Comprehensive Physiology Wiley Online Library
For Librarians For Authors Editors About

Forced Expiration

Robert E. Hyatt

10.1002/cphy.cp030319

Source: Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing

Originally published: 1986

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 Mechanism of Expiratory Flow Limitation
1.1 Wave‐Speed Limitation
1.2 Viscous Flow Limitation
1.3 Computational Model
2 Measurement and Analysis
2.1 Volume‐Time
2.2 Flow‐Volume
3 Relative Merits of Presentations
3.1 Volume‐Time
3.2 Flow‐Volume
4 Additional Considerations
4.1 Volume and Time History
4.2 Effects of Changing Gas Properties
4.3 Dysanaptic Growth
4.4 Axial Bronchial Tension
4.5 Thoracoabdominal Mechanics
Figure 1.

Left: flow‐volume plot for normal subject. values are plotted against their corresponding volume at A, B, and C and define the MEFV curve (solid line). Right: three isovolume pressure‐flow curves from same subject. Curves A, B, and C were measured at volumes of 0.8, 2.3, and 3.0 liters from total lung capacity (TLC), respectively. Transpulmonary pressure is the difference between pleural (estimated by an esophageal balloon) and mouth pressures.
Figure 2.

Representation of flow limitation at wave speed. A: typical curve of airway area (A) as a function of p, the difference between lateral airway pressure and pleural pressure. If dissipative pressure losses are neglected, p can be calculated by subtracting the Bernoulli terρ2/2A2 from alveolar pressure (PALV). Because PALV (or PA) is measured relative to pleural pressure, it is equivalent to static recoil pressure. The intersection of this curve with the airway pressure‐area curve determines pressure and airway area at a given flow. There is a maximal flow for which a point common to both curves exists. B: airway pressure‐area curves for generations 2, 3, and 4 and the Bernoulli curve for maximal flow. Flow limitation occurs in generation 3, but there is an additional pressure drop because of compression downstream of the flow‐limiting site in generation 2.

From Wilson et al. 149
Figure 3.

Viscous flow limitation. A: pressure‐area curve of a smaller airway. B: if the pressure gradient in the flow is described by the Poiseuille equation, then for a fixed pressure at the upstream end of the tube (p1), flow will depend on the pressure at the downstream end of the tube (p2).

From Wilson et al. 149
Figure 4.

Top: flow‐volume plot of a forced expired vital capacity maneuver from a normal subject. Bottom: derived volume‐time trace of the same breath. , maximum expiratory flow; TLC, total lung capacity; FEF, mean forced expiratory flow between two designated volume points in FVC; FEV, forced expiratory volume in time interval.

Adapted from Hyatt 51
Figure 5.

A: two consecutive forced vital capacity efforts by same subject with flow and volume measured at the mouth. B: same efforts with volume measured from body plethysmograph. Efforts are identical because gas compression has been corrected for.

From Hyatt 52
Figure 6.

Averaged flow‐volume curves for normal subject. Upper panels: initial standing (left) and supine (right) curves. Middle panels: comparison of standing (solid lines) and supine (dashed lines) average flow‐volume curves obtained initially (left) and 3 mo later (right). Lower panels: comparison of standing (solid lines) and supine (dashed lines) slope ratios (SR) versus volume (V) plots obtained initially (left) and 3 mo later (right). , flow.

From Castile et al. 19
Figure 7.

Characteristic flow‐volume loops produced by major airway lesions. Fixed lesion resulted from fracture of larynx. Variable extrathoracic lesion was due to bilateral vocal cord paralysis. Variable intrathoracic pattern was produced by malignancy of trachea at carina.

From Hyatt and Black 53
Figure 8.

A: maximal expiratory flow‐volume curve (dashed curve) obtained from series of expiratory efforts, none of which represented an acceptable flow‐volume curve effort. Sequence was effort a (initiated from full inspiration) followed by effort b and then effort c. B: lower two‐thirds of maximal expiratory flow‐volume curve can be reliably estimated from a series of coughs initiated from full inspiration. For clarity flow transients have been filtered out.

From Hyatt and Black 53
Figure 9.

Maximal expiratory flow‐volume curves from patient with asthma. Patient was asymptomatic during control period. Symptoms including wheezing were induced by inhaling an extract of ragweed. Resulting change in lung mechanics is readily identified from maximal expiratory flow‐volume curves.

From Hyatt and Black 53


Figure 1.

Left: flow‐volume plot for normal subject. values are plotted against their corresponding volume at A, B, and C and define the MEFV curve (solid line). Right: three isovolume pressure‐flow curves from same subject. Curves A, B, and C were measured at volumes of 0.8, 2.3, and 3.0 liters from total lung capacity (TLC), respectively. Transpulmonary pressure is the difference between pleural (estimated by an esophageal balloon) and mouth pressures.



