Pathophysiology of Flow Limitation

  • W. A. Zin
Conference paper


It has long been acknowledged that there is a maximum limit to the gas flow rate that can be achieved during expiration. Once this limit is attained, greater muscular effort does not further augment flow. The key documentation of what is nowadays named expiratory flow limitation was made by Fry and coworkers [1, 2], and was derived from isovolume 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 plethysmograph, which corrects for gas compression. They were instructed to perform repeated vital capacity manoeuvres with varying amounts of effort. From these data, it is possible to plot flow against pleural pressure at any given lung volume, as shown in Fig. 1 (left). It can be noticed that at high lung volumes (e.g., 90% of the vital capacity) expiratory flow is not limited. However, at volumes below 80-85% vital capacity plateaus are present, indicating maximum flow limitation. A maximum expiratory flow-volume curve (Fig. 1, right) can be easily constructed from the isovolume flow-pressure curves depicted in the left panel of Fig. 1. After peak flow is achieved flow decreases with volume but is always the maximum attainable flow at that particular lung volume.


Flow Limitation Transmural Pressure Pleural Pressure Expiratory Flow Limitation Maximal Expiratory Flow 
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© Springer-Verlag Italia, Milano 1998

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  • W. A. Zin

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