Influence of head-dependent positions on lung volume and oxygen saturation in chronic air-flow obstruction

We investigated the influence of head-dependent positions upon functional residual capacity (FRC) and arterial oxygen saturation in 25 patients with clinically stable chronic air-flow obstruction and 25 normal subjects. Lung volume was measured by gas dilution in normal subjects and by plethysmography in patients with chronic obstructive pulmonary disease (COPD). Arterial oxygen saturation was determined by ear oximetry. In normal subjects, sitting FRC declined by 29.9% when a horizontal-supine posture was assumed, but underwent little further change as the supine subject was tilted head-downward to -25 degrees. Lateral decubitus positions caused declines from sitting FRC of 17.1% at 0 degrees, and 27.4% at -25 degrees. In contrast, patients with COPD experienced negligible changes in lung volume as position was varied. The mean falls from sitting FRC were 3.5% and 1.9% in the 0 degree supine and 0 degree lateral decubitus postures, respectively, and little further volume loss occurred in head-dependency. Eight patients actually increased FRC when recumbent. Positional lung volume changes measured by gas dilution exceeded those measured by plethysmography, suggesting that increased air trapping helped to maintain FRC as position was altered. Patients with COPD did not desaturate in any position tested. We conclude that patients with advanced COPD conserve lung volume and do not desaturate when tipped into head-dependent positions. Reduction of FRC is unlikely to contribute to the hypoxemia or dyspnea previously reported to occur in these patients during chest physiotherapy.