阅读说明：本技术 用于测量气道阻力和肺顺应性的方法和装置 (Method and apparatus for measuring airway resistance and lung compliance ) 是由 奥列格·格鲁丁 维克托·洛帕塔 于 2014-11-06 设计创作，主要内容包括：本发明涉及测量气道阻力和肺顺应性中的至少一个的方法,基于通过最初被快门闭合的流量计的呼气,包括当肺和所述流量计内的空气被压缩直到累积压力达到预定的快门打开阈值的闭塞阶段,和被压缩的空气通过打开的流量计呼出的阶段。在闭塞阶段开始时开始呼气,而在闭塞阶段提供缓慢的空气压缩,而不用强制呼气。在达到预先设定的足够高的快门打开阈值时打开快门,以产生显著超过在安静呼气期间产生的最大气流的闭塞后流量峰值。在快门开启后,继续缓慢而静静地呼气；根据快门打开之前测量的流量计内的空气压力和气流波形的形状来确定所述气道阻力和肺顺应性中的至少一个。本发明还涉及相应的方法。(The invention relates to a method of measuring at least one of airway resistance and lung compliance, based on exhalation through a flow meter that is initially shuttered, including an occlusion phase when the lungs and air within the flow meter are compressed until the cumulative pressure reaches a predetermined shutter-open threshold, and a phase in which the compressed air is exhaled through the open flow meter. Exhalation is initiated at the beginning of the occlusion phase, while slow air compression is provided during the occlusion phase without forced exhalation. The shutter is opened upon reaching a preset shutter opening threshold high enough to produce a post-occlusion flow peak that significantly exceeds the maximum airflow produced during quiet expiration. After the shutter is opened, the air is continuously and slowly and statically exhaled; determining at least one of the airway resistance and lung compliance from a shape of an air pressure and air flow waveform within the flow meter measured before the shutter opens. The invention also relates to a corresponding method.)

1. A method of measuring at least one of airway resistance and lung compliance, the method being based on exhalation through a flow meter that is initially shuttered, including an occlusion phase when the lungs and air within the flow meter are compressed until the cumulative pressure reaches a predetermined shutter open threshold, and a phase in which the compressed air is exhaled through the open flow meter;

initiating the exhalation at the beginning of the occlusion phase, while providing a slow air compression during the occlusion phase without forcing exhalation;

opening the shutter upon reaching a preset shutter opening threshold high enough to produce a post occlusion flow peak significantly exceeding the maximum airflow produced during quiet exhalation;

continuing to exhale slowly and quietly after the shutter is opened;

determining at least one of the airway resistance and lung compliance from a shape of an air pressure and air flow waveform within the flow meter measured before the shutter opens.

2. The method of claim 1, wherein the air compression during occlusion is performed slowly for longer than 0.2 seconds.

3. The method of claim 1 or 2, wherein the airway resistance R_awIs based on the maximum air pressure P measured before the shutter opens_maxAnd peak flow f from the airflow waveform_peak:R_aw＝P_max/f_peak-R_btIs defined in which R is_btIs the aerodynamic impedance of the flow meter.

4. The method of claim 1 or 2, wherein the airway resistance R_awIs based on the maximum air pressure P measured before the shutter is opened_maxAnd flow rate value f R_aw＝P_max/f*-R_btIs determined wherein R_btIs the aerodynamic impedance of the flow meter, and f corresponds to a value that can be determined by:

plotting a flow waveform on a flow-volume or log-time axis of flow, wherein the volume represented by the horizontal axis is the integral of the flow after the shutter opens;

selecting a segment of the flow waveform over an interval between the peak flow and a post-occlusion peak end point, wherein the post-occlusion peak end point is a point at which the flow still significantly exceeds the quiet exhaled airflow;

establishing a line tangent to the segment;

the tangent is taken with the vertical axis of the flow waveform and the intercept is assigned f.

5. The method according to any one of claims 1 to 4, wherein the determining comprises determining airway resistance of the small airways, and the airway resistance is determined by a degree of curvature of a flow waveform within a log-time axis of flow-volume or flow as an indicator of small airway occlusion.

6. The method according to any one of claims 1 to 5, wherein several single breath trials are performed and the mean airway resistance and lung compliance are determined from a set of resistance and compliance determined per breath trial.

7. The method according to any one of claims 1 to 6, wherein specific criteria are determined to determine whether each breath test is acceptable or unacceptable; unacceptable testing is excluded from airway resistance and lung compliance analysis, and preferably the unacceptable testing includes one or more of:

testing the duration of the occlusion phase to be less than a predetermined time;

tests with high expiratory gas flow resulting from the mandatory effort exerted by the tester after occlusion; and

an initial pressure build-up in the flow meter during occlusion is measured to determine whether a pressure development is indicative of forced or non-forced exhalation.

8. The method according to any one of claims 1 to 7, wherein the shutter is automatically released and the predetermined high level shutter opening threshold is a pressure level established by a typical tester relaxing respiratory muscles without forced expiration, preferably wherein the shutter is released when the pressure in the flow tube exceeds the threshold, more preferably when the pressure in the flow tube exceeds a first predetermined threshold and when the rate of increase of the pressure in the flow tube falls below a second threshold.

9. The method according to claim 8, wherein the shutter is released when the rate of pressure increase in the flow tube falls below a threshold indicative of alveolar and oral pressure equalization, preferably wherein the threshold is small compared to the maximum rate of pressure increase detected during occlusion.

10. The method according to any one of claims 1 to 9, comprising providing a flow tube with a shutter and a measuring device of sensors for measuring pressure and flow, the sensors being wirelessly coupled to a handheld computer having software providing a flow and pressure recorder and calculator for determining airway resistance and/or lung compliance.

11. The method of any of claims 1-10, wherein a separation between the airflow waveform used to determine the at least one of airway resistance and lung compliance and the post-occlusion flow peak is less than 200 milliseconds.

12. The method of any one of claims 1 to 11, wherein the distal end of the flow meter is initially tightly closed by a shutter.

