Obstructing lesions of the larynx and trachea: clinical and physiologic characteristics
Miller, R.D.; Hyatt, R.E.
Mayo Clinic Proceedings 44(3): 145-161
1969
ISSN/ISBN: 0025-6196 PMID: 5776050 Document Number: 5557
Major airway lesions simulating asthma, bronchitis, or emphysema usually show clinical or physiologic evidence of inspiratory as well as expiratory slowing. The relative slowing in each phase depends on whether the lesion is fixed or variable and whether the latter type is intrathoracic or extrathoracic. If the obstructing lesion is fixed, both inspiratory and expiratory phases are proportionately slowed. If the lesion is variable, the location becomes of prime importance because of transmural pressure gradients, the extrathoracic lesion causing slowing predominantly in inspiration and the intrathoracic lesion causing slowing predominantly in expiration. In the patient with significant impairment of maximal voluntary ventilation, we suggest that analysis of the flowvolume loop and the ratio of expiratory to inspiratory flow at mid-vital capacity will aid in the detection and characterization of the various types of major airway obstruction. Peroral endoscopy should be done to delineate the nature of the lesion and to guide therapy.
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