Non-uniform lung elastic properties and the slope of the alveolar plateau

Dispersion of elastic properties within the lungs may contribute to the creation of a sloping alveolar plateau of the single-breath N2 washout curve. In this study we have systematically explored the behaviour of a simple two-compartment lung model with non-uniform pressure-volume characteristics. The inhomogeneity was expressed in terms of the ratio between the shape constants (k1/k2) of the compartmental pressure-volume curves and the ratio between compartmental RV/TLC (R-RV/TLC). The model simulations indicate that normal slope magnitudes can be achieved with a moderate degree of inhomogeneity (k1/k2 and R-RV/TLV = 2). The model simulations also show that a phase II-like shape of the curve--of non dead space origin--may occur and furthermore that single-breath TLC determinations increasingly underestimate true TLC as the R-RV/TLC deviates from unity. For a given degree of inhomogeneity, the model predicts the slope to increase with overall RV/TLC and k but decrease with TLC. The relations between these overall factors and the slope of phase III are also found in a patient group, where these factors explain approximately 61% of the slope variance.