13. An apparatus for determining at least one of airway resistance and lung compliance during non-forced exhalation, the apparatus comprising an interface portion, a flow tube, a shutter for occluding exhaled airflow in the flow tube during initial exhalation when closed and allowing airflow through the flow tube when open, and at least one sensor for measuring pressure in the flow tube when the shutter is closed and for measuring exhaled airflow through the flow tube when the shutter is open, characterised in that a calculator is used to calculate airway resistance and/or compliance according to the method of any one of claims 1 to 12.

14. The apparatus of claim 13, further comprising a venturi or pitot structure configured to generate a negative pressure corresponding to an ambient environment as a function of exhaled breath flow through the flow tube, the at least one sensor comprising a flow sensor configured to measure forward and reverse flow and connected to the structure for measuring the negative pressure proportional to flow in the flow tube and for measuring a positive pressure in the structure through the flow tube.

15. The apparatus of claim 13 or 14, further comprising a pressure monitor connected to the sensor for measuring pressure when the shutter is closed during the beginning of expiration and configured to detect incorrect forced expiration while issuing an error signal or rejecting pressure and flow measurements from forced expiration tests.

16. The apparatus of any one of claims 13 to 15, further comprising a data store for recording measurements from the at least one sensor.

17. The apparatus of any of claims 13 to 16, further comprising a processor configured to measure a pressure in the flow tube when the shutter is closed and measure an expiratory flow through the flow tube when the shutter is open for calculating at least one of airway resistance and lung compliance during non-forced expiration.

18. The apparatus of claim 17, wherein the processor is configured to measure at least one of airway resistance and lung compliance according to the method of any one of claims 1 to 12.

19. The apparatus of any one of claims 13 to 18, wherein a check valve is provided in the flow meter or the shutter to allow quiet breathing to start with inspiration.

20. A system comprising a device as claimed in any one of claims 13 to 19, further comprising a wireless coupling, and a computing device with software providing a flow and pressure recorder and a calculator for determining airway resistance and/or lung compliance according to the method of any one of claims 1 to 12.

Technical Field

The present application relates to medical diagnostic devices, and more particularly to devices that measure respiratory parameters, such as airway resistance and lung compliance.

Background

Respiratory parameters are typically measured to monitor and diagnose the progression of respiratory disease and to develop treatment recommendations. Using data on airway resistance and compliance may help in determining the condition and appropriate treatment for individuals exposed to smoke, biological or chemical substances, or suffering from chronic lung disease.

There are several techniques available for measuring airway resistance. The technique of forced oscillation, which measures the total respiratory resistance, requires a high level of expertise of medical personnel. Body plethysmography measures airway resistance, but requires large instruments and is not easy to use.

So-called circuit breaker or shutter measurement methods provide an alternative way of determining airway resistance, which requires a minor fit of the patient. In this way, the test person breathes through the breathing tube. In a first step, the flow through the breathing tube is measured. In a second step, the opening of the breathing tube is closed briefly by a shutter. For a short time after closure (typically from 20 to 150 milliseconds), the air pressure in the mouth and breathing tubes increases to a level corresponding to the alveolar pressure at the time of the interruption of the air flow. The measurement of airflow and the resulting pressure are used to determine airway resistance. The interruption of the airflow is typically repeated a number of times during the test in synchronism with the breathing of the test person.

One variation of the interrupt technique, called the "open" interrupt method, uses a different order of measurement. The measured flow is not before the airflow is interrupted, but is measured shortly after the shutter is opened. In this approach, a longer interruption time provides a more complete balance between alveolar and oral pressure, thereby improving the accuracy of airway resistance measurements. According to this method, the interruption is made only during inspiration and in the middle part of the inspiration phase. The oral pressure is measured immediately after the shutter is opened and before the air flow is averaged over a period of 15 to 35 milliseconds.

A shutter-integrated flow meter for measuring end-tidal flow (PEF) after closure has been completed is disclosed in Fairfax et al, US 5,634,471. According to this invention, the tester performs forced exhalation with the device initially closed at the distal end of the flow tube. The proposed breathing action includes a phase of a brief pressure rise within the flow tube, limited to about 200 milliseconds after the shutter is automatically opened, even if the pressure has not yet reached a preset shutter opening threshold. This patent states that the air pressure ratio before the end of occlusion, and the peak air flow equals the airway resistance.

Muscles are used to move the lungs and chest wall to breathe, and the abdominal wall muscles are forced to be used for additional exhalation. Passive or resting exhalation is the process of rebound of the lungs and ribs from certain inhalation phases (greater energy after full inhalation) due to stored elastic energy. In normal breathing during regular activities, only passive exhalation is used.

One disadvantage of the method taught by Fairfax et al is that: the extreme muscular strength conditions associated with forced breathing cause high pressure in the thoracic cavity and narrowing of the airway, and possibly even collapse, resulting in a substantially uneven distribution of tracheal resistance throughout the bronchi compared to normal, quiet breathing.

Another source of inaccuracy in this method is that too short duration of occlusion is used for the determination, which may not be sufficient to average alveolar and oral pressure, especially for testers with moderately and severely occluded airways.

The respiratory action described in US 5,634,471 has a typical high opening pressure shutter (10 to 20kPa) of forced exhalation, which defines a high peak flow rate of up to and exceeding 50l/s for a tester with an airway resistance of 200Pa · s/l. Such peak flows quickly empty the lungs. Accurate measurement of such high flows is a technically challenging problem. In addition to this, detailed analysis of the required peak flow waveform for determining lung parameters such as compliance becomes problematic due to the imposed forced exhalation waveform that is supposed to be generated by the tester.

Disclosure of Invention

Applicants have discovered that when an un-forced exhalation is initially blocked by the shutter and then allowed to follow its natural exhalation, the un-forced exhalation can be used to obtain accurate and repeatable measurements of airway resistance and/or compliance. The onset of the non-forced exhalation is initiated by the relaxation of the chest wall muscles, allowing the lungs and ribs to spring back to create air pressure. With the shutter closed, this pressure stabilizes (or is the same in the mouth as in the lungs and bronchial tree). When the shutter is open, the airflow produces a peak that is greater than that associated with normal relaxed expiration, and then the optional expiration follows its usual course and airflow. The steady pressure at which the shutter closes represents the stored elastic energy, which varies according to the patient's inspiratory level and pulmonary condition. The peak flow value after shutter opening is inversely proportional to the bronchial resistance without substantial compression due to muscle action and steady pressure that creates forced expiration prior to shutter release.

