Expiratory flow limitation.

Abstract

The first major advance in understanding expiratory flow limitation of the lungs came with the description of isovolume pressure-flow curves. These curves documented the existence of a volume-dependent limit to maximal expiratory flow and led directly to the description of the maximal expiratory flow-volume (MEFV) curve. Definitive modeling of flow limitation awaited the description of a localized mechanism that dominated the flow-limiting process. The phenomenon of wave speed limitation of flow was shown to apply to the airways and provided the needed localized mechanism. Using this concept and recent data on airway mechanics and the frictional losses in the flow, a computational model of the MEFV curve has been developed. Further progress will require modeling of inhomogeneous emptying in diseased lungs, perfecting noninvasive techniques of estimating pertinent airway characteristics, and improving techniques for increasing the signal-to-noise ratio in MEFV curves.