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Cited by 37Chronic Obstructive Pulmonary Disease (COPD) ResearchInterstitial Lung Diseases and Idiopathic Pulmonary FibrosisPneumothorax, Barotrauma, Emphysema

Elastic recoil changes in early emphysema

Open access
Silvers, G W, Petty, T L, Stanford, R E·1980·Thorax
DOI 10.1136/thx.35.7.490PMC PMC471319
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Abstract

An attempt was made to determine if emphysema and static lung recoil were related in a group of 65 excised human lungs. We studied 23 normal lungs, 24 lungs with an emphysema score of 5 or less, and 18 lungs with an emphysema score greater than 5. A comparison of the percentage of predicted elastic recoil revealed that both emphysema groups were significantly different from normal lungs. In addition, the total lung capacities were significantly different between the three groups. In the group with an emphysema score greater than 5 we found a linear negative correlation between the extent of emphysema and percent of predicted elastic recoil at 90% total lung capacity (r = -0.696, p < 0.01). We found a negative correlation between the percentage of predicted elastic recoil and the lung volume (r = -0.612, p < 0.01). We conclude that a significant loss of elastic recoil and a significant increase in total lung capacity occurs in the early stages of emphysema.

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Written from the paper’s full text.

TL;DR

In 65 excised human lungs, both minimal (score ≤5) and greater (>5) emphysema groups had significantly lower percentage predicted elastic recoil and higher percentage predicted TLC than normal lungs. The authors conclude that loss of elastic recoil and increased TLC occur early in emphysema and are not entirely explained by emphysema extent, suggesting emphysema and recoil loss may be only coincidentally related.

Key findings

  • Among 65 lungs (23 normal, 24 trace–grade 5 emphysema, 18 >grade 5), percentage predicted static recoil after Knudson was lower in both emphysema groups than normal at all volumes studied (p<0.01); at 50% TLC, values were 44.3±2.9 (normal), 29.2±2.6 (≤5), and 16.0±1.8 (>5).
  • Percentage predicted TLC differed significantly among the three groups (p<0.02); the >grade 5 group had emphysema scores from 10 to 85, mean 39.7±4.9 SEM.
  • In the >grade 5 group, emphysema extent negatively correlated with percentage predicted recoil at Pst(l) 90% TLC (r=−0.696, p<0.01), and lung volume as percentage predicted TLC negatively correlated with recoil at 90% TLC (r=−0.612, p<0.01).
  • Nine of the >grade 5 and 14 of the ≤grade 5 emphysema lungs were below 2 SEE for normal lungs; the >grade 5 group also showed a correlation between percentage predicted TLC and emphysema score (r=0.618, p<0.01), while normal lungs showed no significant correlation between percentage predicted TLC and age (r=0.13, p>0.05).

Methods

  • Excised human lungs were obtained from necropsies at Colorado General Hospital or the Denver Veterans Administration Hospital; lungs were selected if free of significant disease other than emphysema and excluded if another pathological process involved >10% of the lung; the protocol was completed within 48 hours of death or cessation of mechanical ventilation.
  • Lungs were cannulated, leaks repaired by ligature, and inflated with air; static pressure-volume curves were constructed by inflating to 20 cm H₂O and deflating in 2 cm H₂O decrements using a U-tube water manometer with 30 seconds for equilibration; TLC was calculated assuming left lung 45% and right lung 55% of total lung volume and expressed as percentage predicted using Goldman and Becklake values for females and Boren et al values for males.
  • Emphysema score was established by a modification of the Thurlbeck et al method using 20 standardized photographs; scores were increased by 5, 10, or 20 points for mild, moderate, or severe fenestration of alveolar walls, respectively; only five of 65 cases were altered by the fenestration reading, and all specimens were scored independently.

Limitations

  • Stated: age differed among groups (normal 33.0±15.9 years, ≤grade 5 47.8±14.6 years, >grade 5 65.4±12.7 years), so recoil was expressed as percentage predicted at specific TLC volumes; the authors note excised lung TLC may be greater than in vivo TLC, and the emphysema–recoil correlation was significant but not as strong as expected if loss of recoil were directly caused by emphysema extent.
  • Evident: the sample is small, especially with only 2 women in the >grade 5 group; the cross-sectional necropsy design cannot establish temporal or causal sequence; selection from two hospital necropsy services may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/thx.35.7.490

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In lungs with minimal emphysema (grade 5 or less), static lung recoil expressed as a percentage of predicted was reduced compared to normal subjects.

    “We found that the group with minimal emphysema did have re- duced elastic recoil compared to normal subjects when we expressed the static lung recoil as a percentage of predicted.”
    Quote in the paperSubstantial claim
  • Findingown data

    In excised human lungs, total lung capacities (percentage predicted TLC) differed significantly among the three groups (normal, emphysema score 5 or less, and emphysema score greater than 5).

    “In addition, the total lung capacities were significantly different between the three groups.”
    • Also stated in: § Results · plain
      “An analysis of variance shows that the percentage predicted TLC differed significantly (p<0-02) between the three groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the normal group, percentage predicted TLC was not significantly correlated with age (r=0.13, p>0.05).

    “Since age differences were present in the groups studied we tested the normal group with respect to percentage predicted TLC and age.No significant correlation was found (r=0-13, p>0 05).”
    Quote in the paperSubstantial claim
  • Findingown data

    Using Knudson predicted values, the greater than 5 emphysema group was statistically different from the trace-grade 5 emphysema group at all volumes examined (p<0.01).

