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J Appl Physiol (March 20, 2008). doi:10.1152/japplphysiol.01355.2007
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Submitted on December 20, 2007
Accepted on March 10, 2008

Effect of Heterogeneous Ventilation and Nitric Oxide Production on Exhaled Nitric Oxide Profiles

Vinod Suresh1, David A Shelley2, Hye-Won Shin1, and Steven C George3*

1 Biomedical Engineering, University of California, Irvine, Irvine, California, United States
2 Chemical Engineering and Materials Science, University of California, Irvine, Irvine, California, United States
3 Biomedical Engineering, University of California-Irvine, Irvine, California, United States

* To whom correspondence should be addressed. E-mail: scgeorge{at}uci.edu.

Elevated exhaled nitric oxide (NO) in the breath of asthmatic subjects is thought to be a non-invasive marker of lung inflammation. Asthma is also characterized by heterogeneous bronchoconstriction and inflammation which impact the spatial distribution of ventilation in the lungs. Since exhaled NO arises from both airway and alveolar regions, and its level in exhaled breath depends strongly on flow, spatial heterogeneity in flow patterns and NO production may significantly affect the exhaled NO signal. In order to investigate the effect of these factors on exhaled NO profiles, we developed a multicompartment mathematical model of NO exchange using a trumpet-shaped central airway segment that bifurcates into two similarly shaped peripheral airway segments, each of which empties into an alveolar compartment. Heterogeneity in flow alone has only a minimal impact on the exhaled NO profile. In contrast, placing 70% of the total airway NO production in the central compartment or the distal poorly ventilated compartment can significantly increase (35%) or decrease (-10%) the plateau concentration, respectively. Reduced ventilation of the peripheral and acinar regions of the lungs with concomitant elevated NO production delays the rise of NO during exhalation resulting in a positive phase III slope and reduced plateau concentration (-11%). These features compare favorably with experimentally observed profiles in exercise-induced asthma, and cannot be simulated with single path models. We conclude that variability in ventilation and NO production in asthmatic subjects impacts the shape of the exhaled NO profile, and thus impacts the physiological interpretation.




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