Flow Limitation and its Determination

  • W. A. Zin
  • V. R. Cagido


During expiration, there is a maximum limit to the gas flow rate that can be achieved; once this limit is attained, greater muscular effort does not further augment flow. This phenomenon, known as expiratory flow limitation (EFL), has been identified from flow-volume curves. The key documentation was made by Fry and co-workers [1,2], who identified EFL from iso-volume pressure-flow relationships. To obtain such curves, flow, volume and oesophageal pressure (i.e. pleural pressure) were simultaneously measured in subjects seated in a volume displacement plethysmograph, which corrects for gas compression. The subjects were instructed to perform repeated vital capacity manoeuvres with varying amounts of effort. The highest flow obtained at each lung volume was then plotted against pleural pressure, as shown in Fig. 1 (left). It can be seen that at high lung volumes (e.g. 90% of vital capacity) expiratory flow is not limited; however, at volumes <80–85%, vital capacity plateaus occur, indicating maximum flow limitation. A maximum expiratory flow-volume curve (Fig. 1, right) can be easily constructed from the iso-volume flow-pressure curves depicted in the left panel of Fig. 1. After peak flow is achieved, flow decreases with volume but it always reflects the maximum attainable flow at that particular lung volume. If the expiratory flow generated during tidal respiration represents the maximal possible flow someone can generate at that volume, this subject is said to be flow limited [3].


Flow Limitation Transmural Pressure Pleural Pressure Forced Oscillation Technique Maximal Expiratory Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fry DL, Ebert RV, Stead WW et al (1954) The mechanics of pulmonary ventilation in normal subjects and in patients with emphysema. Am J Med 16:80–97PubMedCrossRefGoogle Scholar
  2. 2.
    Fry DL, Hyatt RE (1960) Pulmonary mechanics: a unified analysis of the relationship between pressure, volume and gas flow in the lungs of normal and diseased human subjects. Am J Med 29:672–689PubMedCrossRefGoogle Scholar
  3. 3.
    O’Donnell DE, Parker CM (2006) COPD exacerbations 3: pathophysiology. Thorax 61:354–361PubMedCrossRefGoogle Scholar
  4. 4.
    Dayman H (1951) Mechanics of airflow in health and in emphysema. J Clin Invest 30:1175–1190PubMedCrossRefGoogle Scholar
  5. 5.
    Fry DL (1958) Theoretical considerations of the bronchial pressure-flow-volume relationships with particular reference to the maximum expiratory flow-volume curve. Phys Med Biol 3:174–194PubMedCrossRefGoogle Scholar
  6. 6.
    Mead J, Turner JM, Macklem PT et al (1967) Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol 22:95–108PubMedGoogle Scholar
  7. 7.
    Pride NB, Permutt S, Riley RL et al (1967) Determinants of maximal expiratory flow from the lungs. J Appl Physiol 23:646–662PubMedGoogle Scholar
  8. 8.
    Olafsson S, Hyatt RE (1969) Ventilatory mechanics and expiratory flow limitation during exercise in normal subjects. J Clin Invest 48:564–573PubMedGoogle Scholar
  9. 9.
    Guenette JA, Sheel AW (2007). Physiological consequences of a high work of breathing during exercise in humans. J Sci Med Sport [Epub ahead of printing, doi:10.1016/j.jsams.2007.02.003]Google Scholar
  10. 10.
    Dawson SV, Elliott EA (1977) Wave-speed limitation on expiratory flow-a unifying concept. J Appl Physiol 43:498–515PubMedGoogle Scholar
  11. 11.
    Shapiro AH (1977) Steady flow in collapsible tubes. J Biomech Eng 99:126–147Google Scholar
  12. 12.
    Polak AG (2007) A model-based method for flow limitation analysis in the heterogeneous human lung. Comput Methods Pograms Biomed [Epub ahead of printing, doi:10.1016/j.cmpb.2007.03.009]Google Scholar
  13. 13.
    Hyatt RE (1983) Expiratory flow limitation. J Appl Physiol 55:1–8PubMedGoogle Scholar
  14. 14.
