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J Appl Physiol (May 14, 2009). doi:10.1152/japplphysiol.91386.2008
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Submitted on October 19, 2008
Revised on April 15, 2009
Accepted on May 11, 2009

The Prone Position Results in Smaller Ventilation Defects during Bronchoconstriction in Asthma

R. Scott Harris1*, Tilo Winkler2, Guido Musch1, Marcos Francisco Vidal Melo3, Tobias Schroeder3, Nora Tgavalekos4, and Jose G. Venegas1

1 Massachusetts General Hospital
2 Harvard Medical School
3 Massachusetts General Hospital and Harvard Medical School
4 Boston University

* To whom correspondence should be addressed. E-mail: rharris{at}partners.org.

The effect of body posture on regional ventilation during bronchoconstriction is unknown. In 5 subjects with asthma we measured spirometry, low frequency (0.15 Hz) lung elastance and resistance and regional ventilation by intravenous 13NN-saline positron emission tomography before and after nebulized methacholine. The subjects were imaged prone on one day and supine on another, but on both days the methacholine was delivered while prone. From the residual 13NN after washout, ventilation defective areas were defined and their location, volume, ventilation and fractional gas content relative to the rest of the lung were calculated. Independent of posture all subjects developed ventilation defective areas. Although ventilation within these areas were similarly reduced in both postures, their volume was smaller in prone than supine (25% vs. 41%, p<0.05). The geometric center of the ventilation defective areas was gravitationally dependent relative to that of the lung in both postures. Mean lung fractional gas content was greater in the prone position before methacholine and did not increase as much as in the supine position after methacholine. In the prone position at baseline, areas that became ventilation defects had lower gas content than the rest of the lung. In both positions at baseline, there was a gradient of gas content in the vertical direction. In asthma, the size and location of ventilation defects is affected by body position and likely affected by small differences in lung expansion during bronchoconstriction.







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