Chest wall configurational changes before and during acute obstructive episodes in asthma.

Abstract

We induced bronchial obstruction in 7 otherwise healthy asthmatic subjects and then measured the degree of airway obstruction and the dimensions of the chest wall including the anteroposterior (AP) diameters of the upper and lower rib cage and the abdomen and the transverse diameter of the lower rib cage. Airway obstruction was accompanied by a pronounced increase in the end-expiratory AP diameter of the upper rib cage in all 7 subjects and of the low lateral rib cage in 3 of the 4 subjects in whom this was measured. Other end-expiratory dimensions showed variable changes. In 6 of 7 subjects, obstruction caused the lower rib cage to become more elliptical in cross section during inspiration; transient inward motion of the lower anterior rib cage during early inspiration was noted. This latter motion coupled with the continuous outward motion of the upper anterior rib cage produced a pronounced rocking motion of the sternum during inspiration. These distortions of the chest cage were maximal when obstruction was most severe and gradually diminished as obstruction resolved. These inspiratory changes in chest cage cross-sectional configuration are similar to those seen in normal subjects who attempt to overcome external resistive loading by the increased use of inspiratory muscles; the end-expiratory configuration in asthma indicates an increase in functional residual capacity, which is actively maintained. Multiple degrees of freedom of motion of the chest cage exist during obstructive episodes. Estimates of volume change from measurements of rib cage cross-sectional area and abdominal diameter should be made with caution.