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Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 896-904

Central Airways Behave More Stiffly during Forced Expiration in Patients with Asthma

HEIN J. L. BRACKEL, OLE F. PEDERSEN, PAUL G. H. MULDER, SHELLEY E. OVERBEEK, KAREL F. KERREBIJN, and JAN M. BOGAARD

Department of Pediatric Pulmonology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht; Departments of Epidemiology and Biostatistics, Pulmonary Diseases, and Pediatric Pulmonology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; and Department of Environmental and Occupational Medicine, University of Aarhus, Aarhus, Denmark

Chronic inflammation and extracellular remodeling of the airway wall characterize asthma. The purpose of this study was to examine whether these features cause a change in airway mechanical properties. We examined 14 healthy and 10 young adults with long-lasting asthma, the latter treated with inhaled bronchodilators and corticosteroids. To obtain area-versus-transmural pressure (A-Ptm) curves during forced expiration (Pedersen, O. F., et al. J. Appl. Physiol. 1982;52:357-369), we used an esophageal balloon and a Pitot static probe positioned at five locations between the right lower lobe and midtrachea. Cross-sectional area (A), airway compliance (Caw = dA/dPtm), and specific airway compliance (sCaw = Caw/A) were obtained from the A-Ptm curves. Results showed that: (1) A was larger in males than in females; (2) Caw and sCaw decreased with a more downstream position; and (3) Caw and sCaw were significantly lower in the patients with asthma, with the differences between the asthmatic patients and the healthy subjects becoming smaller toward the trachea. The lower Caw and sCaw in the patients with long-lasting asthma support the concept that chronic inflammation and remodeling of the airway wall may result in stiffer dynamic elastic properties of the asthmatic airway.




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