Applicants have discovered that an apparatus may be configured to detect or distinguish between non-forced exhalation and forced exhalation, and use such detection to signal that a measurement is based on forced exhalation and therefore is erroneous, or to stop the measurement.

The applicant has also found that the apparatus can be provided with a single pressure sensor which measures the positive pressure in the breathing tube relative to the ambient pressure when the shutter is closed and the exhaled flow in the breathing tube by measuring the negative pressure relative to the ambient caused by the exhaled air flow when the shutter is open. This has the following advantages: both pressure and flow measurements are based on the same sensor, and since airway resistance is the ratio of these measurements, the stability of the sensor sensitivity is less important. The pressure sensor used in the measurement may be, for example, a calorimetric type micro-flow sensor.

It is an object of the invention to simplify the testing procedure, thereby minimizing the need for coordination for the tester, shortening the testing time and/or determining medically valuable information about the airway resistance distribution of the entire bronchial tree. Another object is to simplify the design of the breathing apparatus, to reduce its size and/or to improve the accuracy of the measurement.

According to the present invention, the tester holds the breathing tube in his/her mouth with the proximal end of the tube tightly wrapped by the lips. The coupling to the patient's mouth may be an end portion of a tube (i.e., an integrated interface portion) or an interface portion, as desired. The end of the breathing tube is initially closed tightly with a shutter. After the tester begins to exhale without force, the pressure in the closed breathing tube increases to a certain threshold, after which the shutter rapidly opens the breathing tube. The threshold may simply be a fixed level and is preferably a fixed level or a deceleration of the pressure increase for a predetermined time indicative of a stable pressure. The pressure in the breathing tube drops to almost ambient pressure and shortly after the shutter opens, the air flow through the breathing tube reaches its maximum and then decreases. The time of the non-forced expiration remains substantially the same regardless of the use or non-use of the device. Assuming that the alveolar pressure is equal to the pressure in the breathing tube when the shutter is open, airway resistance can be determined from the airflow waveform.

Lung compliance is determined by the rate of airflow reduction after the maximum peak is reached.

The difference between the proposed breathing pattern and the prior art blocking breathing technique is that the measurement starts in the occluded state when the tester starts to exhale easily into the breathing tube closed by the shutter. During occlusion, exhalation proceeds slowly without forced exhalation. The preferred duration of occlusion is 0.3-1 second, a period of time long enough to equalize alveolar and oral pressure. Synchronization of shutter opening with the breathing cycle is not required. Because the pressure in the lungs and breathing tube should be stable when the shutter is closed, it is not too hard to open the shutter, e.g., it may wait, e.g., 100 milliseconds to about 1000 milliseconds, before releasing the shutter. Opening may be automatically initiated by an increased accumulated pressure exceeding a predetermined threshold. After the occlusion is over, the subject continues to exhale quietly without forcing, and can naturally and slowly stop easy exhalation within about 0.5-5 seconds after the shutter is opened. The opening pressure is set at a sufficiently high level that the post-opening flow peak substantially exceeds the quiet expiratory flow.

Drawings

The invention will be better understood by describing in detail embodiments thereof with reference to the attached drawings, in which:

fig. 1 shows a general scheme of a breathing apparatus for airway resistance measurement.

Fig. 2 schematically shows the flow waveform during quiet exhalation through an open flow tube, with the tube having an initially closed shutter.

Fig. 3 shows a simplified electrical model of the respiratory system.

Fig. 4 shows a calculated flow waveform after the shutter is opened.

Fig. 5 shows an electrical model of the respiratory system, where the upper and lower levels of the lungs are represented by different rcc networks.

FIG. 6 shows R representing small airway resistance_aw2Different values of flow waveform.

FIG. 7 shows the different levels of built-in R in the diagram of the ln (flow) -time axis_aw2The calculated waveform of (2).

FIG. 8 shows built-in R at different levels in a plot of flow vs. volume axis_aw2The calculated waveform of (2).

Fig. 9 illustrates the process of calculating the interception flow f and its slope from the flow-volume waveform.

FIG. 10 shows R_awAs a function of expired volume.

Fig. 11 is a sketch of an experimental breathing apparatus.

Figure 12 shows a typical voltage output and derived oral pressure and flow waveforms during the test.

Figure 13 shows the oral pressure and flow waveforms measured in multiple trials with and without an external flow restrictor.

Figure 14 shows the flow-volume waveforms generated by the tester at different levels of lung volume.

Fig. 15 shows experimental oral pressure and flow waveforms measured for four different testers.

Figure 16 shows the flow waveforms of different trials by a tester with extra effort during exhalation.

FIG. 17 is a sketch of a venturi-based breathing apparatus.

Fig. 18 is a schematic block diagram of a measurement device and a signal processing system.

Detailed Description

One possible embodiment of a breathing apparatus is shown in fig. 1. The flow meter comprises a breathing tube 1 having a proximal end 2 and a distal end 3. A shutter 4 is attached to the distal end 3 of the tube. The gas flow through the tube and the pressure within the tube are measured by the transducer 5. The flow meter contains a functional element 6, which functional element 6 generates a differential pressure as a function of the gas flow. Such elements may alternatively be pitot tubes or orifices, for example, or other types of known flow restrictors, such as those used in Fleisch or Lilly pneumatic high pressure gauges.

The transducer 5 may comprise one sensor 8 for measuring the pressure difference across the functional element 6 and a second sensor 9 for measuring the pressure inside the tube 1. It is also possible to use only one pressure sensor for measuring the pressure caused by the gas flow and the pressure in the pipe 1, as will be described below.

According to the proposed test regime, the tester produces a quiet exhalation through the breathing tube 1 without having to make a hard effort. The flow waveform during quiet exhalation with the shutter permanently open is shown schematically in dashed lines in fig. 2. Typical maximum air flow at the expiration of silence is less than or about 1 l/s.

