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Exhaled Particles After a Standardized Breathing Maneuver

Journal article
Authors Björn Bake
Evert Ljungström
Annika Claesson
Hanne Krage Carlsen
Mathias Holm
Anna-Carin Olin
Published in Journal of Aerosol Medicine and Pulmonary Drug Delivery
Volume 30
Issue 4
Pages 267-273
ISSN 1941-2711
Publication year 2017
Published at Institute of Medicine, School of Public Health and Community Medicine
Department of Chemistry and Molecular Biology
Institute of Medicine
Pages 267-273
Language en
Keywords aerosol distribution, age, airway closure, airway opening, BMI, breathing maneuver, healthy subjects, AIRWAY-CLOSURE, LUNG-VOLUMES, OBSTRUCTION, SITE, AGE
Subject categories Respiratory Medicine and Allergy, Environmental medicine


Background: Particles in exhaled air (PEx) provide samples of respiratory tract lining fluid from small airways and offer a new opportunity to monitor pathological changes. The exhaled particles are produced by reopening of closed small airways and contain surfactant. The amount of PEx varies by orders of magnitude among subjects. A standardized breathing pattern reduces the variation, but it remains large and the reasons are unknown. The aim of the present study was to assess to what extent sex, age, body size, and spirometry results explain the interindividual variation of PEx among healthy middle-aged subjects. Methods: The PExA((R)) instrument was used to measure PEx in 126 healthy middle-aged nonsmoking subjects participating in the European Respiratory Community Health Survey (ERCS-III). The subjects performed a standardized breathing maneuver involving expiration to residual volume, a breath-hold of 3 seconds, a full inspiration, and then a full expiration into the PExA instrument. PEx number concentrations were expressed per exhalation and per exhaled liter. Age and anthropometric and spirometric variables were analyzed as potential predictors. Results: PEx/L was consistently and negatively associated to lung size-related variables and accordingly lower in men than in women. PEx/Exhalation was similar in women and men. Increasing age was associated with increasing PEx. Reference equations are presented based on age, weight, and spirometry variables and independent of sex. These predictors explained 28%-29% of the interindividual variation. Conclusions: The interindividual variation of PEx after a standardized breathing maneuver is large and the considered predictors explain a minor part only.

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