Figure 2.

Representation of flow limitation at wave speed. A: typical curve of airway area (A) as a function of p, the difference between lateral airway pressure and pleural pressure. If dissipative pressure losses are neglected, p can be calculated by subtracting the Bernoulli terρ2/2A2 from alveolar pressure (PALV). Because PALV (or PA) is measured relative to pleural pressure, it is equivalent to static recoil pressure. The intersection of this curve with the airway pressure‐area curve determines pressure and airway area at a given flow. There is a maximal flow for which a point common to both curves exists. B: airway pressure‐area curves for generations 2, 3, and 4 and the Bernoulli curve for maximal flow. Flow limitation occurs in generation 3, but there is an additional pressure drop because of compression downstream of the flow‐limiting site in generation 2.

From Wilson et al. 149


Figure 3.

Viscous flow limitation. A: pressure‐area curve of a smaller airway. B: if the pressure gradient in the flow is described by the Poiseuille equation, then for a fixed pressure at the upstream end of the tube (p1), flow will depend on the pressure at the downstream end of the tube (p2).

From Wilson et al. 149


Figure 4.

Top: flow‐volume plot of a forced expired vital capacity maneuver from a normal subject. Bottom: derived volume‐time trace of the same breath. , maximum expiratory flow; TLC, total lung capacity; FEF, mean forced expiratory flow between two designated volume points in FVC; FEV, forced expiratory volume in time interval.

Adapted from Hyatt 51


Figure 5.

A: two consecutive forced vital capacity efforts by same subject with flow and volume measured at the mouth. B: same efforts with volume measured from body plethysmograph. Efforts are identical because gas compression has been corrected for.

From Hyatt 52


Figure 6.

Averaged flow‐volume curves for normal subject. Upper panels: initial standing (left) and supine (right) curves. Middle panels: comparison of standing (solid lines) and supine (dashed lines) average flow‐volume curves obtained initially (left) and 3 mo later (right). Lower panels: comparison of standing (solid lines) and supine (dashed lines) slope ratios (SR) versus volume (V) plots obtained initially (left) and 3 mo later (right). , flow.

From Castile et al. 19


Figure 7.

Characteristic flow‐volume loops produced by major airway lesions. Fixed lesion resulted from fracture of larynx. Variable extrathoracic lesion was due to bilateral vocal cord paralysis. Variable intrathoracic pattern was produced by malignancy of trachea at carina.

From Hyatt and Black 53


Figure 8.

A: maximal expiratory flow‐volume curve (dashed curve) obtained from series of expiratory efforts, none of which represented an acceptable flow‐volume curve effort. Sequence was effort a (initiated from full inspiration) followed by effort b and then effort c. B: lower two‐thirds of maximal expiratory flow‐volume curve can be reliably estimated from a series of coughs initiated from full inspiration. For clarity flow transients have been filtered out.

From Hyatt and Black 53


Figure 9.

Maximal expiratory flow‐volume curves from patient with asthma. Patient was asymptomatic during control period. Symptoms including wheezing were induced by inhaling an extract of ragweed. Resulting change in lung mechanics is readily identified from maximal expiratory flow‐volume curves.