The solid line in fig. 2 shows the flow waveform during exhalation through the breathing tube 1 when the shutter 4 is initially closed. In phase 1 (occlusion) between the beginning of expiration and the opening of the shutter 4, the flow through the breathing tube 1 is zero and the air in the lungs is compressed, resulting in an increase in the oral pressure (see fig. 2).

As described above, the tester may start an un-forced exhalation and the pressure in the closed breathing tube may increase to reach a certain level determined by the relaxation of the breathing muscles and the inhalation state. When the pressure reaches this level, the shutter can be opened. A pressure sensor and control electronics may be used to detect this level or achieve it, however, in some cases, manual release of the shutter may be used. The tester may be instructed to release the shutter when he or she has relaxed the breathing muscles while maintaining the seal at the interface. The tester can easily self-regulate. It will be appreciated that the shutter opening pressure may be set a little higher so long as the subsequent exhalation is not forced, thereby allowing the tester to exert a little force to trigger the shutter. An advantage of setting the opening pressure higher than the normal static pressure of the relaxed breathing muscle is that a single fixed set point can be used, simplifying electronic control, and in at least some cases, moderately higher occlusion pressures can provide better peak flow signals. The disadvantage is that the cooperation of the tester only uses temporary forces to play a role in the measurement. As mentioned above, forced expiration adversely affects the lungs and interferes with the measurement of airway resistance when the force is too great. It may also hinder the ability to measure characteristics from the shape of the flow curve, as this depends on the subject's forced expiratory muscle control.

Phase 2 begins with the opening of the shutter 4. At this stage, the air flow is at time t after the shutter 4 is opened_pReaches a peak and then decreases. The shape of the airflow waveform generally depends on the airway resistance and the elasticity of the lung tissue, airway and chest wall. A typical duration for phase 2 is about 100-300 milliseconds, the peak flow time t_p15-30 milliseconds.

Phase 3 covers the rest of the exhalation maneuver, not substantially unlike quiet exhalation through an open tube (dashed line). This phase is not important for measurement purposes and after the shutter is opened, the tester can stop the exhalation slowly (without rapid interruption) for about 0.5-1 seconds without affecting the measurement.

The airflow waveform caused by chest air compression and subsequent rapid opening of the shutter 4 causes normal, non-forced exhalation by the test person. When such a waveform is significantly different from a quiet breath, it is preferable to create test conditions.

For this reason, the tester should not be forced to exhale quietly and easily. The design of the shutter is also important so that its opening takes place at a sufficiently high pressure P_maxTo produce a significant flow peak. In most patients, this is not a problem, as the chest wall musclesThe relaxation of (a) may cause the rebound of the lungs and ribs to generate sufficient air pressure. Assuming that airway resistance typically varies from 150Pa s/l to 450Pa s/l, P_maxA reasonable value of approximately 900Pa, resulting in a peak flow of 2-6l/s, clearly distinguished from a quiet expiratory flow. In general, for the proposed method, the shutter opening pressure P_maxAnd may be 500Pa to 2000Pa, which does not cause serious inconvenience to the tester during the test.

For example, at the start of the test, the shutter 4 is closed and the air in the breathing tube and the upper part of the respiratory tract are slowly compressed. From atmospheric pressure P in order to increase the pressure_atmTo P_atm+P_maxVolume quantity Δ V of air that must be delivered from the lungs:

wherein V_compIs the internal volume of the breathing tube and the volume of the upper part of the respiratory tract.

At a compression time t of about 1 second_compDuring this period, the average airflow delivered through the respiratory tract can be estimated as:

for volume V_comp0.5l and an overpressure P_max1000Pa, estimated air flow f₁About 0.02 l/s. At such low airflow, the pressure drop across airway resistance is negligible and alveolar pressure approaches oral pressure.

The preferred duration of closure may be about 0.3-1 second. To implement the proposed method, it is advantageous to control the ratio of the pressure to time waveform, where P is measured_maxIf too fast, e.g. 0.2s fast, the experiment is cancelled. In this case appropriate information may be generated to advise the tester that a slower exhalation is occurring, or the measurement may simply be cancelled.

The respiratory system's performance in terms of electrical component response is helpfulA simple airflow waveform analysis model is constructed. Fig. 3 shows a simplified electrical model of a respiratory system. Here a resistance R_awAnd inertia I_rsIs the sum of the airway, lung tissue and chest wall contributions. Determining compliance C primarily by virtue of lung tissue and chest wall compliance_rs. The shutter 4 is schematically shown by a switch K (initially open). At the beginning of the test procedure, the compression of the air in the lungs is equal to the compliance volume C_rsThe energy is charged. The opening of the shutter 4 is equivalent to the closing of the switch K.

The airflow f (t) through the breathing tube after opening the shutter 4 can be obtained from the equation of a linear circuit:

equation (3) describes the compliance capacity C_rsThrough a resistance R_aw+R_btAnd an inductance I_rsThe discharging process of (1).

Simplifying the qualitative analysis of equation (3), assuming R_awAnd R_btIndependent of gas flow, and (R)_aw+R_bt)²>>I_rs/C_rs. Under these assumptions, (3) can be expressed as:

wherein

τ₁＝(R_aw+R_bt)C_rs(4b)

Time t_pEqual to:

replacement of airway resistance, lung compliance and inertiaValue R_aw＝200Pa·s/l，C_rs＝10^-3l/Pa，I_rs＝1Pa·s²L and R_bt50Pa · s/l, yielding: tau is₁＝250ms，τ₂＝4ms，τ_pApproximately 16 ms. The flow waveform f (t) is shown in fig. 4. (the opening pressure of the shutter is 1000 Pa).

According to the proposed method, the value of airway resistance is determined from the measured flow waveform f (t). In one possible procedure, a straight line is created tangent to the flow time curve, as shown in fig. 4, and is found at f, the intercept of the flow axis. Airway resistance is determined as:

based on general τ₁>>τ₂And peak flow f_peakThe fact that R is approximately the same as the flow f, a simpler method can be used to determine R_aw. In this case:

lung compliance C_rsMay be determined from the flow waveform generated after the shutter is opened. The flow reaches the peak value (t)>>τ₂) Thereafter, the slope of the straight line shown in fig. 4 is established, depending on the compliance, which can be estimated from:

or

Where a is the integration constant.

