Chest wall hyperinflation during acute bronchoconstriction in asthma

Massimo Gorini, Iacopo Iandelli, Gianni Misuri, Francesco Bertoli, Mario Filippelli, Marco Mancini, Roberto Duranti, Francesco Gigliotti, Giorgio Scano

Research output: Contribution to journalArticlepeer-review

Abstract

The mechanics of the chest wall was studied in seven asthmatic patients before and during histamine-induced bronchoconstriction (B). The volume of the chest wall (VCW) was calculated by three-dimensional tracking of 89 chest wall markers. Pleural (PpI) and gastric (Pga) pressures were simultaneously recorded. VCW was modeled as the sum of the volumes of the pulmonary-apposed rib cage (VRC,p), diaphragm-apposed rib cage (VRC,a), and abdomen (VAB). During B, hyperinflation was due to the increase in end-expiratory volume of the rib cage (0.63 ± 0.09 L, p <0.01), whereas change in VAB was inconsistent (0.09 ± 0.07 L, NS) because of phasic recruitment of abdominal muscles during expiration. Changes in end-expiratory VRC,p and VRC,a) were along the rib cage relaxation configuration, indicating that both compartments shared proportionally the hyperinflation. VRC,p-PpI plot during B was displaced leftward of the relaxation curve, suggesting persistent activity of rib cage inspiratory muscles throughout expiration. Changes in end-expiratory VCW during B did not relate to changes in FEV1 or time and volume components of the breathing cycle. We concluded that during B in asthmatic patients: (1) rib cage accounts largely for the volume of hyperinflation, whereas abdominal muscle recruitment during expiration limits the increase in VAB; (2) hyperinflation is influenced by sustained postinspiratory activity of the inspiratory muscles; (3) this pattern of respiratory muscle recruitment seems to minimize volume distortion of the rib cage at end-expiration and to preserve diaphragm length despite hyperinflation.

Original languageEnglish
Pages (from-to)808-816
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume160
Issue number3
Publication statusPublished - 1999

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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