Estimating Airway Resistance from Forced Expiration in Spirometry

Spirometry is the gold standard to detect airflow limitation, but it does not measure airway resistance, which is one of the physiological factors behind airflow limitation. In this study, we describe the dynamics of forced expiration in spirometry using a deflating balloon and using this model. We propose a methodology to estimate &zeta
(zeta), a dimensionless and effort-independent parameter quantifying airway resistance. In N = 462 (65 &plusmn
8 years), we showed that &zeta
is significantly (p &lt
0.0001) greater in COPD (2.59 &plusmn
0.99) than healthy smokers (1.64 &plusmn
0.18), it increased significantly (p &lt
0.0001) with the severity of airflow limitation and it correlated significantly (p &lt
0.0001) with airway resistance (r = 0.55) and specific conductance (r = &minus
0.60) obtained from body-plethysmography. &zeta
also showed significant associations (p &lt
0.001) with diffusion capacity (r = &minus
0.64), air-trapping (r = 0.68), and CT densitometry of emphysema (r = 0.40 against % below &minus
950 HU and r = &minus
0.34 against 15th percentile HU). Moreover, simulation studies demonstrated that an increase in &zeta
resulted in lower airflows from baseline. Therefore, we conclude that &zeta
quantifies airway resistance from forced expiration in spirometry&mdash
a method that is more abundantly available in primary care than traditional but expensive methods of measuring airway resistance such as body-plethysmography and forced oscillation technique.