According to some embodiments, airway resistance R is first determined as described in equation 6_aw. Then lung compliance C_rsCan be derived from equation 7.

More advanced models of the human Respiratory System [ I.Jablonski, A.G.Polak, J.Mroczka, "A Complex Mathematical Model of the Respiratory System as a Tool for the quantitative Analysis of the interrupt technology", XIX IMEKO World consistency future and Applied Metrology, 6-11 th 2009, Portugaris book, p. 1601-1604 ], in which the electrical equivalent of the Respiratory tree is represented as a ladder network describing the resistance-capacitance-inductance elements of the 24-level airway. It is important to the respiratory system assessment to understand the effect of the distribution of electrical resistance across the bronchi corresponding to different levels of airway occlusion on the shape of the airflow waveform. For a simplified network representing the respiratory system shown in fig. 5, a quantitative analysis without complex calculations was performed.

The network consists of two parts. One part represents the upper respiratory tract and the upper part of the central airway, and a distribution resistor R_aw1Capacitor C_rs1And an inductance I_rs1. The second part represents the lower half of the central and peripheral airways, with resistance R_aw2Capacitor C_rs2. The analysis was performed for the following assumptions: r_aw1＝150Pa·s/l，C_rs1＝10^-4l/Pa，C_rs2＝10^-3l/Pa，I_rs1＝1Pa·s²/l，R_bt50Pa · s/l. The opening pressure of the shutter was 1000 Pa. FIG. 6 shows the difference in R_aw2The calculated flow waveform at value.

For analysis of the flow waveform, it may be convenient to plot it so that its line segment describes an exponential decrease in flowA segment of the slope determined by the time constant τ. Suppose that at time t₁And t₂The flow rates in the time intervals between are as follows:

wherein f is₁Is t ═ t₁The flow rate of (a) to (b),is a time constant. Taking the logarithm of equation (8) yields:

the logarithm of the gas flow ln (f (t)) is the time t₁<t<t₂The slope of the linear function of time within the range is inversely proportional to the time constant τ.

If the amount of exhalation is calculated as the integral of the airflow over time since the shutter was opened, it is at the same interval t₁<t<t₂A value of (1) is equal to:

wherein Vol₁Is t ═ t₁Volume of time.

Equation (10) can be converted to:

at a time interval t₁<t<t₂The flow rate and volume function is linear with a slope inversely proportional to the time constant τ.

Thus, if the flow waveform is plotted with the axis ln (flow) -time or flow-volume and contains segments with different slopes, it can be understood that the time constant τ varies with time or volume expired.

Fig. 7 and 8 show the calculated flow waveform plotted with the axis ln (flow) -time and flow-volume. R_aw2An increase in flow rate, corresponding to an increase in small airway occlusion, causes the flow curve to "bend". The portion of the waveform with the steep flow reduction is followed by a segment with a relatively constant slope. Wave formCan be interpreted as such. The airflow shortly after shutter opening is mainly due to the capacitor C_rs1At the resistance R_aw1Has a time constant R_aw1C_rs1Approximately 15 ms. About 50 milliseconds after the shutter opens, the main contribution to the airflow is made by the capacitance C_rs2Providing, a capacitance C_rs2At R_aw2Has a ratio of C in the case of significant value of_rs1Low discharge rate. Capacitor C_rs2Discharge R through total airway resistance_aw＝R_aw1+R_aw2。

At R_aw2For the base resistance value, the flow peak (equation 6b) is used to calculate the total airway resistance R_aw＝R_aw1+R_aw2Becomes inaccurate. More precisely, airway resistance can be calculated by equation (6a), where a straight line is used to find the intercepted flow f using a tangent to a segment of the airflow waveform, where the flow reduction is primarily by the capacitance C_rs2Is determined by the discharge of (a).

Fig. 7 and 8 show the straight tangents of the ln (flow) -time and flow-volume curves for finding the cut-off flow f. From the formulae (6b) -R_{aw_peak}And (6a) -R_{aw_intercept}The results of the airway resistance calculations obtained are listed in table 1.

Table 1 calculation R based on peak flow and intercepted flow_aw

Raw1+Raw2,Pa·s/l	Raw_peak,Pa·s/l	Raw_intercept,Pa·s/l
			170	181	163
220	203	207
			300	213	278
370	217	341

Note that the resistance R_aw2The change between 50 and 220Pa s/l did not significantly change the peak flow-less than 7%. At the same time, the change of the shape of the air flow waveform and R_{aw_intercept}An increase of more than 60% can be used for a more sensitive indicator of minor airway occlusion.

The rule for selecting segments of the flow-volume waveform to construct a tangent line can be described as follows. The slope of the waveform is zero at the extreme point where the flow reaches its peak, then reaches a maximum absolute value, then falls to a relatively constant level (fig. 9). Segment 16 is selected from a portion of the waveform having a relatively constant slope. Truncating the line of the segment 16 with the flow axis (i.e. zero exhalation volume corresponding to the time of opening the shutter) yields the value of f. After f is determined, the airway resistance can be calculated from equation (6a), and then the lung compliance can be calculated from the slope of segment 16, which is inversely proportional to the time constant τ.

The same method can be used to define segments of the flow waveform for calculating airway resistance and lung compliance, which is plotted by the axis ln (flow) -time (fig. 7).

The process of determining the flow f by finding the intercept of the tangent with the flow axis can be generalized. The flow f may be determined for each point of the waveform and a suitable value of airway resistance may be calculated from equation (6 a). FIG. 10 shows a simulated resistance R_aw2Calculated R for three curves of 70, 150 and 220Pa · s/l (curves 2, 3, 4 in FIG. 8)_awAs a function of expired volume. For having a value corresponding to capacitance C_rslThe segment of the steepest slope of the waveform of the discharge of (1) obtains the minimum resistance and is equivalent to R_aw1. Tangent lines to curves 3 and 4 at these points of steepest slope at about 4.5l/c of the flow axis (see FIG. 8), which yields R_awValue close to R_aw1。

Maximum value (Total R)_aw) And minimum (R)_aw1) The difference between the resistances is a resistance R representing a small airway_aw2(as shown in fig. 10). Thus, the proposed method can evaluate not only the total airway resistance, but also its parts related to the upper, middle and small airways.

