

From von Neergaard and Wirz 73
Figure 3. Figure 3.

Idealized Moody diagram. Region 1 has a slope of −1 and indicates laminar flow. Region 2 has a slope of zero and represents fully turbulent flow. Region 3 has a variable slope between −1 and zero (average –½) representing transitional flow regimes.

From Drazen et al. 7
Figure 4. Figure 4.

Predicted variation of viscous flow resistance down the bronchial tree at airflow rates of 0.17 (□), 0.83 (▴), and 1.67 (▪) liters · s−1. Also shown on the same scale is the Poiseuille resistance (○).

From Pedley et al. 55
Figure 5. Figure 5.

Log‐log (Moody) plot of friction factor for the lower airways (CF) against tracheal Reynolds number (Re0). Solid curve: as predicted from theory of Pedley et al. 55; broken line: straight line of slope −½; dashdot curve: theory modified according to proposals of Jaffrin and Kesic 38; dotted curve: best fit according to Rohrer's equation; three lines marked S: results of Slutsky et al. 66. Experimental points: ○, adapted from Jaeger and Matthys 36; ×, from Hyatt and Wilcox 33; □, from Ferris et al. 12, corrected for tracheal diameter; Δ, from Vincent et al. 72; ♦, from Blide et al. 3.

Figure 6. Figure 6.

Predicted variation of viscous pressure down different pathways of asymmetric model of bronchial tree given by Horsfield et al. 30. Viscous pressure drops were plotted at points representing downstream ends of all airways in model, and points joined by straight lines. Broken line is prediction for corresponding symmetric model. Flow rate = 1 liter · s−1; 100 N · m2 = 1 cmH2O.

From Pedley et al. 56
Figure 7. Figure 7.

Ratio × 100 of upper to lower airway resistance plotted against absolute values of lower airway resistance. Note that with increasing lower airway resistance there is decrease in relative contribution of upper airways to total resistance.

From Hyatt and Wilcox 32
Figure 8. Figure 8.

Schematic drawing showing how relative volume changes of volume‐pressure systems exposed to identical pressure cycles can be used to assess relative volume‐pressure hysteresis. V1, airway volume measured as anatomical dead space; V2, lung volume. Note in middle panel, for example, that airways are larger at same lung volume when volume is reached from deflation than when reached from inflation if airway hysteresis exceeds that of lung.

From Froeb and Mead 17
Figure 9. Figure 9.

Four plethysmographic methods for measuring airway resistance. Pmouth, mouth pressure; Pbox, pressure within plethysmograph; , airflow rate at mouth. A: most commonly used technique. [Adapted from DuBois et al. 10.] B: bag contains air at BTPS conditions to avoid thermal effects. [Adapted from Jaeger and Otis 37.] C: ΔVpump is volume change of pump at mouth. [Adapted from Finucane et al. 13.] D: barospirator technique.

Adapted from Schwaber and Mead 64


Figure 1.

Measurement of pulmonary resistance showing airflow rate (P.T. denotes pneumotachograph) and both static (Pl.stat) and dynamic (Pl.dyn) components of pleural pressure during breathing. Zero pressure level for pleural pressure denoted by 0L; Ph. indicates pleural pressure points at instants of zero flow. Resistance is pressure difference between Pl.dyn and Pl.stat divided by simultaneous airflow rate.

From von Neergaard and Wirz 73


Figure 2.

Mouth pressure (dark line) with the zero pressure and airflow levels (OL) and airflow rate (lighter line, P. T. denotes pneumotachograph). V. Dr. indicates mouth pressure during occlusion. Note that during occlusion, airflow drops to zero and mouth pressure falls during inspiration or rises during expiration. Airway resistance was thought to be represented by ratio of mouth pressure to airflow rate either just before or after occlusion. See AIRWAY RESISTANCE, p. 289, for criticism of the authors' interpretation.

From von Neergaard and Wirz 73


Figure 3.

Idealized Moody diagram. Region 1 has a slope of −1 and indicates laminar flow. Region 2 has a slope of zero and represents fully turbulent flow. Region 3 has a variable slope between −1 and zero (average –½) representing transitional flow regimes.

From Drazen et al. 7


Figure 4.

Predicted variation of viscous flow resistance down the bronchial tree at airflow rates of 0.17 (□), 0.83 (▴), and 1.67 (▪) liters · s−1. Also shown on the same scale is the Poiseuille resistance (○).

