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Original Research |

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy VolunteersAge and Sex in Expiratory Airway Collapse

Carl R. O’Donnell, ScD; Diana Litmanovich, MD; Stephen H. Loring, MD; Phillip M. Boiselle, MD, FCCP
Author and Funding Information

Division of Pulmonary, Critical Care and Sleep Medicine (Dr O’Donnell), Department of Radiology (Drs Litmanovich and Boiselle), Department of Anesthesia and Critical Care (Dr Loring), Beth Israel Deaconess Medical Center, Boston, MA; and Harvard Medical School (Drs O’Donnell, Litmanovich, Loring, and Boiselle), Boston, MA.

Correspondence to: Carl R. O’Donnell, ScD, Beth Israel Deaconess Medical Center, E/Dana 717b, 330 Brookline Ave, Boston, MA 02215; e-mail: codonne1@bidmc.harvard.edu

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Funding/Support: This work was supported by National Institutes of Health [Grant HL 084331].


Funding/Support: This work was supported by National Institutes of Health [Grant HL 084331].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):168-174. doi:10.1378/chest.11-2361
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Background:  A recent estimate for the normal range of forced expiratory tracheal collapse differs substantially from that in an earlier study performed with comparable measurement methods. Given differences in subject characteristics between the two samples, we hypothesized that these discrepant findings may reflect a heretofore unrecognized association between forced expiratory tracheal collapse and age or sex.

Methods:  We enrolled 40 female and 41 male healthy volunteers between 25 and 75 years of age who were without respiratory symptoms or known risk factors for tracheomalacia. Subjects underwent low-dose CT scanning at total lung capacity (TLC) and during forced exhalation (Expdyn) with spirometric monitoring and coaching. Percentage forced expiratory collapse was regressed on age for the total sample and separately within sex.

Results:  Mean tracheal cross-sectional area (CSA) was 2.54 cm2 ± 0.57 cm2 at TLC and 1.15 cm2 ± 0.53 cm2 at Expdyn. Mean percentage forced expiratory collapse (%collapse) was 54% ± 20%. Men aged 24 to 31 years (n = 12) had mean %collapse of 36% ± 19%, comparable to results previously reported for similarly aged men (35% ± 18%). Men, but not women, showed a significant positive correlation (R2 = 0.40, P < .001) between %collapse and age. Older men had both greater CSA at TLC (P = .02) and smaller CSA at Expdyn (P = .001) than younger men.

Conclusions:  Men exhibit positive age dependence of forced expiratory tracheal collapse. The influence of age and sex on forced expiratory tracheal collapse should be considered in the diagnostic evaluation of expiratory dynamic airway collapse and/or tracheomalacia.

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