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Limitation of Expiratory Flow in Chronic Obstructive Pulmonary Disease: Relation of Clinical Characteristics, Pathophysiological Type, and Mechanisms

G. MICHAEL DUFFELL, M.D.; JULIUS H. MARCUS, M.B., Ch.B.; and ROLAND H. INGRAM JR., M.D.
[+] Article and Author Information

Supported by grants HE 12002 and Research Career Development Award 1-K04-HE 31700, the National Heart Institute, National Institutes of Health, Bethesda, Md.

A preliminary report of this work appeared in Clin Res 17:49, 1969, and was presented June 1969 at the Aspen Emphysema Conference, Aspen, Colo.

▸Requests for reprints should be addressed to Roland H. Ingram, Jr., M.D., Associate Professor of Medicine, 69 Butler St S.E., Atlanta, Ga. 30303


Atlanta, Georgia


Ann Intern Med. 1970;72(3):365-374. doi:10.7326/0003-4819-72-3-365
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Loss of lung elastic recoil as an assessment of emphysema and increased airway resistance as a functional evaluation of chronic bronchitis were used to classify 25 patients with chronic obstructive pulmonary disease. Impairment of steady-state exercise carbon monoxide transfer related linearly to loss of lung elastic recoil. Six patients had emphysema predominant; 7 had chronic bronchitis predominant; and 12 had functionally combined disease. From clinical, laboratory, and radiographic findings, the combined disease group had greater sputum production, severe hypoxemia, hypercapnia, and a frequent history of respiratory insufficiency with heart failure. The combined-disease patients also had the most severe limitation of maximal expiratory flow rates. Those with emphysema and those with bronchitis had similar limitation of maximal expiratory flow rates. With emphysema, expiratory flow limitation was in direct proportion to loss of lung elastic recoil, whereas with bronchitis, limitation of expiratory flow rates was proportional to increase in resistance.

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