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Maneuver induces airway obstruction or bronchodilatation

Partial and maximal expiratory flow-volume curves

A deep breath may lead to bronchodilation as well as bronchoconstriction (ref. 1). This is in part explained by differences in the hysteresis of lung parenchyma and airways. It can often be demonstrated by comparing flow-volume curves started after a normal tidal breath (partial expiratory flow-volume curve: PEFV) with curves started from the level of TLC (maximum expiratory flow-volume curve: MEFV). In ‘healthy’ subjects the curves are practically superimposable; in patients with lung disease flow during the FVC maneuver is either larger (bronchodilatation) or smaller (bronchoconstriction) than in the partial curve.

When airway obstruction arises from an inflammatory process in small airways, hysteresis of the parenchyma is larger than that of the airways; in that case a deep inspiration is associated with bronchoconstriction, the extent of which is a measure of the activity of the inflammatory process (ref. 2). After induced airway obstruction (allergen, cold air, histamine or methacholine challenge) airway hysteresis predominates over that of lung parenchyma, leading to airway dilatation: contracted smooth muscles, after being stretched, only slowly return to previous muscle tone. More information about basal factors affecting bronchial hyperresponsiveness is available elsewhere on this site.

Ref. 1 - Deep breath and airway patency

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Ref. 2 - Airway and lung hysteresis
Ingram RH. Physiological assessment of inflammation in the peripheral lung of asthmatic patients. Lung 1990; 168: 237-247.

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