Effect of lung volume and intrathoracic pressure on airway mucosal blood flow in man

We have recently described an inert soluble gas uptake technique (using dimethyl-ether, DME) for the non-invasive measurement of airway mucosal blood flow (Qaw) in humans. In the present study, we assessed the effects of lung volume and intrathoracic pressure on Qaw, in healthy non-smokers (age range 19-52 years). Qaw was calculated from the steady-state uptake of DME from a 50 ml segment of the anatomic dead space. The mean (+/- SD) Qaw of three consecutive measurements at a lung volume of FRC + 300 ml was 8.3 +/- 2.3, 8.6 +/- 2.6 and 8.3 +/- 2.7 ml.min-1 (n = 13; coefficient of variation 14 +/- 7%). At zero airway pressure, there was an inverse relationship between apparent Qaw on the one hand and lung volume and anatomic dead space (DS) on the other: mean Qaw was 12.2 +/- 5.3, 8.2 +/- 2.5 and 5.3 +/- 2.2 ml.min-1 at RV + 300 ml (DS = 131 +/- 11 ml), FRC + 300 ml (DS = 153 +/- 12 ml) and TLC (DS = 206 +/- 22 ml) positions, respectively (n = 11; P < 0.05 among all three). At a lung volume of FRC + 300 ml, an increase in intrathoracic pressure to +25 cmH2O (modified Valsalva maneuver) decreased mean Qaw to 3.3 +/- 2.8 ml.min-1 while a decrease in intrathoracic pressure to -35 cmH2O (modified Müller maneuver) increased mean Qaw to 17.1 +/- 7.4 ml.min-1 from a control value of 7.2 +/- 2.2 ml.min-1 (n = 7; P < 0.05 among all three). These results indicate that lung volume has an effect on apparent Qaw, presumably by influencing the depth to which the analyzed anatomical dead space segment extends into the bronchial tree. The results also show that changes in intrathoracic pressure alter Qaw, possibly reflecting concomitant changes in left ventricular output and its distribution to intrathoracic and extrathoracic vascular beds.