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A simple method to detect expiratory flow limitation during spontaneous breathing

N G Koulouris1, P Valta, A Lavoie

  • 1Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.

The European Respiratory Journal
|February 1, 1995
PubMed
Summary

A new negative expiratory pressure (NEP) technique simplifies detecting expiratory flow limitation in chronic obstructive pulmonary disease (COPD) patients. This method is reliable and doesn't require patient cooperation or specialized equipment, showing high prevalence in COPD.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Expiratory flow limitation at rest is common in severe COPD.
  • Traditional methods require specialized equipment like body plethysmographs and patient cooperation.

Purpose of the Study:

  • To introduce and validate a simple negative expiratory pressure (NEP) technique for detecting expiratory flow limitation.
  • To assess the prevalence of flow limitation in COPD patients using the NEP technique in different positions.

Main Methods:

  • Applied negative pressure at the mouth during tidal expiration (NEP) in 26 stable COPD patients.
  • Assessed flow limitation based on whether NEP increased expiratory flow.
  • Studied patients in both sitting and supine positions.

Main Results:

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  • The NEP technique successfully identified expiratory flow limitation without requiring patient cooperation or body plethysmography.
  • Flow limitation was detected in 19 of 26 COPD patients, particularly when in the supine position.
  • Severe ventilatory impairment (FEV1 < 40%) was present in only 5 of the 19 flow-limited patients.

Conclusions:

  • The NEP technique is a simple, rapid, and reliable method for detecting expiratory flow limitation in spontaneously breathing individuals.
  • This method is applicable across different body positions and can be used at rest and during exercise.
  • A high prevalence of expiratory flow limitation exists in COPD patients at rest, especially when supine.