Flow limitation in upper-airway obstruction. Theoretical analysis.

During a maximal forced expiration from total lung capacity (TLC) in normal human subjects flow limitation will occur (i.e., the flow will become independent of muscular effort) after the initial part of the expiratory manoeuvre. Flow limitation starts at the flow that causes a pressure drop in the bronchial tree large enough for the generation of a flow-limiting segment. In patients with upper-airway obstruction such as laryngeal obstruction or tracheal stenosis, the upper-airway resistance may keep the flow so low that flow limitation cannot arise. The present theoretical study confirms that glottic resistance does not prevent flow limitation from arising in normal human subjects. On the other hand, the mean glottic resistance characteristics measured for 19 patients with bilateral vocal-cord paralysis were found to be such as to prevent flow limitation. This means that in such patients and also in patients with other types of upper-airway obstruction flow may remain effort-dependent throughout the forced expiratory manoeuvre or in any case during much more of this manoeuvre than normal.