From Pedley et al. 55


Figure 5.

Log‐log (Moody) plot of friction factor for the lower airways (CF) against tracheal Reynolds number (Re0). Solid curve: as predicted from theory of Pedley et al. 55; broken line: straight line of slope −½; dashdot curve: theory modified according to proposals of Jaffrin and Kesic 38; dotted curve: best fit according to Rohrer's equation; three lines marked S: results of Slutsky et al. 66. Experimental points: ○, adapted from Jaeger and Matthys 36; ×, from Hyatt and Wilcox 33; □, from Ferris et al. 12, corrected for tracheal diameter; Δ, from Vincent et al. 72; ♦, from Blide et al. 3.



Figure 6.

Predicted variation of viscous pressure down different pathways of asymmetric model of bronchial tree given by Horsfield et al. 30. Viscous pressure drops were plotted at points representing downstream ends of all airways in model, and points joined by straight lines. Broken line is prediction for corresponding symmetric model. Flow rate = 1 liter · s−1; 100 N · m2 = 1 cmH2O.

From Pedley et al. 56


Figure 7.

Ratio × 100 of upper to lower airway resistance plotted against absolute values of lower airway resistance. Note that with increasing lower airway resistance there is decrease in relative contribution of upper airways to total resistance.

From Hyatt and Wilcox 32


Figure 8.

Schematic drawing showing how relative volume changes of volume‐pressure systems exposed to identical pressure cycles can be used to assess relative volume‐pressure hysteresis. V1, airway volume measured as anatomical dead space; V2, lung volume. Note in middle panel, for example, that airways are larger at same lung volume when volume is reached from deflation than when reached from inflation if airway hysteresis exceeds that of lung.

From Froeb and Mead 17


Figure 9.

Four plethysmographic methods for measuring airway resistance. Pmouth, mouth pressure; Pbox, pressure within plethysmograph; , airflow rate at mouth. A: most commonly used technique. [Adapted from DuBois et al. 10.] B: bag contains air at BTPS conditions to avoid thermal effects. [Adapted from Jaeger and Otis 37.] C: ΔVpump is volume change of pump at mouth. [Adapted from Finucane et al. 13.] D: barospirator technique.

