The Role of Airway Shunt Elastance on the Compartmentalization of Respiratory System Impedance.

Abstract

An inverse model consisting of two elastic compartments connected in series and served by two airway conduits has recently been fit to measurements of respiratory impedance in obese subjects. Increases in the resistance of the distal conduit of the model with increasing body mass index have been linked to peripheral airway compression by mass loading of the chest wall. Nevertheless, how the two compartments and conduits of this simple model map onto the vastly more complicated structure of an actual lung remain unclear. To investigate this issue, we developed a multiscale branching airway tree model of the respiratory system that predicts realistic input impedance spectra between 5 and 20 Hz with only four free parameters. We use this model to study how the finite elastances of the conducting airway tree and the proximal upper airways affect impedance between 5 and 20 Hz. We show that progressive constriction of the peripheral airways causes impedance to appear to arise from two compartments connected in series, with the proximal compartment being a reflection of the elastance of upper airway structures proximal to the tracheal entrance and the lower compartment reflecting the pulmonary airways and tissues. We thus conclude that while this simple inverse model allows evaluation of overall respiratory system impedance between 5 and 20 Hz in the presence of upper airway shunting, it does not allow the separate contributions of central versus peripheral pulmonary airways to be resolved.