Diagnostic value of elastic resistance of the lungs in asthma and COPD

Aim. To study the diagnostic value of indicators of elastic resistance of the lungs depending on the value of bronchial resistance (Raw) in patients with asthma and COPD.

Materials and methods. 71 people were examined, including 20 practically healthy volunteers (control group), 18 asthma patients with a normal Raw, 17 asthma patients with a high index of Raw, 16 COPD patients with a high index of Raw. The study of respiratory mechanics was carried out by measuring transpulmonary pressure, the simultaneous recording of spirogram. Transpulmonary pressure was determined by the difference between the pressure in the mouth and in the lower third of the esophagus. The pressure in the esophagus was determined using a special probe, introduced through the lower nasal passage into the lower third of the esophagus. The difference between intra-esophageal pressure and the pressure in the oral cavity was determined using the differential pressure sensor PDP 1000 MD.

Results. In asthma patients with normal bronchial resistance in comparison with the control group there is a decrease in static lung compliance (p<0.05) and a compensatory increase in the total work of breathing (p<0.05). In patients with asthma and increased bronchial resistance there was a reduction of static lung compliance (p<0.05) and dynamic lung compliance (p<0.001), elastic traction (p<0.001) and increase overall work of breathing (p<0.001), due to the elastic work of breathing (p<0.05). In asthma patients with increased Raw, there is an increased residual lung volume (p<0.001), and residual lung capacity (p<0.001), in comparison with the control group and asthmatics with normal Raw. In the group of patients with COPD showed a reduction in static and dynamic lung compliance, elastic traction, total lung compliance and increase overall work of breathing (p<0.001), due to the elastic work of breathing (p<0.001), compared with the control group and asthma patients with normal Raw.

Conclusion. Based on the first results of a study of the elastic properties of the lungs in asthma patients with increased Raw and COPD patients, we can suggest a new pattern of mechanical activity of the lungs - valve bronchial obstruction or “air trap”, which is clearly manifested in COPD, when even small bronchi are subject to significant expiratory narrowing and increase the amplitude of respiratory movements.

1. Grippi M.A. Pulmonary Pathophysiology (2nd ed.). Moscow: Binom; 2018 (in Russian).

2. Tetenev F. F., Bodrova T. N., Tetenev K. F. Research issues of respiratory biomechanics. Pul'monologiya 2006; (2):109-111(in Russian).

3. Tetenev F.F., Bodrova T.N., Tetenev K.F. Mechanical properties of lungs in bronchial asthma. Ter. Arkh. 2007; 79(3):30-33 (in Russian).

4. Tetenev K.F., Bodrova T.N., Tetenev F.F. Mechanical properties of lungs in patients progressing muscular dystrophy various severity of the disease. Bulletin of Siberian Medicine 2013; 12(6):182-188 (in Russian). https://doi.org/10.20538/1682-0363-2013-6-182-188

5. Ageeva T.S., Tetenev F.F., Dubodelova A.V. Fabric non-elastic pulmonary resistance in case of bronchial asthma and gold: distinction and changes nature. Bulletin of Siberian Medicine 2013; 12 (6): 94-98 (in Russian). https://doi.org/10.20538/1682-0363-2013-6-94-98

6. Gronkvist M., Bergsten E., Gustafsson P.M. Effects of body posture and tidal volume on inter- and intraregional ventilation distribution in healthy men. J. Appl. Physiol. 2002; 92(2): 634-642. doi: 10.1152/japplphysiol.00161.2001

7. Tetenev F.F., Levchenko A.V., Tetenev K.F., Ageeva T.S., Kashuta A.Y, Yurchenko A.D., Mishustin S.P. Regional mechanical properties of the lungs of healthy people. Eur. Respir. J. 2008; 32(Suppl.52):949-950. Abstract P2391.

8. Russian Respiratory Society. Federal clinical guidelines for the diagnosis and treatment of bronchial asthma, 2019. Available at: http://spulmo.ru/upload/kr_bronhastma_2019.pdf (in Russian).

9. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (Updated 2019). Available at: www.ginasthma.com.

10. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Update 2019. Available at: https://goldcopd.org

11. Tetenev F.F., Bodrova T.N., Tetenev K.F., Karzilov A.I., Levchenko A.V., Kalinina O.V. Study of the function of the external breathing apparatus: fundamentals of clinical respiratory physiology. Tomsk: Pechatnaya manufactura; 2008 (in Russian).

12. Cormier Y., Lecours R., Legris C. Mechanisms of hyperinflation in asthma. Eur. Respir. J. 1990; 3(6):619-624.

13. Mergoni M., Rossi A. Physiopathology of acute respiratory failure in COPD and asthma. MinervaAnestesiol. 2001; 67(4):198-205.