From Hyatt and Black 53
References
 1. Agostoni, E., and W. O. Fenn. Velocity of muscle shortening as a limiting factor in respiratory air flow. J. Appl. Physiol. 15: 349-353, 1960.
 2. Arkins, J. A., M. R. Glaser, and R. J. Trettel. The maximal expiratory flow rate of normal individuals. Dis. Chest 37: 496-498, 1960.
 3. Ashford, J. R., D. P. Duffield, and J. W. J. Fay. A search for simple combinations of F.E.V. (1 second) and F.V.C. independent of age and physique in coal miners. Ann. Occup. Hyg. 4: 68-81, 1961.
 4. Bashoff, M. A., R. H. Ingram, Jr., and D. P. Schilder. Effect of expiratory flow rate on the nitrogen concentration vs. volume relationship. J. Appl. Physiol. 23: 895-901, 1967.
 5. Bernstein, L., and D. Mendel. The accuracy of spirographic recording at high respiratory rates. Thorax 6: 297-309, 1951.
 6. Black, L. F., R. E. Hyatt, and S. E. Stubbs. Mechanism of expiratory airflow limitation in chronic obstructive pulmonary disease associated with alpha‐1‐antitrypsin deficiency. Am. Rev. Respir. Dis. 105: 891-899, 1972.
 7. Black, L. F., K. Offord, and R. E. Hyatt. Variability in the maximal expiratory flow volume curve in asymptomatic smokers and in nonsmokers. Am. Rev. Respir. Dis. 110: 282-292, 1974.
 8. Bouhuys, A., V. R. Hunt, B. M. Kim, and A. Zapletal. Maximum expiratory flow rates in induced bronchoconstriction in man. J. Clin. Invest. 48: 1159-1168, 1969.
 9. Brody, J. S., and B. N. Connell. Dietary protein deficiency and postnatal lung growth (Abstract). Federation Proc. 34: 934, 1975.
 10. Brody, J. S., S. Lahiri, M. Simpser, E. K. Motoyama, and T. Velasquez. Lung elasticity and airway dynamics in Peruvian natives to high altitude. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 245-251, 1977.
 11. Brown, P., D. Sadowsky, and D. C. Gajdusek. Ventilatory lung function studies in Pacific Island Micronesians. Am. J. Epidemiol. 108: 259-265, 1978.
 12. Bruce, E. N., and A. C. Jackson. Smoothing of MEFV curves by digital filtering of flow as a function of volume. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 202-206, 1980.
 13. Burki, N. K., and M. C. Dent. The forced expiratory time as a measure of small airway resistance. Clin. Sci. Mol. Med. 51: 53-58, 1976.
 14. Cander, L., and J. H. Comroe, Jr. A method for the objective evaluation of bronchodilator drugs. Effects of dapanone, isuprel, and aminophylline in patients with bronchial asthma. J. Allergy 26: 210-218, 1955.
 15. Caro, C. G., J. Butler, and A. B. DuBois. Some effects of restriction of chest cage expansion on pulmonary function in man: an experimental study. J. Clin. Invest. 39: 573-583, 1960.
 16. Caro, C. G., and A. B. DuBois. Pulmonary function in kyphoscoliosis. Thorax 16: 282-290, 1961.
 17. Carpenter, R. G., A. L. Cochrane, J. C. Gilson, and I. T. T. Higgins. The relationship between ventilatory capacity and simple pneumoconiosis in coal workers. The effect of population selection. Br. J. Ind. Med. 13: 166-176, 1956.
 18. Castile, R. G., R. E. Hyatt, and J. R. Rodarte. Determinants of maximal expiratory flow and density dependence in normal humans. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 897-904, 1980.
 19. Castile, R., J. Mead, A. Jackson, M. E. Wohl, and D. Stokes. Effects of posture on flow‐volume curve configuration in normal humans. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 53: 1175-1183, 1982.
 20. Celli, B. R., E. Lucey, and J. S. Brody. Physiological consequences of dysanaptic lung growth (Abstract). Federation Proc. 36: 469, 1977.
 21. Cherniack, R. M. Ventilatory function in normal children. Can. J. Med. 87: 80-81, 1962.
 22. Cotes, J. E. Lung Function: Assessment and Application in Medicine (4th ed.). Oxford, UK: Blackwell Scientific, 1979, p. 347-352.
 23. Dawson, S. V., and E. A. Elliott. Wave‐speed limitation on expiratory flow—a unifying concept. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 43: 498-515, 1977.
 24. Dayman, H. Mechanics of airflow in health and in emphysema. J. Clin. Invest. 30: 1175-1190, 1951.
 25. De Troyer, A., J.‐C. Yernault, M. Englert, D. Baran, and M. Paiva. Evolution of intrathoracic airway mechanics during lung growth. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 521-527, 1978.
