[Failure of static pulmonary volume measurements in mucoviscidosis]

With worsening of bronchial obstruction during the course of cystic fibrosis the functional residual capacity (CRF) measured by plethysmography increases progressively. The difference between values of CRF obtained by plethysmography or by Helium dilution increases even more. The difference between the two methods (for CRF) is supposed to show the volume of "trapped"' gas. A similar outcome, although less marked, is observed after physiotherapy. The extent of pulmonary distention and gas trapping is markedly overestimated by plethysmographic measurements, when one considers the anatomical and radiological anomalies. It was recently suggested that the rise in compliance of the walls of the extra-thoracic airways in the presence of bronchial obstruction may lead to an over-estimation of the pulmonary volumes measured by plethysmography. This may be the case during the course of mucoviscidosis, when repeated infections lead to a destruction of the bronchial walls. However, this anomaly does not explain this rise in CRF after mucolytic treatment and postural drainage. The CRF seems to reflect not only the volume of trapper gas in the lung, but equally the failure to equalize the interior pressures of the obstructed airways. In order to appreciate the effects of respiratory physiotherapy, different methods of measuring pulmonary volumes are necessary but the interpretation of the results take account of the complex meterology.