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Clinical Investigations: ASTHMA |

Overall Contribution of Chest Wall Hyperinflation to Breathlessness in Asthma*

Mario Filippelli; Roberto Duranti; Francesco Gigliotti; Roberto Bianchi; Michele Grazzini; Loredana Stendardi; Giorgio Scano
Author and Funding Information

*From the Department of Internal Medicine, Section of Respiratory Disease, University of Florence, and Fondazione Don C.Gnocchi, IRCCS, Pozzolatico, Florence, Italy.

Correspondence to: Giorgio Scano, MD, FCCP, Department of Internal Medicine, Section of Clinical Immunology, Allergology and Respiratory Disease, University of Florence, Viale Morgagni 87, 50134 Firenze, Italy; e-mail: g.scano@dmi.unifi.it



Chest. 2003;124(6):2164-2170. doi:10.1378/chest.124.6.2164
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Background: Studies suggest that the increased volume of both abdominal and rib cage compartments of the chest wall contribute to dyspnea during methacholine-induced airway narrowing.

Material: Eight male patients with asthma aged 34 ± 13 years (mean ± SD) before and during methacholine challenge.

Methods: The volume of the chest wall (Vcw), volume of the abdomen (Vab), and volume of the rib cage (Vrc) were measured by using a three-dimensional optoelectronic plethysmography.

Results: During methacholine challenge, the increase in end-expiratory Vcw (Vcw,ee) [0.55 ± 0.23 L, p < 0.001] was due to increased Vrc (0.37 ± 0.20 L, p < 0.01) and, to a lesser extent, Vab (0.18 ± 0.10 L, p < 0.005). Linear univariate regression analysis showed that changes in dyspnea (Borg scale) with the highest methacholine dose correlated with both ΔFEV1 and ΔVcw,ee. Multiple regression analysis with the Borg score as dependent variable and all other ventilatory indexes as independent variables showed that ΔVcw,ee and ΔFEV1 were the only significant contributors to the Borg score. Taken together Vcw,ee and FEV1 explained 56% of variance in the Borg score (r2 = 0.56), although Vcw,ee explained 48% of it.

Conclusions: During methacholine challenge in patients with asthma, the overall increase in Vcw,ee is a better predictor of dyspnea that the reduction in FEV1.

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