    Fry DL (1968) A preliminary model for simulating the aerodynamics of the bronchial tree. Comput Biomed Res 2:111–134PubMedCrossRefGoogle Scholar
  15. 15.
    Lambert RK, Wilson TA (1973) A model for the elastic properties of the lung and their effect on expiratory flow. J Appl Physiol 34:34–48PubMedGoogle Scholar
  16. 16.
    Pardaens J, Van de Woestijne KP, Clement J (1972) A physical model of expiration. J Appl Physiol 33:4790–5490Google Scholar
  17. 17.
    Pedersen OF, Thiessen B, Lyager S (1982) Airway compliance and flow limitation during forced expiration in dogs. J Appl Physiol 52:357–369PubMedGoogle Scholar
  18. 18.
    Hyatt RE, Wilson TA, Bar-Yishay E (1980) Prediction of maximal expiratory flow in excised human lungs. J Appl Physiol 48:991–998PubMedGoogle Scholar
  19. 19.
    Elliot EA, Dawson SV (1977) Test of wave-speed theory of flow limitation in elastic tubes. J Appl Physiol 43:516–522Google Scholar
  20. 20.
    Pellegrino R, Brusasco V (1997) On the causes of lung hyperinflation during bronchoconstriction. Eur Respir J 10:468–475PubMedCrossRefGoogle Scholar
  21. 21.
    Mead J (1980) Expiratory flow limitation: a physiologist’s point of view. Fed Proc 39:2771–2775PubMedGoogle Scholar
  22. 22.
    Hyatt RE (1961) The interrelationship of pressure, flow and volume during various respiratory maneuvers in normal and emphysematous patients. Am Rev Respir Dis 83:676–683PubMedGoogle Scholar
  23. 23.
    Potter WA, Olafsson S, Hyatt R (1971) Ventilatory mechanics and expiratory flow limitation during exercise in patients with obstructive lung disease. J Clin Invest 50:910–919PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson BD, Beck KC, Zeballos et al (1999) Advances in pulmonary laboratory testing. Chest 116(5): 1377–1387PubMedCrossRefGoogle Scholar
  25. 25.
    Ingram RH Jr, Schilder DP (1966) Effect of gas compression on pulmonary pressure, flow, and volume relationship. J Appl Physiol 21:1821–1826PubMedGoogle Scholar
  26. 26.
    Fairshter RD (1985) Airway hysteresis in normal subjects and individuals with chronic air-flow obstruction. J Appl Physiol 58:1505–1510PubMedCrossRefGoogle Scholar
  27. 27.
    Melissinos CG, Webster P, Tien YK et al (1979) Time dependence of maximum flow as an index of nonuniform emptying. J Appl Physiol 47:1043–1050PubMedGoogle Scholar
  28. 28.
    D’Angelo E, Prandi E, Marazzini L et al (1994) Dependence of maximal flow-volume curves on time course of preceding inspiration in patients with chronic obstructive lung disease. Am J Respir Crit Care Med 150:1581–1586PubMedGoogle Scholar
  29. 29.
    Valta P, Corbeil C, Lavoie A et al (1994) Detection of expiratory flow limitation during mechanical ventilation. Am J Respir Crit Care Med 150:1311–1317PubMedGoogle Scholar
  30. 30.
    Koulouris NG, Valta P, Lavoie A et al (1995) A simple method to detect expiratory flow limitation during spontaneous breathing. Eur Respir J 8:306–313PubMedCrossRefGoogle Scholar
  31. 31.
    Koulouris NG, Dimopoulou I, Valta P et al (1997) Detection of expiratory flow limitation during exercise in COPD patients. J Appl Physiol 82:723–731PubMedGoogle Scholar
  32. 32.
    Murciano D, Pichot M-H, Boczkowski J et al (1997) Expiratory flow limitation in COPD patients after single lung transplantation. Am J Respir Crit Care Med 155:1036–1041PubMedGoogle Scholar
  33. 33.
