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Expiratory Flow Limitation*: Roger S. Mitchell Lecture

Joseph Milic-Emili, MD
Author and Funding Information

*From the Meakins-Christie Laboratories, McGill University, Montreal, Canada.

Correspondence to: Joseph Milic-Emili, MD, Meakins-Christie Laboratories, 3626 St. Urbain St, Montreal, Quebec, Canada H2X 2P2; e-mail: milic@meakins.lan.mcgill.ca



Chest. 2000;117(5_suppl_1):219S-223S. doi:10.1378/chest.117.5_suppl_1.219S-a
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Extract

Abbreviations: FL = flow limitation; NEP = negative expiratory pressure; Vt = tidal volume; V̇-V = tidal expiratory flow-volume

The highest pulmonary ventilation that a subject can achieve is ultimately limited by the highest flow rates that can be generated. Most normal subjects do not exhibit expiratory flow limitation (FL) even during maximal exercise. In contrast, patients with COPD may exhibit FL even at rest, as first suggested by Hyatt.1 This was based on his observation that patients with severe COPD often breathe tidally along their maximal expiratory flow-volume curve. The presence of expiratory FL during tidal breathing promotes dynamic pulmonary hyperinflation, with concomitant increase of inspiratory work, impairment of inspiratory muscle function, and adverse effects on hemodynamics.2 This, together with flow-limiting dynamic compression during tidal breathing, may contribute to dyspnea.34

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