 26. Dosman, J., F. Bode, J. Urbanetti, R. Martin, and P. T. Macklem. The use of a helium‐oxygen mixture during maximum expiratory flow to demonstrate obstruction in small airways in smokers. J. Clin. Invest. 55: 1090-1099, 1975.
 27. Duffell, G. M., J. H. Marcus, and R. H. Ingram, Jr. Limitation of expiratory flow in chronic obstructive pulmonary disease: relation of clinical characteristics, pathophysiological type, and mechanisms. Ann. Intern. Med. 72: 365-374, 1970.
 28. Elliott, E. A., and S. V. Dawson. Test of wave‐speed theory of flow limitation in elastic tubes. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 43: 516-522, 1977.
 29. Engstrom, I., F. E. Escardo, P. Karlberg, and S. Kraepelien. Respiratory studies in children. VI. Timed vital capacity in healthy children and in symptom‐free asthmatic children. Acta Paediatr. 48: 114-120, 1959.
 30. Femi‐Pearse, D., and E. A. Elebute. Ventilatory function in healthy adult Nigerians. Clin. Sci. 41: 203-211, 1971.
 31. Frank, N. R., M. O. Amdur, J. Worcester, and J. L. Whittenberger. Effects of acute controlled exposure to SO2 on respiratory mechanics in healthy male adults. J. Appl. Physiol. 17: 252-258, 1962.
 32. Franklin, W., and F. C. Lowell. The expiratory rate during the third quarter of a maximal forced expiration (E50-75). J. Allergy 32: 162-168, 1961.
 33. Fry, D. L. Theoretical considerations of the bronchial pressure‐flow‐volume relationships with particular reference to the maximum expiratory flow‐volume curve. Phys. Med. Biol. 3: 174-194, 1958.
 34. Fry, D. L. A preliminary lung model for simulating the aerodynamics of the bronchial tree. Comput. Biomed. Res. 2: 111-134, 1968.
 35. Fry, D. L., R. V. Ebert, W. W. Stead, and C. C. Brown. The mechanics of pulmonary ventilation in normal subjects and in patients with emphysema. Am. J. Med. 16: 80-97, 1954.
 36. Fry, D. L., and R. E. Hyatt. Pulmonary mechanics. A unified analysis of the relationship between pressure, volume and gasflow in the lungs of normal and diseased human subjects. Am. J. Med. 29: 672-689, 1960.
 37. Gaensler, E. A. Analysis of the ventilatory defect by timed capacity measurements. Am. Rev. Tuberc. 64: 256-278, 1951.
 38. Gamsu, G., D. B. Borson, W. R. Webb, and J. H. Cunningham. Structure and function in tracheal stenosis. Am. Rev. Respir. Dis. 121: 519-531, 1980.
 39. Gandevia, B. Normal standards for single breath tests of ventilatory capacity in children. Arch. Dis. Child. 35: 236-239, 1960.
 40. Goldsmith, J. R. A simple test of maximal expiratory flow for detecting ventilatory obstruction. Am. Rev. Tuberc. Pulm. Dis. 78: 180-190, 1958.
 41. Goldstein, D., and J. Mead. Use of magnetometers to volume‐reference flow‐volume curves. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 731-736, 1980.
 42. Grassino, A. E., and N. R. Anthonisen. Chest wall distortion and regional lung volume distribution in erect humans. J. Appl. Physiol. 39: 1004-1007, 1975.
 43. Green, M., and J. Mead. Time dependence of flow‐volume curves. J. Appl. Physiol. 37: 793-797, 1974.
 44. Green, M., J. Mead, and J. M. Turner. Variability of maximum expiratory flow‐volume curves. J. Appl. Physiol. 37: 67-74, 1974.
 45. Griffiths, D. J. Negative resistance effects in flow through collapsible tubes. Med. Biol. Eng. 13: 758-802, 1975.
 46. Hadorn, W. Über die Bestimmung des Exspirationsstosses (maximale Ausatmungsstromstärke). Z. Klin. Med. 140: 266-290, 1942.
 47. Higgins, I. T. T. Respiratory symptoms, bronchitis, and ventilatory capacity in random sample of an agricultural population. Br. Med. J. 2: 1198-1203, 1957.
 48. Hutcheon, M., P. Griffin, H. Levison, and N. Zamel. Volume of isoflow. A new test in detection of mild abnormalities of lung mechanics. Am. Rev. Respir. Dis. 110: 458-465, 1974.
 49. Hutchinson, J. On the capacity of lungs and on the respiratory function with view of establishing a precise and easy method of detecting diseases by spirometer. Trans. Med. Soc. London 29: 137-252, 1846.
 50. Hyatt, R. E. The interrelationships of pressure, flow and volume during various respiratory maneuvers in normal and emphysematous subjects. Am. Rev. Respir. Dis. 83: 676-683, 1961.
 51. Hyatt, R. E. Dynamic lung volumes. In: Handbook of Physiology. Respiration, edited by W. O. Fenn and H. Rahn. Washington, DC: Am. Physiol. Soc., 1965, sect. 3, vol. II, chapt. 54, p. 1381-1397.
