Determinants of maximal expiratory flow and density dependence in normal humans

There is a large variability in maximal expiratory flow (V) and density dependence (DD) in normal humans. Lung mechanics and flow-volume curves were obtained in 40 normal males while they breathed air or helium-oxygen (80%-20%). Static lung recoil (Pst) at 50% vital capacity, total lung capacity, and pulmonary resistance each correlated (P < 0.05) with airflow at 50% vital capacity. The relationship of V and Pst was described by Pst = 1/2 p V2/A2 + RV, where p is gas density, A is the critical area at the flow-limiting site, and R is peripheral resistance. At constant Pst and R, this simplified equation predicts an inverse relation between DD and airflow, which was found at recoil pressures of 8 and 7 cmH2O (P < 0.05). If peripheral losses are small, subjects with smaller flow-limiting airways would have lower airflows but higher DD than subjects with larger airways. Our findings are consistent with concept of dysanaptic growth and suggest that the central airways play a significant role in determining V and DD in normal humans.