To implement the described method, a device comprising a shutter attached to the flow meter may be used, as shown in fig. 1. The flow meter may be a standard flow meter for use in one of the typical lung function tests or may be a dedicated flow meter specifically designed for a given application. The flow meter preferably provides accurate measurements over a flow range of about 0.2l/s to about 10l/s, with a maximum flow rate measurement of about 61/s, typically sufficient to directly measure peak flow. The technique of measuring the slope of the flow curve to measure f as described above can be used with flow meters that cannot measure the actual full peak flow rate, as long as the lower flow level of the curve immediately following the peak can be measured in order to determine the tangent to the curve and find f accurately.

Fig. 11 shows a cross-section of one possible embodiment of the proposed device. The experimental set-up consists of a 100mm long flow tube 1 with an internal diameter of 15mm at its centre and a 22mm distal end. A metal or plastic tube with an inner diameter of 1mm is bent at its end and located inside the flow tube 1, as shown in fig. 11, and serves as a pressure probe 7.

The shutter comprises an optically rigid plastic cover 9 with a spherical surface and a thin ferromagnetic metal ring 10 attached at its periphery. The metal ring is attracted to the flow tube 1 by several miniature permanent magnets 11 fixed in a ring 12 mounted at the end of the flow tube 1.

The shutter opens when the air force, which is equal to the air pressure in the flow tube 1, and the air force in the area of the tube bore at its distal end exceed the attraction force generated by the permanent magnet. The attractive force required to open the shutter and the corresponding air pressure are adjusted by the number of magnets 11 and the distance d between the magnets 11 and the metal ring 10. Note that the pressure required to open the shutter also depends on the diameter of the tube bore.

As mentioned above, a manual release mechanism for the shutter or cover may be provided rather than an electrically controlled release.

A measuring sensor 8 is used to measure a) the oral cavity pressure during occlusion when air is compressed in the closed tube, and b) the pressure caused by the airflow after the shutter is opened. During occlusion, the sensor 8 measures the positive pressure fed to the sensor input by the pressure sensor 7. As shown in fig. 11, the sensor 8 has one port connected to the tube 7 and another port in communication with the environment. After opening the shutter, the sensor 8 measures the negative pressure caused by the airflow through the tube 1.

The device comprises a plastic interface 17 attached to the proximal end 2 of the flow tube 1. The interface portion may be of various types. For example, it may be a small tube like a mouth-engaging straw at the end of the tube itself or a separate part (engaging the lips around the mouthpiece), it may be a larger mouthpiece, using a horn-like mouthpiece (pressing the lips against the mouthpiece), or it may be a mouthpiece like a patient placed in the mouth and may even bite into a fixed breathing nozzle.

A floating interface portion is flanged between the gums and lips of the subject. In this case, it is more time consuming to insert the mouthpiece and it is more convenient for the mouthpiece to breathe into place. This may be by opening the shutter for inhalation and then closing the shutter for operation as described above, or an access port may be provided. For example, a suction flap or check valve may be provided to allow the tester to breathe. In one possible embodiment, the check valve may be disposed within the shutter itself. This may allow a tester to breathe quietly starting with inhalation rather than exhalation.

As shown in fig. 11, the interface 17 may be a replaceable and separable part of the tube 1. The tube 1 can be made sterilizable.

FIG. 12a shows a typical voltage response U generated by the device upon exhalation by a normal test person_out(t) 13. The pressure sensitivity of the sensor 8 was 2mV/Pa and the time response was 2 milliseconds. The flow tube 1 with pressure probe 7 and open shutter produces a pressure difference as a function of flow, which approximates the following equation:

dP＝P–P_atm＝-a·f² (8)

wherein a is 17.4Pa/(l/s)². The aerodynamic impedance of the flow tube is approximately in the range of 11/s to 51/s:

R_bt＝4.6+15·f， (9)

wherein R is_btMeasured in Pa.s/1 and the flow rate f in 1/s.

With this calibration data, the port pressure and airflow generated after the shutter opens can be derived from the waveform 13. Fig. 12b presents the mouth pressure 14 and the air flow 15.

The measurement time interval between the maximum oral pressure and zero pressure is about 50 milliseconds. Peak flow is reached within about 25 milliseconds after a zero pressure condition.

In order to evaluate the proposed method and to verify the functioning of the experimental setup, several tests were performed. In a first test, the possibility of measuring changes in airway resistance as simulated by an external flow restrictor was examined.

The two external flow restrictors consist of narrow plastic strip meshes fixed inside a silica gel tube with an internal diameter of 1.8 cm and a length of 2.5 cm. The flow restrictor is inserted into the interface portion 17. The aerodynamic resistance of the restrictor is determined as the ratio of the back pressure and the air flow through the restrictor. Both restrictors have a resistance proportional to the flow. The resistance of the first restrictor varies from 40 to 60 Pa.s/l at a flow rate of 2 to 3 l/s. The resistance of the second flow restrictor in the same flow range is between 70Pa s/l and 105Pa s/l.

Fig. 13 shows the pressure and flow waveforms generated by the tester without restrictor (fig. 13a), with restrictor 1 (fig. 13b) and with restrictor 2 (fig. 13c), respectively. The measurement results are shown in tables 2 to 4. Airway resistance is calculated based on the peak flow value according to equation (6 b).

TABLE 2R of infinite current device_awMeasuring

TABLE 3R with flow restrictor 1_awMeasuring

TABLE 4R with flow restrictor 2_awMeasuring

TABLE 5R_awFinally, the measurement is ended

Each test was conducted five times at about 1 minute intervals. At the end of the test, two control trials without flow restrictor were performed to check whether the airway resistance was changed by multiple measurements. The results of the last two tests are shown in table 5.

For tests of restrictors 1 and 2, which reasonably correspond to their pre-measured aerodynamic resistance, increases in mean airway resistance of 45 and 72Pa s/l were detected. R_awThe multiple measurements of (a) require that a single breath through the flow tube be quiet is not a violent movement by the tester, and the last measurement to end confirms that R is not changed by the test_awThe value is obtained.