    “By one-way analysis of variance,9 the elastic recoil was decreased in the trace-grade5group compared to the normal group (p<0-01) at all volumes studied and in the grade 5 or greater group was statistically different from normal and the trace-grade 5 group (p<0-01) at all volumes examined when using regression curves obtained from the data of Knudson et al,7 (table 2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Knudson et al.7 Knudson RJ, Clark DF, Kennedy TC, Knudson DE. Effect of aging alone on mechanical properties of the normal adult human lung. J Appl Physiol: Respir Environ Exercise Physiol 1977; 43:1054-62. source
  • Findingown data

    The data obtained from the excised lungs are comparable with data from live subjects.

    “The data we obtained from the excised lungs are comparable with data from live subjects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Turner et al.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 3
  • Classified as probably not a substantial claim. 6

  • May combine two claims.

    Findingown data

    In excised human lungs, both the emphysema group with score 5 or less and the group with score greater than 5 had a percentage of predicted elastic recoil significantly different from normal lungs.

    “A comparison of the percentage of predicted elastic recoil revealed that both emphysema groups were significantly different from normal lungs.”
    • Also stated in: § Discussion · plain
      “By one-way analysis of variance,9 the elastic recoil was decreased in the trace-grade5group compared to the normal group (p<0-01) at all volumes studied and in the grade 5 or greater group was statistically different from normal and the trace-grade 5 group (p<0-01) at all volumes examined when using regression curves obtained from the data of Knudson et al,7 (table 2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Knudson et al.7 Knudson RJ, Clark DF, Kennedy TC, Knudson DE. Effect of aging alone on mechanical properties of the normal adult human lung. J Appl Physiol: Respir Environ Exercise Physiol 1977; 43:1054-62. source

  • May combine two claims.

    Findingcitation

    Using Bode prediction data, both emphysema groups were statistically different from normal at Pst(l) 50, 60, and 80% of total lung capacity, and only at Pst(l) 80% was the greater than 5 group significantly different from the trace-grade 5 group.

    “When using the prediction data of Bode et al,8 the two emphysema groups were statistically different from normal at Pst(l) 50, 60, and 80% of total lung capacity (table 2).Only at Pst(l) 80% was the greater than 5 emphysema group significantly different from trace-grade 5 emphysema group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bode et al,8

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    In a multiple comparisons test after correcting for age with Turner et al data, both emphysema groups differed significantly from normal lungs (p<0.03), but there was no significant difference between the two emphysema groups.

    “A multiple comparisons test reveals a significant difference when comparing the two emphysema groups with the normal lungs (p<0-03) (table 3).Surprisingly, there was no significant difference between the two emphysema groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Turner et al.1

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Because of age differences among the groups, elastic recoil was expressed as a percentage of predicted recoil at specific volumes of total lung capacity.

    “Because of obvious age differences among the groups studied, we have expressed elastic recoil as a percentage of predicted recoil at specific volumes of total lung capacity (Pst(l) x, where x= % total lung capacity).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The experimental protocol was completed within 48 hours of death or cessation of mechanical ventilation.

    “This experimental protocol was completed within 48 hours of death or of cessation of mechanical ventilation in the case of cadaveric transplant donors.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Only specimens that could be made airtight were used in this study.

    “Only specimens that could be made airtight were used in this study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All specimens were scored independently of the other studies.

    “All specimens were scored inde- pently of the other studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    To correct for age, the data of Turner et al were used.

    “To correct for age we have used the data of Turner et al.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Turner et al.1

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The pressure-volume curves were corrected for gas compression.

    “The pressure-volume curves were corrected for gas compression.”
    Quote in the paperSubstantial claim
9 of 9

  • The paper relies on this without support.

    A cause-and-effect relationship between emphysema and elastic recoil would produce a good correlation between the amount of emphysema and the loss of elastic recoil.

    “If emphysema and elastic recoil are related as cause and effect then a good correlation between the amount of emphysema and the loss of elastic recoil should be present.”
1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Scarpelli V, Repetto M. The elastic content of the lung in relation to age. Ital J Biochem 1959; 8:169-72.
  2. Wright GW, Kleinerman J, Zorn EM. The elastin and collagen content of normal and emphysematous human lungs. Am Rev Respir Dis 1960; 81:938.

Cited by

Sorted by citations

Related

Authors
Silvers, G. W., Petty, T. L., & Stanford, R. E.
Affiliations
Lung Institute (US)
Venue
Thorax
Publisher
BMJ
Published
1980-07-01
Volume
35
Issue
7
Pages
490-495
ISSN
0040-6376 (ISSN-L)
DOI
10.1136/thx.35.7.490
PMC
PMC471319
OpenAlex
W2167086230
Semantic Scholar
c0134086415dbade2c207d0d86188b147d80831e
Cited by
37
References
28
Citations by year
2024: 1 · 2017: 1 · 2015: 2 · 2014: 2
FWCI
2.46
Type
journal article
Language
en
Open access
Locations
  • Thorax (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pneumothorax, Barotrauma, Emphysema
Keywords
emphysema, elastic recoil, total lung capacity, lung volume, lung tissue elasticity
MeSH terms
Adolescent, Adult, Aged, Elasticity, Female, Humans, Lung, Male, Middle Aged, Pulmonary Emphysema, Total Lung Capacity, In Vitro Techniques

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