Review Article

The Strain on Airway Smooth Muscle During a Deep Inspiration to Total Lung Capacity

[+] Author and Article Information
Ynuk Bossé

Université Laval,
Faculty of Medicine,
Department of Medicine,
M2694, Pavillon Mallet,
Chemin Sainte-Foy,
Québec, QC G1V 4G5, Canada
e-mail: ynuk.bosse@criucpq.ulaval.ca

Manuscript received August 31, 2018; final manuscript received November 6, 2018; published online January 18, 2019. Assoc. Editor: Chun Seow.

ASME J of Medical Diagnostics 2(1), 010802 (Jan 18, 2019) (21 pages) Paper No: JESMDT-18-1046; doi: 10.1115/1.4042309 History: Received August 31, 2018; Revised November 06, 2018

The deep inspiration (DI) maneuver entices a great deal of interest because of its ability to temporarily ease the flow of air into the lungs. This salutary effect of a DI is proposed to be mediated, at least partially, by momentarily increasing the operating length of airway smooth muscle (ASM). Concerningly, this premise is largely derived from a growing body of in vitro studies investigating the effect of stretching ASM by different magnitudes on its contractility. The relevance of these in vitro findings remains uncertain, as the real range of strains ASM undergoes in vivo during a DI is somewhat elusive. In order to understand the regulation of ASM contractility by a DI and to infer on its putative contribution to the bronchodilator effect of a DI, it is imperative that in vitro studies incorporate levels of strains that are physiologically relevant. This review summarizes the methods that may be used in vivo in humans to estimate the strain experienced by ASM during a DI from functional residual capacity (FRC) to total lung capacity (TLC). The strengths and limitations of each method, as well as the potential confounders, are also discussed. A rough estimated range of ASM strains is provided for the purpose of guiding future in vitro studies that aim at quantifying the regulatory effect of DI on ASM contractility. However, it is emphasized that, owing to the many limitations and confounders, more studies will be needed to reach conclusive statements.

Copyright © 2019 by ASME
Topics: Lung , Muscle , Pressure
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Grahic Jump Location
Fig. 1

The changes in luminal geometry overestimate the stretch the ASM undergoes during a deep inspiration (DI). The schematic illustrates a normal (left) and an asthmatic (right) airways at FRC and after a DI to TLC. The dimensions are zoomed but at scale to an average airway of the ten generation. The springs represent lung recoil. They are stretched at TLC relative to FRC. The arrow at approximately 2 o'clock is the radius (in mm) of the airway lumen (rL). The arrow at approximately 1 o'clock is the radius up to the middle of the airway smooth muscle layer (rM). The material composing the airway wall was considered inextensible. Notice the thinning of the airway wall when the lungs are inflating to TLC. It this schematic it was assumed that the luminal geometry at FRC was equal between normal and asthmatic. It was further assumed that the DI was increasing luminal radius by 25% in both normal and asthmatic, so that the luminal geometry at TLC was also equal between normal and asthmatic. The schematic demonstrates that a 25% increase of luminal perimeter (PL) only causes a 21.2% increase of the perimeter at the middle of the ASM layer (PM). This effect is further amplified in asthmatic because of a thicker airway wall (25 versus 18.2%). The mathematics is developed in the middle. Other abbreviations: AAW—area of the airway wall from the lumen to the middle of the ASM layer, AL—luminal area, AM—area internal to the middle of the ASM layer, and %Δ—change in percentage.

Grahic Jump Location
Fig. 2

Imagine an airway cut open longitudinally and unfolded to form the rectangle on top (a). The letter a represents the airway perimeter and, in this example, is set to 10 mm. The letter b is the airway longitudinal distance covered by the ASM bundle going around the full circumference of the airway. Finally, the letter c represents the length of the ASM bundle and, in this example, is set at an angle 75 deg off the long axis of the airway. Using trigonometry, b and c can be determined. Now imagine that this airway is stretched radially to increase its perimeter by 25%. On the flattened airway shown in (a), this would increase the height of the rectangle by 25% without changing its length (b). Compared to (a), the length of a would increase by 25%, the length of b would remain unchanged and the length of c would increase by 23.5%. The angle of c would also change to 77.9 deg. Therefore, a radial stretch to the airway increasing its perimeter by 25% is expected to strain the ASM bundle by only 23.5%. Now imagine that the airway length is also strained by 25%. On the flattened airway shown in (b), this would increase the length of the rectangle by 25% (c). Compared to (a), the length of a, b, and c would all increase by 25%. In contrast to (b), the angle of c would remain unchanged. Therefore, when both radial and longitudinal strains are applied simultaneously at the same magnitude on an airway, the strain on the ASM is also of this magnitude.



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