The lung compliance was also calculated during the test according to equation (7). The average value thereof was determined to be 0.93X 10^-3l/Pa (infinite flow device), 1.005X 10^-3l/Pa (flow restrictor 1) and 0.935X 10^-3l/Pa (flow restrictor 2). As expected, no significant change in lung compliance was detected. Repeatability ratio R for lung compliance measurements_awThe reproducibility of the measurement was about 20%.

A second test was conducted to examine the ability of the device to measure actual "physiological" changes in airway resistance. Tests were performed on different volumes of the respiratory system-near 100% total lung volume (TLC), inspiratory after quiet breathing, near Residual Volume (RV). The first test was performed after maximum inspiration. In the third case, the test subjects performed the test at depth and after a "very deep" (almost maximal)) exhalation. Figure 14 shows the flow-volume curves measured in several experiments at different levels of lung volume.

As expected, the extension of the lung with the airway dilation reduces airway resistance. Experiments performed after deep expiration also demonstrated significant occlusion of small airways, resulting in "bending" of the flow-volume curve. Although the peak flow difference between runs 2, 3 and 4 was not significant, the intercepted flow of runs 3 and 4 was significantly reduced, which represents a higher total airway resistance.

Note that the tangents of the curves 2, 3, 4 at the steepest part are approximately the same intercept with the flow axis, in the region 4.5-5l/s, which is almost the same as the resistance of the upper airway. R of these tests_aw2And total airway resistance are substantially different.

Fig. 15 shows pressure and flow waveforms measured for four different testers with different airway resistance levels. This test adjusted the shutter opening pressure to about 800 Pa. The peak flow rates for test subjects 1 and 4 were over 3l/s, significantly higher than the typical flow rates during quiet exhalation. The peak flow of test person 3 with the higher airway resistance peaked at 2.2l/s, which was still substantially higher than the flow at quiet expiration.

The high airway resistance of test person 2 was responsible for the peak flow limitation of 1.4 l/s. To increase peak flow and make more accurate measurements for testers with high airway resistance (e.g., severe occlusive disease patients and preschool children), it may be advantageous to increase the shutter opening pressure. The actual value of the opening pressure should be chosen so as not to cause excessive inconvenience to the tester, and on the other hand, to reach a peak flow rate of 2-3l/s or higher level, so as to clearly distinguish from the background of quiet expiration.

Set opening pressure P_maxOne of the possible rules of (a) may be a combination of the following conditions:

for having airway resistance R_aw<300Pa s/l of the tester, P_max＝900Pa；

When 300 Pa.s/l<R_aw<At 500Pa · s/l, P_max＝(3l/s)·R_aw；

When the pressure is 500Pa · s/l<R_aw<750Pa · s/l, P_max＝1500Pa；

When R is_aw<750Pa · s/l, P_max＝(2l/s)·R_aw；

P_maxIs limited to 2000 Pa.

Another possible rule for triggering the shutter may be to look for stability in the pressure build-up as shown in fig. 2. This may involve, for example, detecting a first slope threshold corresponding to an increase in normal pressure indicative of relaxed and quiet exhalation, followed by a decrease in the slope of the pressure curve to a second threshold. Once this is detected, the shutter may be opened immediately or shortly thereafter.

Another possible rule for triggering the shutter may be to detect that a first pressure threshold, e.g. 300Pa, is exceeded for a predetermined period of time, e.g. 250 milliseconds, typically sufficient time for the pressure to stabilize, without exceeding a second pressure threshold indicative of forced exhalation, e.g. 800Pa for children, 1600Pa for adults.

With the described embodiment, such adjustment of the opening pressure of the shutter can be achieved by adjusting the attractive force generated by the permanent magnet 11. In order to change the attractive force, the number of magnets may be changed, the gap between the magnets and the metal ring 10 may be changed or the magnetic strength of the magnets may be changed. For more advanced plants with electromagnets, P_maxIt can be automatically adjusted by using the reading of the pressure sensor to turn off the magnet at the appropriate time during occlusion.

As mentioned above, the maximum lung pressure after occlusion should not substantially exceed the shutter opening pressure. In other words, the tester should not force himself/herself to exhale after the shutter opens. It will also be appreciated that if the shutter opening pressure is set too low, i.e. significantly below the intrapulmonary pressure generated in the case of spontaneous exhalation, this condition may not be reached and the breathing pressure after shutter opening will significantly exceed the shutter opening pressure. Therefore, it may be advantageous to use an adaptive shutter opening algorithm based on pressure analysis and rate of pressure change within the flow tube. For example, the pressure must exceed a predetermined level and/or an expected level of airway occlusion set for testers of different age groups. In addition to this, it may also be advantageous to control the rate of pressure increase during occlusion and initiate shutter opening after the rate falls below a predetermined level. The decrease in the rate of pressure increase during occlusion may be an indication that the lung pressure is close to the maximum that it can be generated by the subject during spontaneous exhalation. If the shutter is opened at this time, it is almost impossible to increase the lung pressure further (if the tester does not purposely make additional effort) due to rapid air ventilation from the lungs.

It will be appreciated that attempts by the tester to force an exhalation violate this method and corrupt the measurement data. Figure 16 shows possible types of errors caused by incorrect exhalation. Fig. 16a shows a normal trial (dashed line) and two "false" trials, generated by the same tester, intentionally trying to exhale faster during occlusion and speeding up the exhalation after occlusion. The peak flow caused by shutter opening in all three tests was almost the same, but the shape of the airflow peak waveform was essentially different due to forced airflow being too fast. Peak flow at peak may provide almost correct data for calculating airway resistance, but attempting to determine lung parameters from the peak waveform (150-.

Figure 16b shows three "false" trials by the same tester, intentionally starting with a rapid exhalation from the beginning of the test. Forced expiration resulted in a short occlusion of about 0.1s, with peak flow rates of 5-6l/s significantly higher than that measured during normal testing. As mentioned above, the data from these experiments cannot be used to calculate lung parameters.

