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(Chest. 1996;110:642-647.)
© 1996 American College of Chest Physicians

Effect of Different Inspiratory Maneuvers on FEV1 in Patients With Cystic Fibrosis

Cesare Braggion MD1; Ugo Pradal MD1; Gianni Mastella MD1; Allan L. Coates MD2; and Joseph Milic-Emili CM, MD3

1 From the Cystic Fibrosis Center, Ospedale Civile Maggiore, Verona, Italy
2 From the Respiratory Medicine Division of Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
3 From the Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada

The time course of inspiration has been shown to have a significant influence on the subsequent maximal expiratory flows and timed forced expiratory volumes in healthy adults and those with COPD. The purpose of this study was to evaluate the effect of two different inspiratory maneuvers on the spirogram in 15 patients with cystic fibrosis, aged 13 to 35 years, who had mild to moderate airway obstruction. Patients performed a forced expiratory maneuver either after a rapid inspiration without an end-inspiratory pause or after a slow inspiration with a 4-s end-inspiratory pause. Flow-time and volume-time curves were measured by a pneumotachograph. The mean values of FVC, FEV1, and peak expiratory flow were significantly larger by 11%, 13%, and 26%, respectively, after the rapid inspiration without an end-inspiratory pause compared to the slow inspiration with the end-inspiratory pause. This discrepancy probably reflects differences in effective elastic recoil pressure between the two maneuvers. Although the nature of this phenomenon is not fully understood, our results show that for spirometry in patients with cystic fibrosis, the preceding inspiratory maneuver influences the results. An important corollary is that this inspiratory maneuver should be standardized.

Key Words: cystic fibrosis • elastic recoil • FEV1 • spirometry • viscoelasticity • volume-time history

Submitted on October 4, 1995
Accepted on March 18, 1996




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