Adapted from Schwaber and Mead 64
References
 1. Albright, C. D., and S. Bondurant. Some effects of respiratory frequency on pulmonary mechanics. J. Clin. Invest. 44: 1362–1370, 1965.
 2. Bert, P. Leçons sur la physiologie comparée de la respiration. Paris: Ballière, 1870, p. 381–389.
 3. Blide, R. W., H. D. Kerr, and W. S. Spicer, Jr. Measurement of upper and lower airway resistance and conductance in man. J. Appl. Physiol. 19: 1059–1069, 1964.
 4. Brody, A. W., and A. B. DuBois. Determination of tissue, airway and total resistance to respiration in cats. J. Appl. Physiol. 9: 213–218, 1956.
 5. Butler, J., C. G. Caro, R. Alcala, and A. B. DuBois. Physiological factors affecting airway resistance in normal subjects and in patients with obstructive respiratory disease. J. Clin. Invest. 43: 584–591, 1960.
 6. Chang, H. K., and O. A. El eMasry. A model study of flow dynamics in human central airways. Part I. Axial velocity profiles. Respir. Physiol. 49: 75–95, 1982.
 7. Douglass, R. W., and B. R. Munson. Viscous energy dissipation in a model of the human bronchial tree. J. Biomech. 7: 551–557, 1974.
 8. Drazen, J. M., S. H. Loring, and R. H. Ingram, Jr. Distribution of pulmonary resistance: effects of gas density, viscosity, and flow rate. J. Appl. Physiol. 41: 388–395, 1976.
 9. Drazen, J. M., S. H. Loring, and R. H. Ingram, Jr. Localization of airway constriction using gases of varying density and viscosity. J. Appl. Physiol. 41: 396–399, 1976.
 10. DuBois, A. B., S. Y. Botelho, and J. H. Comroe, Jr. A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease. J. Clin. Invest. 35: 327–335, 1956.
 11. DuBois, A. B., A. W. Brody, D. H. Lewis, and B. F. Burgess, Jr. Oscillation mechanics of lungs and chest in man. J. Appl. Physiol. 8: 587–594, 1955.
 12. Ferris, B. G., Jr., J. Mead, and L. H. Opie. Partitioning of respiratory flow resistance in man. J. Appl. Physiol. 19: 653–658, 1964.
 13. Finucane, K. E., S. V. Dawson, P. D. Phelan, and J. Mead. Resistance of intrathoracic airways of healthy subjects during periodic flow. J. Appl. Physiol. 38: 517–530, 1975.
 14. Finucane, K. E., and J. Mead. Estimation of alveolar pressure during forced oscillation of the respiratory system. J. Appl. Physiol. 38: 531–537, 1975.
 15. Frank, N. R., J. Mead, and J. L. Whittenberger. Comparative sensitivity of four methods for measuring changes in respiratory flow resistance in man. J. Appl. Physiol. 31: 934–938, 1971.
 16. Fredberg, J. J., and J. Mead. Impedance of intrathoracic airway models during low‐frequency periodic flow. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 347–351, 1979.
 17. Froeb, H. F., and J. Mead. Relative hysteresis of the dead space and lung in vivo. J. Appl. Physiol. 25: 244–248, 1968.
 18. Goldman, M., R. J. Knudson, J. Mead, N. Peterson, J. R. Schwaber, and M. E. Wohl. A simplified measurement of respiratory resistance by forced oscillation. J. Appl. Physiol. 28: 113–116, 1970.
 19. Goldstein, D., and J. Mead. Total respiratory impedance immediately after panting. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 1024–1028, 1980.
 20. Green, M. How big are the bronchioles? St. Thomas' Hosp. Gaz. 63: 136–139, 1965.
 21. Green, M., and J. Mead. Time dependence of flow‐volume curves. J. Appl. Physiol. 37: 793–797, 1974.
 22. Grimby, G., T. Takishima, W. Graham, P. T. Macklem, and J. Mead. Frequency dependence of flow resistance in patients with obstructive lung disease. J. Clin. Invest. 47: 1455–1461, 1968.
 23. Guyatt, A. R., and J. H. Alpers. Factors affecting airways conductance: a study of 752 working men. J. Appl. Physiol. 24: 310–316, 1968.
 24. Hardin, J. C., J. C. Yu, J. L. Patterson, and W. Trible. The pressure/flow relation in bronchial airways on expiration. In: Biofluid Mechanics, edited by D. J. Schneck. New York: Plenum, 1980, vol. 2, p. 39–55.
 25. Higenbottam, T. Narrowing of glottis opening in humans associated with experimentally induced bronchoconstriction. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 403–407, 1980.
 26. Hildebrandt, J. Dynamic properties of air‐filled excised cat lung determined by liquid plethysmograph. J. Appl. Physiol. 27: 246–250, 1969.
 27. Hogg, J. C., J. Williams, J. B. Richardson, P. T. Macklem, and W. M. Thurlbeck. Age as a factor in the distribution of lower‐airway conductance and in the pathologic anatomy of obstructive lung disease. N. Engl. J. Med. 282: 1283–1287, 1970.
