ArticleRespiratory research2026
Effect of airway constriction on ventilation inhomogeneity: multiple-breath washout indices and intrapulmonary reverse flow.
Article in Respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSmall airway dysfunction is an early and clinically important feature of many respiratory diseases but remains difficult to detect using conventional physiological tests. Multiple-breath washout (MBW) is widely used to assess ventilation heterogeneity; however, its sensitivity to the specific location and severity of airway narrowing is not fully understood.
methodsNitrogen MBW was simulated using a physiologically realistic computational airway model reconstructed from high-resolution chest CT imaging. Sixty-four airway constriction scenarios were examined, varying systematically by airway generation, constriction ratio, and constricted branch ratio. Standard MBW indices (LCI, S
resultsMBW indices were predominantly sensitive to severe proximal constriction (Gen 5-9, ≥ 75% severity) with minimal changes observed in distal scenarios. RF showed strong correlations with all MBW indices, particularly S
conclusionsIn simulations, RF was sensitive to ventilation abnormalities arising from mild and distal airway narrowing. As a physiologically interpretable, flow-based marker, RF offers a novel and complementary means of enhancing the sensitivity of MBW for the early detection and motivates further experimental and clinical validation. Importantly, by identifying RF as a convective link between central airway narrowing and peripheral washout behaviour, our study suggests that S
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