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The Best Peak Expiratory Flow Is Flow-Limited and Effort-Independent in Normal Subjects

Clinica di Medicina Interna, Università di Brescia, Brescia, Italy; Laboratoire de Physio-Pathologie Respiratoire et Service de Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, University of Paris VI, Paris, France; and Divisione di Pneumologia, Azienda Ospedaliera di Imola, Bologna, Italy

Correspondence and requests for reprints should be addressed to Claudio Tantucci, M.D., Clinica di Medicina Interna I, Università di Brescia, Spedali Civili, 25100 Brescia, Italy. E-mail: clatantu{at}tin.it

Recently, it has been suggested that peak expiratory flow (PEF) may be determined by the wave speed flow-limiting mechanism. In six normal male subjects (age = 33 ± 8 years) performing expiratory forced vital capacity (FVC) maneuvers, a negative expiratory pressure (NEP) of -10 cm H₂O was randomly applied at the beginning of maximal expiration to assess changes in PEF as compared with baseline. During FVC maneuvers, the expiratory effort was measured by changes in esophageal pressure (Pes), as either peak expiratory Pes-Pes at end expiratory lung volume (Pes_peak) or maximal rate of rise of Pes (dPes/dt_max). In each experimental condition, at least three FVC maneuvers with comparable expiratory effort were selected for analysis for each subject. With similar Pes_peak (107.2 ± 34.9 versus 111.7 ± 40.5 cm H₂O) and dPes/dt_max (1181 ± 518 versus 1177 ± 546 cm H₂O/second) PEF amounted to 10.84 ± 1.08 L/second and to 10.82 ± 1.03 L/second with and without NEP, respectively. These data show that PEF obtained by normal subjects to the best of their abilities (best PEF) does not increase with NEP and indicate that the best PEF is a flow-limited and effort-independent parameter, reflecting only lung and airways mechanics as the other subsequent maximal expiratory flows achieved during the FVC maneuver.

Key Words: peak expiratory flow • expiratory flow limitation • negative expiratory pressure

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