 52. Hyatt, R. E. Effort independence and forced expiratory flow (Letter to the editor). Chest 77: 246-247, 1980.
 53. Hyatt, R. E., and L. F. Black. The flow‐volume curve. A current perspective. Am. Rev. Respir. Dis. 107: 191-199, 1973.
 54. Hyatt, R. E., and R. E. Flath. Relationship of air flow to pressure during maximal respiratory effort in man. J. Appl. Physiol. 21: 477-482, 1966.
 55. Hyatt, R. E., J. R. Rodarte, J. Mead, and T. A. Wilson. Changes in lung mechanics: flow‐volume relations. In: Lung Biology in Health and Disease. The Lung in the Transition Between Health and Disease, edited by P. T. Macklem and S. Permutt. New York: Dekker, 1979, vol. 12, p. 73-112.
 56. Hyatt, R. E., D. P. Schilder, and D. L. Fry. Relationship between maximum expiratory flow and degree of lung inflation. J. Appl. Physiol. 13: 331-336, 1958.
 57. Hyatt, R. E., T. A. Wilson, and E. Bar‐Yishay. Prediction of maximal expiratory flow in excised human lungs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 991-998, 1980.
 58. Ingram, R. H., Jr., and D. P. Schilder. Effect of gas compression on pulmonary pressure, flow, and volume relationship. J. Appl. Physiol. 21: 1821-1826, 1966.
 59. Jansen, J. M., R. Peslin, A. B. Bohadana, and J. L. Racineux. Usefulness of forced expiration slope ratios for detecting mild airway abnormalities. Am. Rev. Respir. Dis. 122: 221-230, 1980.
 60. Jones, J. G., R. B. Fraser, and J. A. Nadel. Prediction of maximum expiratory flow rate from area‐transmural pressure curve of compressed airway. J. Appl. Physiol. 38: 1002-1011, 1975.
 61. Jordanoglou, J., E. Koursouba, C. Lalenis, T. Gotsis, J. Kontos, and C. Gardikas. Effective time of the forced expiratory spirogram in health and airways obstruction. Thorax 34: 187-193, 1979.
 62. Knudson, R. J., M. D. Lebowitz, and B. Burrows. Effort independence and forced expiratory flow (Letter to the editor). Am. Rev. Respir. Dis. 122: 990-991, 1980.
 63. Knudson, R. J., J. Mead, M. D. Goldman, J. R. Schwaber, and M. E. Wohl. The failure of indirect indices of lung elastic recoil. Am. Rev. Respir. Dis. 107: 70-82, 1973.
 64. Knudson, R. J., J. Mead, and D. E. Knudson. Contribution of airway collapse to supramaximal expiratory flows. J. Appl. Physiol. 36: 653-667, 1974.
 65. Kory, R. C., R. Callahan, H. G. Boren, and J. C. Syner. The Veterans Administration‐Army cooperative study of pulmonary function. Am. J. Med. 30: 243-258, 1961.
 66. Lambert, R. K. The use of a computation model for expiratory flow to simulate the effects of two airway abnormalities. Aust. Physiol. Eng. Sci. Med. 4: 100-108, 1981.
 67. Lambert, R. K., and T. A. Wilson. A model for the elastic properties of the lung and their effect on expiratory flow. J. Appl. Physiol. 34: 34-48, 1973.
 68. Lambert, R. K., T. A. Wilson, R. E. Hyatt, and J. R. Rodarte. A computational model for expiratory flow. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 52: 44-56, 1982.
 69. Lapp, N. L., H. E. Amandus, R. Hall, and W. K. C. Morgan. Lung volumes and flow rates in black and white subjects. Thorax 29: 185-188, 1974.
 70. Lebowitz, M. D., R. J. Knudson, G. Robertson, and B. Burrows. Significance of intraindividual changes in maximum expiratory flow volume and peak expiratory flow measurements. Chest 81: 566-570, 1982.
 71. Leith, D. E., and J. Mead. Mechanisms determining residual volume of the lungs in normal subjects. J. Appl. Physiol. 23: 221-227, 1967.
 72. Lemen, R. J., C. B. Gerdes, M. J. Wegmann, and K. J. Perrin. Frequency spectra of flow and volume events for forced vital capacity. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 53: 977-984, 1982.
 73. Leuallen, E. C., and W. S. Fowler. Maximal midexpiratory flow. Am. Rev. Tuberc. Pulm. Dis. 72: 783-800, 1955.
 74. Li, K. Y., L. T. Tan, P. Chong, and J. A. Dosman. Between‐technician variation in the measurement of spirometry with air and helium. Am. Rev. Respir. Dis. 124: 196-198, 1981.
 75. Liang, A., A. E. Macfie, E. A. Harris, and R. M. L. Whitlock. Transit‐time analysis of the forced expiratory spirogram during clinical remission in juvenile asthma. Thorax 34: 194-199, 1979.
 76. Ligas, J. R., F. P. Primiano, Jr., G. M. Saidel, and C. F. Doershuk. Comparison of measures of forced expiration. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 607-613, 1977.