The proposed device may be advantageous to implement a trial selection algorithm to identify that an incorrect trial was performed applying unnecessary brute force during exhalation. Such a trial should be rejected and a warning message may be generated to provide guidance to the tester.

Fig. 17 shows another possible embodiment of a breathing apparatus. The flow-pressure element of the device is based on a venturi. The operation of the device is similar to that of the first embodiment described above. The measuring sensor 8 measures a positive pressure difference with respect to the ambient pressure during the occlusion phase and then a negative pressure difference as the air flows through the venturi after the shutter opens.

As the measurement sensor 8, a thermal micro flow sensor of a volume thermal type is used, such as LBA series from Sensortechnics or AWM series from Honeywell, which is packaged to have two ports through which a flow rate is measured. This type of sensor has a wide dynamic range, operating on the order of about 2kPa to a fraction of Pa, a property that is important for measuring oral pressure that can reach levels of 1-2 kPa. At the same time, the sensor provides low noise and high resolution at low differential pressures, which is important for flow measurements using a venturi, pitot tube, or other type of flow-to-pressure converter.

The sensitivity of known calorimetric sensors is proportional to atmospheric pressure, and additional sensitivity correction is typically required due to changes in atmospheric pressure. A useful feature of the proposed design based on a thermal micro-flow sensor for measuring oral pressure and flow is that the airway resistance measurement does not require atmospheric pressure correction. Simplification of this device is possible because although separate measurements of oral pressure and flow are affected by ambient pressure, airway resistance is dependent on their proportions and is not affected by changes in atmospheric pressure.

Previous considerations generally apply to changes in the sensitivity of pressure sensors caused by other factors such as temperature changes or long term instability. If both measurements are done by one sensor and the airway resistance is determined by their ratio, the end result is not affected by possible sensitivity variations. Note that for each of these measurements, the use of two different sensors may result in complete inaccuracies, as their sensitivities may be different.

As described in one embodiment above, by adjusting the positions of the permanent magnets in the shutter module and varying their number and/or magnetic strength, a degree of shutter opening pressure can be set in accordance with the permanent magnets. If the opening of the shutter is adaptively initiated when certain conditions of pressure and rate of pressure increase are reached during occlusion, the attractive force near the position of the at least one magnet may be intentionally reduced sufficiently to open the shutter long enough, by moving the at least one permanent magnet from a metal ring, or by using additional electromagnets that counteract the permanent magnets.

The described embodiments illustrate the main criteria for the construction of a device for implementing the proposed method. The design of the flow tube in combination with the pressure sensor can be simplified so that only one measurement sensor is needed to measure oral pressure and air flow. Pressure sensors measuring in the range of about 2kPa with a resolution better than 0.5-l Pa are acceptable for this application without the need for accurate measurement of air flow rates below about 0.21/s.

It should be noted that a person skilled in the art may use additional technical solutions to improve and extend some features of the device. For example, more advanced shutters may be used to provide faster opening or more accurate control of the opening pressure. At the same time, the shutter opening and closing in the breathing cycle can also be synchronized to make measurements continuously during quiet breathing.

The design of the functional element that generates a negative pressure when flowing through the tube may also differ from the design described in the embodiments.

The method can be implemented using existing flow meters for one of the standard lung function tests. In this case, a shutter with a pressure sensor for pressure measurement should be installed on the flow tube. In general, devices that implement conventional interrupt techniques can also be used if their flow meters are fast enough to accurately measure flow peaks after shutter opening, and the order of flow and pressure measurements is changed according to the disclosed method.

Fig. 18 shows a block diagram of a measuring device. As shown, the sensor 8 measures the pressure and flow in the pipe 1 as described, for example, above with reference to the embodiments of fig. 1, 11 and 17. A microcontroller or other suitable circuitry may be provided to control the recording of data in the memory. This is schematically shown as a flow and pressure recorder 20. The unit 20 may also be responsible for controlling the shutter in case the shutter is automatically released. The unit 20 may also monitor the pressure and flow signals and determine whether the measurement test has the correct characteristics to produce good data and provide an indication, such as an audio signal or beep, that should be repeated when the test is good and/or not good. For example, if forced expiration is detected, the test should be repeated.

A calculator for calculating airway resistance and/or compliance, calculated according to, for example, the above-described methods and equations, is schematically illustrated as unit 22 in fig. 18. It will be appreciated that the module may be provided in software in a suitable microcontroller or other data processor.

Unit 22 may optionally indicate to the tester if the calculated value indicates that a treatment or symptom control medication is needed or not needed. Such calculations to determine the need or lack thereof for medication may use historical data of past measurements of the patient, and optionally external data such as local weather or pollution in the case of asthma control.

Units 20 and/or 22 may also be wirelessly coupled to flow tube 1 and sensor 8, for example using a bluetooth interface. In this case, a handheld computer, such as a smartphone, tablet or dedicated device, may receive pressure and flow data from the sensor 8 and perform storage and calculations using the computer. Through the application software used in the palm-top computer, the patient has access to rich interaction of data and its related analysis. The current measurements may be compared to historical data to indicate improvement or deterioration of the condition. The trial data may then also be shared with a locally coupled computer and a healthcare professional, for example over the internet, to obtain advice on the current condition.

In one embodiment, the apparatus 1, 8 has an electronic controller with a memory 20 for storing pressure and flow data from the test. The controller also includes an audio output and/or a visual signal output to signal to the user whether the test is good or needs to be repeated. The device may have its own battery and be portable. The device may also record the trial itself without the use of a computer device for displaying the data, or interact with the patient or a healthcare professional. Alternatively, the device may have a USB or other wired connector to transfer the test data from the memory 20 to a computer where further analysis or calculation may be performed. Such a wired connector may be used to charge a device.

The test data in the device may be encrypted. Software used in a computer that analyzes the test data may decrypt the test data. The use of the device may also be controlled such that the device can only be used with predetermined software and/or with predetermined subscriptions for authorized use. By allowing such control over the use and processing of data of the device, better quality of patient data processing and patient interaction may be ensured. If the subscription price can be paid over time as the device is used, the initial cost of purchasing the device can be reduced.