Panting 및 Quiet Breathing시 Airway Resistance 측정의 비교

Comparison of Measurements of Airway Resistance during Panting and Quiet Breathing

연구배경 : Airway resistance 측정시 panting 방법은 비정상적인 호흡패턴으로 환자에 따라서는 수행이 어렵고 quiet breathing 방법은 더욱 생리적인 호흡상태하에서 측정이 가능하다. 과거에는 주로 panting을 이용하였으나 최근에는 quiet breathing을 이용하는 추세로 본 연구에서는 panting 및 quiet breathing시에 airway resistance를 측정하여 이를 비교하였다. 방법 : 정상대조군 및 호흡기질환군을 대상으로 유량기량곡선을 측정하고, body plethysmograph를 이용하여 airway resistance를 quiet breathing과 panting시에 각각 측정하였다. 결과: 1) Quiet breathing과 panting시 측정한 airway resistance는 높은 상관관계를 보였다(Raw tot; 0.887, Raw 0.5; 0.921, p<0.05). 2) Panting시 quiet breathing에 비하여 Raw tot는 21.2%. Raw 0.5는 22.1%의 감소율을 보였으며, Inspiratory와 expiratory Resistance의 측정이 가능하였던 경우 Raw insp은 29.3%, Raw exp은 40.6%의 감소율을 보였다. 3) Panting시 airway resistance의 감소율은 호흡기질환군보다 대조군에서 더 컸다. 4) Panting시 specific airway conductance가 유의하게 증가되었으므로 airway resistance의 감소는 thoracic gas volume의 차이와는 관련이 없었다. 5) Panting시 quiet breathing에 비하여 airway resistance가 감소하지 않는 환자는 비교적 airway resistance가 커서 panting을 잘 수행하지 못하는 환자로 추정된다. 결론 : Airway resistance 측정시 환자의 수행능력에 따라 quiet breathing 혹은 panting 방법을 이용할 수 있으나 panting시 quiet breathing보다 결과가 약 20% 감소됨을 고려하여야 하며, 정상군 및 폐질환군에서 panting보다 quiet breathing이 airway resistance를 측정하는 더 좋은 방법으로 생각된다.

Background: Panting method for airway resistance measurement has the disadvantages of departing from the normal breathing pattern and of difficult for some patients to perform. We can measure airway resistance during quiet breathing under more physiologic conditions. Airway resistance is often measured during panting but attempts have been made to facilitate resistance measurements during quiet breathing. This study was designed to compare airway resistance measurements during panting with those during quiet breathing. Method: The 24 normal persons and 29 pulmonary disease patients were included in this study. Spirometry was performed and airway resistance measurement was also done during panting and quiet breathing concomittently. Results: The results were as follows; 1) High correlations were found between airway resistance measurements during panting and quiet breathing. 2) Resistance fell during panting, 21.2% in Raw tot, and 22.1% in Raw 0.5. 3) In normal persons, airway resistance fell more during panting when comparing to those in pulmonary disease patients. 4) This was largely independent of thoracic gas volume differences, because the specific airway conductance rose significantly during panting 5) The patients in whom resistance didn't fell during panting was supposed to the patients who couldn't perform panting successively because of high resistance. Conclusions: Although airway resistance can be measured during panting or quiet breathing according to the patient's performance, we must consider resistance fell during panting, by a mean 20%. It may be concluded that quiet breathing is more likely than panting to provide a relevant measurement of airway resistance.