Relating indices of inert gas washout to localised bronchoconstriction

Asthma is typically characterised by increased ventilation heterogeneity. This can be directly inferred from the visualisation of ventilation defects in imaging studies, or indirectly inferred from indices derived from the multiple-breath nitrogen washout (MBNW). The basis for the understanding of the MBNW indices and their implication for changes in structure and function at the largest and smallest scales in the lung has been facilitated by mathematical models for inert gas transport. A new model is presented that couples airway resistance and regional tissue compliance, for simulation of the effect of ‘patchy’ bronchoconstriction – as inferred from imaging studies – on the Scond index of ventilation heterogeneity. Patches of reduced washin gas concentration can emerge by constricting only the terminal bronchioles within localised regions, however this pattern of constriction is insufficient to affect Scond; Scond from this model is only sensitive to constriction that occurs within entire contiguous regions. Furthermore the model illustrates the possibility that the MBNW may not detect gas trapped in ventilation defects.

► We model nitrogen washout in anatomically-representative airway and tissue model. ► Ventilation is driven by a nominal pleural pressure change. ► Ventilation defects seen on imaging are simulated by narrowing airway geometry. ► Multiple breath washout is simulated for the integrated system. ► Estimates of asthma severity may differ between using imaging or multiple breath washout.