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Departments of 1 Medicine and 2 Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642-8692
Human airways produce nitric oxide (NO), and
exhaled NO increases as expiratory flow rates fall. We show that mixing
during exhalation between the NO produced by the lower, alveolar
airways (
LNO)
and the upper conducting airways
(UNO)
explains this phenomenon and permits measurement of
LNO,
UNO,
and the NO diffusing capacity of the conducting airways
(DUNO).
After breath holding for 10-15 s the partial pressure of alveolar
NO (PA) becomes constant, and
during a subsequent exhalation at a constant expiratory flow rate the
alveoli will deliver a stable amount of NO to the conducting airways.
The conducting airways secrete NO into the lumen
(UNO),
which mixes with PA during
exhalation, resulting in the observed expiratory concentration of NO
(PE). At fast exhalations, PA makes a large contribution to
PE, and, at slow exhalations, NO
from the conducting airways predominates. Simple equations describing
this mixing, combined with measurements of
PE at several different
expiratory flow rates, permit calculation of
PA,
UNO, and DUNO.
LNO
is the product of PA and the
alveolar airway diffusion capacity for NO. In seven normal subjects,
PA = 1.6 ± 0.7 × 10
6 (SD) Torr,
LNO = 0.19 ± 0.07 µl/min,
UNO = 0.08 ± 0.05 µl/min, and
DUNO = 0.4 ± 0.4 ml · min1 · Torr1.
These quantitative measurements of
LNO
and
UNO
are suitable for exploring alterations in NO production at these sites
by diseases and physiological stresses.
nitric oxide diffusing capacity of airways; nitric oxide production by airways; lung nitric oxide; breath holding
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