 77. Lockhart, W., D. H. Smith, A. Mair, and W. A. Wilson. Practical experience with the peak flow meter. Br. Med. J. 1: 37-38, 1960.
 78. Lyons, H. A., R. W. Tanner, and T. Picco. Pulmonary function studies in children. Am. J. Dis. Child. 100: 196-207, 1960.
 79. MacDonald, J. B., and T. J. Cole. The flow‐volume loop: reproducibility of air and helium‐based tests in normal subjects. Thorax 35: 64-69, 1980.
 80. Macklem, P. T., R. G. Fraser, and W. G. Brown. Bronchial pressure measurements in emphysema and bronchitis. J. Clin. Invest. 44: 897-905, 1965.
 81. Macklem, P. T., R. G. Fraser, and W. G. Brown. The detection of the flow‐limiting bronchi in bronchitis and emphysema by airway pressure measurements. Med. Thorac. 22: 220-230, 1965.
 82. Macklem, P. T., and J. Mead. Factors determining maximum expiratory flow in dogs. J. Appl. Physiol. 25: 159-169, 1968.
 83. Macklem, P. T., and N. J. Wilson. Measurement of intra‐bronchial pressure in man. J. Appl. Physiol. 20: 653-663, 1965.
 84. Malo, J. L., and P. Leblanc. Functional abnormalities in young asymptomatic smokers with special reference to flow volume curves breathing various gases. Am. Rev. Respir. Dis. 111: 623-629, 1975.
 85. March, H. W., and H. A. Lyons. A study of the maximal ventilatory flow rates in health and disease. Dis. Chest 37: 602-614, 1960.
 86. McCall, C. B., R. E. Hyatt, F. W. Noble, and D. L. Fry. Harmonic content of certain respiratory flow phenomena of normal individuals. J. Appl. Physiol. 10: 215-218, 1957.
 87. McDermott, M., and C. B. McKerrow. The effect of an external resistance on hyperventilation (Abstract). Proc. Int. Congr. Physiol. Sci., 20th, Brussels, 1956, p. 628.
 88. Mead, J. Analysis of the configuration of maximum expiratory flow‐volume curves. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 156-165, 1978.
 89. Mead, J. Dysanapsis in normal lungs assessed by the relationship between maximal flow, static recoil, and vital capacity. Am. Rev. Respir. Dis. 121: 339-342, 1980.
 90. Mead, J. Expiratory flow limitation: a physiologist's point of view. Federation Proc. 39: 2771-2775, 1980.
 91. Mead, J., T. Takishima, and D. Leith. Stress distribution in lungs: a model of pulmonary elasticity. J. Appl. Physiol. 28: 596-608, 1970.
 92. Mead, J., J. M. Turner, P. T. Macklem, and J. B. Little. Significance of the relationship between lung recoil and maximum expiratory flow. J. Appl. Physiol. 22: 95-108, 1967.
 93. Meadows, J. A., III, J. R. Rodarte, and R. E. Hyatt. Density dependence of maximal expiratory flow in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 121: 47-53, 1980.
 94. Melissinos, C. G., M. Goldman, E. Bruce, E. Elliott, and J. Mead. Chest wall shape during forced expiratory maneuvers. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 50: 84-93, 1981.
 95. Melissinos, C. G., and J. Mead. Maximum expiratory flow changes induced by longitudinal tension on trachea in normal subjects. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 43: 537-544, 1977.
 96. Melissinos, C. G., P. Webster, Y.‐K. Tien, and J. Mead. Time dependence of maximum flow as an index of nonuniform emptying. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 1043-1050, 1979.
 97. Miller, R. D., and R. E. Hyatt. Obstructing lesions of the larynx and trachea: clinical and physiologic charcteristics. Mayo Clin. Proc. 44: 145-161, 1969.
 98. Miller, R. D., and R. E. Hyatt. Evaluation of obstructing lesions of the trachea and larynx by flow‐volume loops. Am. Rev. Respir. Dis. 108: 475-481, 1973.
 99. Miller, W. F., R. L. Johnson, Jr., and N. Wu. Relationships between fast vital capacity and various timed expiratory capacities. J. Appl. Physiol. 14: 157-163, 1959.
 100. Mink, S. N., and L. D. H. Wood. How does HeO2 increase maximum expiratory flow in human lungs? J. Clin. Invest. 66: 720-729, 1980.
 101. Mink, S., M. Ziesmann, and L. D. H. Wood. Mechanisms of increased maximum expiratory flow during HeO2 breathing in dogs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 490-502, 1979.
 102. Morris, J. F., A. Koski, and L. C. Johnson. Spirometric standards for healthy nonsmoking adults. Am. Rev. Respir. Dis. 103: 57-67, 1971.
 103. Morris, J. F., W. P. Temple, and A. Koski. Normal values for the ratio of one‐second forced expiratory volume to forced vital capacity. Am. Rev. Respir. Dis. 108: 1000-1003, 1973.