    Boczkowski J, Murciano D, Pichot MH et al (1997) Expiratory flow limitation in stable asthmatic patients during resting breathing. Am J Respir Crit Care Med 156(3Ptl):752–757PubMedGoogle Scholar
  34. 34.
    Baydur A, Milic-Emili J (1997) Expiratory flow limitation during spontaneous breathing: comparison of patients with restrictive and obstructive respiratory disorders. Chest 112:1017–1023PubMedCrossRefGoogle Scholar
  35. 35.
    Tauber E, Fazekas T, Eichler I et al (2003) Negative expiratory pressure: a new tool for evaluating lung function in children? Pediatr Pulmonol 35:162–168PubMedCrossRefGoogle Scholar
  36. 36.
    Vanpee D, Swine CH, Delwich JP, Delanois L (2002) Evaluation of flow limitation in elderly patients unable to perform a forced expiratory maneuver. Aging Clin Exp Res 14:208–211PubMedGoogle Scholar
  37. 37.
    Eltayara L, Becklake MR, Volta CA et al (1996) Relationship between chronic dyspnea and expiratory flow limitation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 154:1726–1734PubMedGoogle Scholar
  38. 38.
    Volta CA, Ploysongsang Y, Eltayara L et al (1996) A simple method to monitor performance of forced vital capacity. J Appl Physiol 80:693–698PubMedGoogle Scholar
  39. 39.
    Tantucci C, Duguet A, Ferretti A et al (1999) Effect of negative expiratory flow limitation on respiratory system flow resistence in awake snorers and nonsnorers. J Appl Physiol 87:969–976PubMedGoogle Scholar
  40. 40.
    Baydur A, Wilkinson L, Mehdian R et al (2004) Extrathoracic expiratory flow limitation in obesity and obstructive and restrictive disorders: effects of increasing negative expiratory pressure. Chest 35:162–168Google Scholar
  41. 41.
    Ninane V, Leduc D, Kafi SA et al (2001) Detection of expiratory flow limitation by manual compression of the abdominal wall. Am J Respir Crit Care Med 163:1326–1330PubMedGoogle Scholar
  42. 42.
    Calverley PM, Koulouris NG (2005) Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J 25(1):186–199PubMedCrossRefGoogle Scholar
  43. 43.
    Dellaca RL, Santus P, Aliverti A et al (2004) Detection of expiratory flow limitation in COPD using the forced oscillation technique. Eur Respir J 23:232–340PubMedCrossRefGoogle Scholar
  44. 44.
    Weibel ER (1963) Morphometry of human lung. Springer Verlag, Heidelberg-BerlinGoogle Scholar
  45. 45.
    Horsfield K, Dart G, Olso DE et al (1971) Models of the human bronchial tree. J Appl Physiol 31:207–217PubMedGoogle Scholar
  46. 46.
    Barbini P, Brighenti C, Cevenini G et al (2005) A dynamic morphometric model of the normal lung for studying expiratory flow limitation in mechanical ventilation. Ann Biomed Eng 33:518–530PubMedCrossRefGoogle Scholar
  47. 47.
    Polak AG, Mroczka J (2006) Nonlinear model for mechanical ventilation of human lungs. Comput Biol Med 36:41–58PubMedCrossRefGoogle Scholar
  48. 48.
    Barbini P, Brighenti C, Gnudi G (2006) A simulation study of expiratory flow limitation in obstructive patients during mechanical ventilation. Ann Biomed Eng 4:1879–1889CrossRefGoogle Scholar
  49. 49.
    Brighenti C, Barbini P, Gnudi G et al (2007) Helium-oxygen ventilation in the presence of expiratory flow-limitation: a model study. Respir Physiol Neurobiol 157:326–334PubMedCrossRefGoogle Scholar
  50. 50.
    Liu CH, Niranjan SC, Clark Jr et al (1998). Airway mechanics, gas exchange, and blood flow in a nonlinear model of the normal human lung. J Appl Physiol 84:1447–1469PubMedGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • W. A. Zin
    • 1
  • V. R. Cagido
    • 1
  1. 1.Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil

Personalised recommendations