 28. Hoppin, F. G., Jr., M. Green, and M. S. Morgan. Relationship of central and peripheral airway resistance to lung volume in dogs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 728–737, 1978.
 29. Horsfield, K., and G. Cumming. Morphology of the bronchial tree in the dog. Respir. Physiol. 26: 176–182, 1976.
 30. Horsfield, K., G. Dart, D. E. Olson, G. F. Filley, and G. Cumming. Models of the human bronchial tree. J. Appl. Physiol. 31: 207–217, 1971.
 31. Hughes, J. M. B., F. G. Hoppin, Jr., and J. Mead. Effect of lung inflation on bronchial length and diameter in excised lungs. J. Appl. Physiol. 32: 25–35, 1972.
 32. Hyatt, R. E., and R. E. Wilcox. Extrathoracic airway resistance in man. J. Appl Physiol. 16: 326–330, 1961.
 33. Hyatt, R. E., and R. E. Wilcox. The pressure‐flow relationship of the intrathoracic airways in man. J. Clin. Invest. 42: 29–39, 1963.
 34. Isabey, D., and H. K. Chang. Steady and unsteady pressure‐flow relationships in central airways. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 1338–1348, 1981.
 35. Jackson, A. C., P. J. Gulesian, Jr., and J. Mead. Glottal aperture during panting with voluntary limitation of tidal volume. J. Appl. Physiol. 39: 834–836, 1975.
 36. Jaeger, M. J., and H. Matthys. The pressure‐flow characteristics of the human airways. In: Symposium on Airway Dynamics, edited by A. Bouhuys. Springfield, IL: Thomas, 1969.
 37. Jaeger, M. J., and A. B. Otis. Measurement of airway resistance with a volume displacement body plethysmograph. J. Appl. Physiol. 19: 813–820, 1964.
 38. Jaffrin, M. Y., and P. Kesic. Airway resistance: a fluid mechanical approach. J. Appl. Physiol. 36: 354–361, 1974.
 39. Jonson, B., and A. Bouhuys. Measurement of alveolar pressure. J. Appl. Physiol. 22: 1081–1085, 1967.
 40. Landau, L. I., and P. D. Phelan. Evaluation of two techniques for measurement of respiratory resistance by forced oscillation. Thorax 28: 136–141, 1973.
 41. Lisboa, C., L. D. H. Wood, J. Jardim, and P. T. Macklem. Relation between flow, curvilinearity, and density dependence of pulmonary pressure‐flow curves. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 878–885, 1980.
 42. Macklem, P. T., and J. Mead. Resistance of central and peripheral airways measured by a retrograde catheter. J. Appl. Physiol. 22: 395–401, 1967.
 43. McIlroy, M. B., J. Mead, N. J. Selverstone, and E. P. Radford. Measurement of lung tissue viscous resistance using gases of equal kinematic viscosity. J. Appl. Physiol. 7: 485–490, 1955.
 44. Mead, J. Measurement of inertia of the lungs at increased ambient pressure. J. Appl. Physiol. 9: 208–212, 1956.
 45. Mead, J. Control of respiratory frequency. J. Appl. Physiol. 15: 325–336, 1960.
 46. Mead, J. Contribution of compliance of airways to frequency‐dependent behavior of lungs. J. Appl. Physiol. 26: 670–673, 1969.
 47. Mead, J., and C. Collier. Relation of volume history of lungs to respiratory mechanics in anesthetized dogs. J. Appl. Physiol. 14: 669–678, 1959.
 48. Mead, J., and J. L. Whittenberger. Physical properties of human lungs measured during spontaneous respiration. J. Appl. Physiol. 5: 779–796, 1953.
 49. Mead, J., and J. L. Whittenberger. Evaluation of airway interruption technique as a method for measuring air‐flow resistance. J. Appl. Physiol. 6: 408–416, 1954.
 50. Mount, L. E. The ventilation flow‐resistance and compliance of rat lungs. J. Physiol. London 127: 157–167, 1955.
 51. Nadel, J. A., and D. F. Tierney. Effect of a previous deep inspiration on airway resistance in man. J. Appl. Physiol. 16: 717–719, 1961.
 52. Olson, D. E., G. A. Dart, and G. F. Filley. Pressure drop and fluid flow regime of air inspired into the human lung. J. Appl. Physiol. 28: 482–494, 1970.
 53. Olson, D. E., L. D. Iliff, and M. F. Sudlow. Some aspects of the physics of flow in the central airways. Bull. Physio‐Pathol. Respir. 8: 391–408, 1972.
 54. Otis, A. B., C. B. McKerrow, R. A. Bartlett, J. Mead, M. B. McIlroy, N. J. Selverstone, and E. P. Radford. Mechanical factors in distribution of pulmonary ventilation. J. Appl. Physiol. 8: 427–443, 1956.
 55. Pacome, J.‐J. Structures D'écoulement et pertes de charge calculées dans le modèle D'arbre bronchique de Weibel. Toulouse, France: Paul Sabatier Univ., 1975. Dissertation.
 56. Pedley, T. J., R. C. Schroter, and M. F. Sudlow. The prediction of pressure drop and variation of resistance within the human bronchial airways. Respir. Physiol. 9: 387–405, 1970.
