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Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1573-1577

Conductive and Acinar Lung-zone Contributions to Ventilation Inhomogeneity in COPD

SYLVIA VERBANCK, DANIEL SCHUERMANS, ALAIN VAN MUYLEM, CHRISTIAN MELOT, MARC NOPPEN, WALTER VINCKEN, and MANUEL PAIVA

AZ-VUB, Brussels; Erasmus Hospital, Brussels; and Biomedical Physics Laboratory-ULB, Brussels, Belgium

We investigated ventilation inhomogeneity in patients with chronic obstructive pulmonary disease (COPD) through use of the multiple breath N2 washout test (MBW). From an alveolar slope analysis throughout the MBW, we derived two indices, Scond and Sacin , as a measure of ventilation inhomogeneity in conductive and acinar zones of the lungs, respectively ( J. Appl. Physiol. 1997;83:1807-1816). We evaluated the relationship of Scond and Sacin to standard lung-function indices by means of a principal-components factor analysis, which linked correlated indices to independent factors accounting for 81% of the total variance within the COPD group. Sacin was linked to the so-called acinar lung-zone factor, which also comprises diffusion capacity measurements. Scond was linked to the so-called conductive lung-zone factor, which also comprises specific airway conductance (SGaw) and forced expiratory flows. FEV1 divided by FVC (FEV1/FVC) was the only variable linked to both the conductive and the acinar lung-zone factors. The fact that Scond and Sacin were linked to independent factors provides statistical confirmation of the hypothesis that Scond and Sacin reflect independent lung alterations, whereas FEV1/FVC behavior indicates a combined conductive and acinar contribution to airways obstruction.




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