Chest -- eLetters for Stanescu, 116 (1) 231-233

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opinions/hypotheses:
Dan Stanescu
Small Airways Obstruction Syndrome
Chest 1999; 116: 231-233 [Abstract] [Full text] [PDF]

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Electronic letters published:

Small Airway Obstruction or restrictive ventilatory impairment: Mehmet POLATLI (9 December 1999)

Small Airway Obstruction or restrictive ventilatory impairment 9 December 1999

Mehmet POLATLI,
MD
Assistant Proffessor
Send letter to journal:
Re: Small Airway Obstruction or restrictive ventilatory impairment

mpolatli{at}turnet.net.tr Mehmet POLATLI

I read with great interest the article by Stanescu about the opinions of small airways obstruction syndrome in which pointed out that a decreased VC and FEV1 and increased RV, but with a normal FEV1/VC ratio and total lung capacity reflects a small airway obstruction. It seems true as a hypotheses but, FRC increase becomes more evident in obstructive lung diseases when one blows out air as forcefully as he can. That is the consequence of air trapping and the dynamic effect of the mechanics of the lungs. So, maybe FEV1/FVC ratio can be measured as normal while FEV1 to slow vital capacity ratio decrease. On the other hand residual volume means a volume which can not be expired. Obstruction means a limitation against to flow of the airways. I couldn’t understand how can we say the term of “obstruction” here. Of course, there is a limitation of the ventilation but the reason may be restriction because of the increase in RV. Gibson and MacNee (Gibson GJ, MacNee W. Chronic obstructive pulmonary disease: investigations and assessment of severity. Eur Respir Mon, 1998; 7: 25-40) pointed out “negative effort dependence” is more evident in patients with airway obstruction than healthy subjects. Interpretation of pulmonary function tests must also be made with flow volume curve and predicted values together. As expected, an obstructive defect only in small airways cause a sudden decrease just after PEF in flow volume curve because of early closure of the small airways. As a conclusion, I suggest that the gradient between FVC and VC, and the shape of flow volume curve gives additional knowledge about the pulmonary functional status of the patient easily.