 57. Pedley, T. J., R. C. Schroter, and M. F. Sudlow. Gas flow and mixing in the airways. In: Lung Biology in Health and Disease. Bioengineering Aspects of the Lung, edited by J. B. West. New York: Dekker, 1977, vol. 3, chapt. 3, p. 163–265.
 58. Pimmel, R. L., M. J. Tsai, D. C. Winter, and P. A. Bromberg. Estimating central and peripheral respiratory resistance. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 45: 375–380, 1978.
 59. Proctor, D. F., and D. Swift. The nose—a defence against the atmospheric environment. In: Inhaled Particles and Vapours III, edited by W. H. Walton. Old Woking, UK: Unwin, 1971, vol. 1.
 60. Reynolds, D. B., and J.‐S. Lee. Steady pressure‐flow relationship of a model of the canine bronchial tree. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 1072–1079, 1981.
 61. Rohrer, F. Der Strömungswiderstand in den menschlichen Atemwegen und der Einfluss der unregelmässigen Verzweigung des Bronchialsystems auf den Atmungsverlauf verschiedenen Lungenbezirken. Pfluegers Arch. Gesamte Physiol. Menschen Tiere 162: 225–229, 1915.
 62. Saibene, F., and J. Mead. Frequency dependence of pulmonary quasi‐static hysteresis. J. Appl. Physiol. 26: 732–737, 1969.
 63. Sasaki, H., and F. G. Hoppin, Jr. Hysteresis of contracted airway smooth muscle. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 1251–1262, 1979.
 64. Schmid‐Schönbein, G. W., and Y. C. Fung. Forced perturbation of respiratory system. A. The traditional model. Ann. Biomed. Eng. 6: 194–211, 1978.
 65. Schwaber, J., and J. Mead. Use of a modified Thunberg barospirator to determine airway resistance in man. J. Appl. Physiol. 25: 328–332, 1968.
 66. Sharp, J. T., J. P. Henry, S. K. Sweaney, W. R. Meadows, and R. J. Pietras. Total respiratory inertance and its gas and tissue components in normal and obese man. J. Clin. Invest. 43: 503–509, 1964.
 67. Slutsky, A. S., G. G. Berdine, and J. M. Drazen. Steady flow in a model of human central airways. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 417–423, 1980.
 68. Slutsky, A. S., G. G. Berdine, and J. M. Drazen. Oscillatory flow and quasi‐steady behavior in a model of human central airways. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 50: 1293–1299, 1981.
 69. Slutsky, A. S., and J. M. Drazen. Estimating central and peripheral respiratory resistance: an alternative analysis. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 1325–1331, 1979.
 70. Slutsky, A. S., J. M. Drazen, R. H. Ingram, Jr., R. D. Kamm, A. H. Shapiro, J. J. Fredberg, S. H. Loring, and J. Lehr. Effective pulmonary ventilation with small‐volume oscillations at high frequency. Science 209: 609–611, 1980.
 71. Sonne, C. Untersuchungen über die relative Weite der Broncholen bei der verschiedenen Luftspannung der Lungen. Acta Med. Scand. 58: 313–341, 1923.
 72. Stänescu, D. C., J. Pattijn, J. Clément, and K. P. van de Woestijne. Glottis opening and airway resistance. J. Appl. Physiol. 32: 460–466, 1972.
 73. Thunberg, T. Der Barospirator, ein neuer Apparat für kunstliche Atmung. Skand. Arch. Physiol. 48: 80–98, 1926.
 74. Vincent, N. J., R. Knudson, D. E. Leith, P. T. Macklem, and J. Mead. Factors influencing pulmonary resistance. J. Appl. Physiol. 29: 236–243, 1970.
 75. Von Neergaard, K., and K. Wirz. Die Messung der Strömungswiderstände in den Atemwegen des Menschen, insbesondere bei Asthma und Emphysem. Z. Klin. Med. 105: 51–82, 1927.
 76. Weibel, E. R. Morphometry of the Human Lung. Berlin: Springer‐Verlag, 1963.
 77. Williams, S. P., R. L. Pimmel, J. M. Fullton, M. J. Tsai, and A. M. Collier. Fractionating respiratory resistance in young children. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 551–555, 1979.
 78. Wirz, K. Das Verhalten des Druckes im Pleuraraum bei der Atmung und die Ursachen seiner Veränderlichkeit. Pfluegers Arch. Gesamte Physiol. Menschen Tiere 199: 1–12, 1923.
 79. Wood, L. D. H., L. A. Engel, P. Griffin, P. Despas, and P. T. Macklem. Effect of gas physical properties and flow on lower pulmonary resistance. J. Appl. Physiol. 41: 234–244, 1976.

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Roland H. Ingram, T. J. Pedley. Pressure‐Flow Relationships in the Lungs. Compr Physiol 2011, Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing: 277-293. First published in print 1986. doi: 10.1002/cphy.cp030318