 104. 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.
 105. Needham, C. D., M. C. Rogan, and I. McDonald. Normal standards for lung volumes, intrapulmonary gas‐mixing, and maximum breathing capacity. Thorax 9: 313-325, 1954.
 106. Neuburger, N., H. Levison, A. C. Bryan, and K. Kruger. Transit time analysis of the forced expiratory spirogram in growth. J. Appl. Physiol. 40: 329-332, 1976.
 107. Nickerson, B. G., R. J. Lemen, C. B. Gerdes, M. J. Wegmann, and G. Robertson. Within‐subject variability and per cent change for significance of spirometry in normal subjects and in patients with cystic fibrosis. Am. Rev. Respir. Dis. 122: 859-866, 1980.
 108. Olafsson, S., and R. E. Hyatt. Ventilatory mechanics and expiratory flow limitation during exercise in normal subjects. J. Clin. Invest. 48: 564-573, 1969.
 109. Olive, J. T., Jr., and R. E. Hyatt. Maximal expiratory flow and total respiratory resistance during induced bronchoconstriction in asthmatic subjects. Am. Rev. Respir. Dis. 106: 366-376, 1972.
 110. Oscherwitz, M., S. A. Edlavitch, T. R. Baker, and T. Larboe. Differences in pulmonary functions in various racial groups. Am. J. Epidemiol. 96: 319-327, 1972.
 111. Pardaens, J., K. P. Van de Woestijne, and J. Clément. A physical model of expiration. J. Appl. Physiol. 33: 479-490, 1972.
 112. Pedersen, O. F., B. Thiessen, and S. Lyager. Airway compliance and flow limitation during forced expiration in dogs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 52: 357-369, 1982.
 113. Pemberton, J., and E. G. Flanagan. Vital capacity and timed vital capacity in normal men over forty. J. Appl. Physiol. 9: 291-296, 1956.
 114. Permutt, S., and H. A. Menkes. Spirometry: analysis of forced expiration within the time domain. In: Lung Biology in Health and Disease. The Lung in the Transition Between Health and Disease, edited by P. T. Macklem and S. Permutt. New York: Dekker, 1979, vol. 12, p. 113-152.
 115. Peslin, R., A. Bohadana, B. Hannhart, and P. Jardin. Comparison of various methods for reading maximal expiratory flow‐volume curves. Am. Rev. Respir. Dis. 119: 271-277, 1979.
 116. Pimmel, R. L., M. J. Tsai, and J. F. Donohue. Forced expiratory spirometric parameters derived by feature‐extraction techniques. Am. Rev. Respir. Dis. 120: 1245-1250, 1979.
 117. Potter, W. A., S. Olafsson, and R. E. Hyatt. Ventilatory mechanics and expiratory flow limitation during exercise in patients with obstructive lung disease. J. Clin. Invest. 50: 910-919, 1971.
 118. Pride, N. B., S. Permutt, R. L. Riley, and B. Bromberger‐Barnea. Determinants of maximal expiratory flow from the lungs. J. Appl. Physiol. 23: 646-662, 1967.
 119. Racineux, J. L., R. Peslin, and B. Hannhart. Sensitivity of forced expiration indices to induced changes in peripheral airway resistance. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 50: 15-20, 1981.
 120. Reynolds, D. B., and J.‐S. Lee. Modeling study of the pressure‐flow relationship of the bronchial tree (Abstract). Federation Proc. 38: 1444, 1979.
 121. 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.
 122. Ruff, F., R. R. Martin, and J. Milic‐Emili. Previous volume history of the lung and regional distribution of residual volume. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 313-316, 1981.
 123. Sasaki, H., T. Takishima, and T. Sasaki. Influence of lung parenchyma on dynamic bronchial collapsibility of excised dog lungs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 699-705, 1977.
 124. Schilder, D. P., A. Roberts, and D. L. Fry. Effect of gas density and viscosity on the maximal expiratory flow‐volume relationships. J. Clin. Invest. 42: 1705-1713, 1963.
 125. Schoenberg, J. B., G. J. Beck, and A. Bouhuys. Growth and decay of pulmonary function in healthy blacks and whites. Respir. Physiol. 33: 367-393, 1978.
 126. Segall, J. J., and B. A. Butterworth. The maximal mid‐expiratory flow time. Br. J. Dis. Chest 62: 139-146, 1968.
 127. Selby, T., and J. Read. Maximal expiratory flow rates in Australian adults. Australas. Ann. Med. 10: 49-51, 1961.
 128. Seltzer, C. C., A. B. Siegelaub, D. G. Friedman, and M. F. Collen. Differences in pulmonary function related to smoking habits and race. Am. Rev. Respir. Dis. 110: 598-608, 1974.
 129. Shapiro, A. H. Steady flow in collapsible tubes. J. Biomech. Eng. 99: 126-147, 1977.
