Background: Lower peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) have been consistently found after slow inspiration with end-inspiratory pause (EIP). Objectives: It was the aim of this study to establish the respective influence of the speed of preceding inspiration (SPI) and EIP on the parameters obtained from the following expiratory forced vital capacity (FVC) manoeuvre. Methods: In 8 healthy subjects and 12 patients with chronic obstructive pulmonary disease (COPD), a number of inspirations with different SPI and EIP were performed. In the subsequent FVC manoeuvre, maximal expiratory flows, including PEF, and maximal expired volumes at different times, including FEV1, were measured. For each FVC manoeuvre, peak expiratory time, expired volume at PEF (as % of FVC), flow limitation by the negative expiratory pressure technique and FVC were checked to be sure of achieving a similar expiratory effort and starting inflation lung volume. Results: The highest values of PEF and FEV1 were found in normal subjects and COPD patients after fastest SPI without EIP (p < 0.001). In normal subjects, no significant PEF and FEV1 changes during FVC manoeuvre were observed with different SPI, in the absence of EIP. In contrast, inspirations with slower SPI (inspiratory time >2 s) without EIP were followed by lower PEF in COPD patients (p < 0.05). As compared with inspirations without EIP, those with a presence of EIP were invariably followed by lower PEF and FEV1, both in normal subjects and in COPD patients (p < 0.05). Conclusions: The effect of SPI on subsequent PEF and FEV1 is irrelevant in healthy subjects as well as in COPD patients, unless SPI is too slow (inspiratory time >2 s), while any EIP decreases these indices in all individuals.

Keywords:
Spirometry, Chronic obstructive pulmonary disease, Forced vital capacity, Inspiration, Peak expiratory flow
1.
American Thoracic Society: Standardization of spirometry. Am J Respir Crit Care Med 1995;152:1107–1136.
2.
D’Angelo E, Prandi E, Milic-Emili J: Dependence of maximal flow-volume curves on time course of preceding inspiration. J Appl Physiol 1993;75:1155–1159.
3.
Wanger JS, Ikle DN, Cherniack RM: The effect of inspiratory maneuvers on expiratory flow rates in health and asthma: influence of lung elastic recoil. Am J Respir Crit Care Med 1996;153:1302–1308.
4.
Tzelepis GE, Zakynthinos S, Vassilakopoulos T: Inspiratory maneuver effects on peak expiratory flow. Role of lung elastic recoil and expiratory pressure. Am J Respir Crit Care Med 1997;156:1399–1404.
5.
D’Angelo E, Prandi E, Marazzini L: Dependence of maximal flow-volume curves on time course of preceding inspiration in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994;150:1581–1586.
6.
Braggion C, Pradal U, Mastella G: Effect of different inspiratory maneuvers on FEV1 in patients with cystic fibrosis. Chest 1996;110:642–647.
7.
Koulouris NG, Rapakoulias P, Rassidakis A: Dependence of forced vital capacity manoeuvre on time course of preceding inspiration in patients with restrictive lung disease. Eur Respir J 1997;10:2366–2370.
8.
Tzelepis GE, Pavleas I, Altarifi A: Expiratory effort enhancement and peak expiratory flow in humans. Eur J Appl Physiol 2005;94:11–16.
9.
Quanjer PH: Standardized lung function testing: report of working party on standardization of lung function tests. Bull Eur Physiopathol Respir 1983;19(suppl 5):1–95.
10.
Melissinos CG, Mead J: Maximum expiratory flow changes induced by longitudinal tension on trachea in normal subjects. J Appl Physiol 1997;43:537–544.
11.
Koulouris NG, Valta P, Lavoie A: A simple method to detect expiratory flow limitation during spontaneous breathing. Eur Respir J 1995;8:306–313.
12.
American Thoracic Society: Lung function testing; selection of reference values and interpretative strategies. American Thoracic Society statement. Am Rev Respir Dis 1991;144:1202–1218.
13.
D’Angelo E, Calderini E, Torri G: Respiratory mechanics in anaesthetized paralysed humans: effects of flow, volume and time. J Appl Physiol 1989;67:2556–2564.
14.
Santos P, Peachier M, Calculi P, et al: Bronchodilation test in COPD: effect of inspiratory manoeuvre preceding forced expiration. Eur Respir J 2003;21:82–85.
15.
D’Angelo E, Milic-Emili J, Marazzini L: Effects of bronchomotor tone and gas density on time dependence of forced expiratory vital capacity maneuver. Am J Respir Crit Care Med 1996;154:1318–1322.
16.
Marthan R, Woolcock AJ: Is a myogenic response involved in deep inspiration-induced bronchoconstriction in asthmatics? Am Rev Respir Dis 1989;140:1354–1358.
17.
Pellegrino R, Violante B, Crimi E, et al: Time course and calcium dependence of sustained bronchoconstriction induced by deep inhalation in asthma. Am Rev Respir Dis 1991;144:1262–1266.
18.
Miller MR, Hankinson J, Brusasco F, on behalf of ATS/ERS Task Force: Standardization of lung function testing. Number 2. Eur Respir J 2006;26:319–338.
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2009
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