 130. Sharp, J. T., N. B. Goldberg, W. S. Druz, and J. Danon. Relative contributions of rib cage and abdomen to breathing in normal subjects. J. Appl. Physiol. 39: 608-618, 1975.
 131. Shephard, R. J. Some observations on peak expiratory flow. Thorax 17: 39-48, 1962.
 132. Siafakas, N. M., A. J. R. Morris, and M. Green. Thoracoabdominal mechanics during relaxed and forced vital capacity. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 38-42, 1979.
 133. Sidor, R., and J. M. Peters. Differences in ventilatory capacity of Irish and Italian fire fighters. Am. Rev. Respir. Dis. 108: 669-671, 1973.
 134. Snowbird workshop on standardization of spirometry: a statement by the American Thoracic Society. Am. Rev. Respir. Dis. 119: 831-838, 1979.
 135. Staats, B. A., T. A. Wilson, S. J. Lai‐Fook, J. R. Rodarte, and R. E. Hyatt. Viscosity and density dependence during maximal flow in man. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 48: 313-319, 1980.
 136. Strang, L. B. The ventilatory capacity of normal children. Thorax 14: 305-310, 1959.
 137. Stubbs, S. E., and R. E. Hyatt. Effect of increased lung recoil pressure on maximal expiratory flow in normal subjects. J. Appl. Physiol. 32: 325-331, 1972.
 138. Takishima, T., G. Grimby, W. Graham, R. Knudson, P. T. Macklem, and J. Mead. Flow‐volume curves during quiet breathing, maximum voluntary ventilation, and forced vital capacities in patients with obstructive lung disease. Scand. J. Respir. Dis. 48: 384-393, 1967.
 139. Tien, Y.‐K., E. A. Elliott, and J. Mead. Variability of the configuration of maximum expiratory flow‐volume curves. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 46: 565-570, 1979.
 140. Tiffeneau, R., and Pinelli. Air circulant et air captif dans l'exploration de la fonction ventilatrice pulmonaire. Paris Med. 133: 624-628, 1947.
 141. Tinker, C. M. Peak expiratory flow measured by the Wright peak flow meter. Distribution of values in men aged 30-59 who denied respiratory symptoms. Br. Med. J. 1: 1365-1366, 1961.
 142. Tockman, M., H. Menkes, B. Cohen, S. Permutt, J. Benjamin, W. C. Ball, Jr., and J. Tonascia. A comparison of pulmonary function in male smokers and nonsmokers. Am. Rev. Respir. Dis. 114: 711-722, 1976.
 143. Webster, P. M., S. H. Loring, J. P. Butler, and F. G. Hoppin, Jr. Lung recoil during rapid vital capacity expirations simulated by gas compression. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 142-149, 1980.
 144. Weibel, E. R. Morphometry of the Human Lung. New York: Academic, 1963, p. 110-143.
 145. Wellman, J. J., R. Brown, R. H. Ingram, Jr., J. Mead, and E. R. McFadden, Jr. Effect of volume history on successive partial expiratory flow‐volume maneuvers. J. Appl. Physiol. 41: 153-158, 1976.
 146. Wells, H. S., W. W. Stead, T. D. Rossing, and J. Ognanovich. Accuracy of an improved spirometer for recording of fast breathing. J. Appl. Physiol. 14: 451-454, 1959.
 147. Williams, D. E., R. D. Miller, and W. F. Taylor. Pulmonary function studies in healthy Pakistani adults. Thorax 37: 243-249, 1978.
 148. Wilson, T. A. Modeling the effect of axial bronchial tension on expiratory flow. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 45: 659-665, 1978.
 149. Wilson, T. A., R. E. Hyatt, and J. R. Rodarte. The mechanisms that limit expiratory flow. Lung 158: 193-200, 1980.
 150. Wood, L. D. H., and A. C. Bryan. Effect of increased ambient pressure on flow‐volume curve of the lung. J. Appl. Physiol. 27: 4-8, 1969.
 151. Wright, B. M. A miniature Wright peak‐flow meter. Br. Med. J. 2: 1627-1628, 1978.
 152. Wright, B. M., and C. B. McKerrow. Maximum forced expiratory flow rate as a measure of ventilatory capacity. With a description of a new portable instrument for measuring it. Br. Med. J. 2: 1041-1047, 1959.
 153. Zamel, N., I. Kass, and G. J. Fleischli. Relative sensitivity of maximal expiratory flow‐volume curves using spirometer versus body plethysmograph to detect mild airway obstruction. Am. Rev. Respir. Dis. 107: 861-863, 1973.

Contact Editor

Submit a note to the editor about this article by filling in the form below.

* Required Field

Article Title: Forced Expiration
 

How to Cite

Robert E. Hyatt. Forced Expiration. Compr Physiol 2011, Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing: 295-314. First published in print 1986. doi: 10.1002/cphy.cp030319