{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:28:36Z","timestamp":1790044116519,"version":"4.0.1"},"reference-count":52,"publisher":"Hindawi Limited","license":[{"start":{"date-parts":[[2012,1,1]],"date-time":"2012-01-01T00:00:00Z","timestamp":1325376000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pulmonary Medicine"],"published-print":{"date-parts":[[2012]]},"abstract":"<jats:p>Patients with severe COPD often exhale along the same flow-volume curve during quite breathing as during forced expiratory vital capacity manoeuvre, and this has been taken as indicating expiratory flow limitation at rest (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:msub><mml:mrow><mml:mtext>EFL<\/mml:mtext><\/mml:mrow><mml:mtext>T<\/mml:mtext><\/mml:msub><\/mml:mrow><\/mml:math>). Therefore,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:msub><mml:mrow><mml:mtext>EFL<\/mml:mtext><\/mml:mrow><mml:mtext>T<\/mml:mtext><\/mml:msub><\/mml:mrow><\/mml:math>, namely, attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow.<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:msub><mml:mrow><mml:mtext>EFL<\/mml:mtext><\/mml:mrow><mml:mtext>T<\/mml:mtext><\/mml:msub><\/mml:mrow><\/mml:math>leads to small airway injury and promotes dynamic pulmonary hyperinflation with concurrent dyspnoea and exercise limitation. In fact,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:msub><mml:mrow><mml:mtext>EFL<\/mml:mtext><\/mml:mrow><mml:mtext>T<\/mml:mtext><\/mml:msub><\/mml:mrow><\/mml:math>occurs commonly in COPD patients (mainly in GOLD III and IV stage) in whom the latter symptoms are common. The existing up-to-date physiological methods for assessing expiratory flow limitation (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mrow><mml:msub><mml:mrow><mml:mtext>EFL<\/mml:mtext><\/mml:mrow><mml:mtext>T<\/mml:mtext><\/mml:msub><\/mml:mrow><\/mml:math>) are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure (NEP) has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, non invasive, most practical, and accurate new technique.<\/jats:p>","DOI":"10.1155\/2012\/234145","type":"journal-article","created":{"date-parts":[[2012,9,12]],"date-time":"2012-09-12T02:44:04Z","timestamp":1347417844000},"page":"1-8","source":"Crossref","is-referenced-by-count":13,"title":["Methods for Assessing Expiratory Flow Limitation during Tidal Breathing in COPD Patients"],"prefix":"10.1155","volume":"2012","author":[{"given":"Nickolaos G.","family":"Koulouris","sequence":"first","affiliation":[{"name":"Respiratory Function Laboratory, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and \u201cSotiria\u201d Chest Disease Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Kaltsakas","sequence":"additional","affiliation":[{"name":"Respiratory Function Laboratory, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and \u201cSotiria\u201d Chest Disease Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios F.","family":"Palamidas","sequence":"additional","affiliation":[{"name":"Respiratory Function Laboratory, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and \u201cSotiria\u201d Chest Disease Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia-Antiopi","family":"Gennimata","sequence":"additional","affiliation":[{"name":"Respiratory Function Laboratory, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and \u201cSotiria\u201d Chest Disease Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"98","reference":[{"key":"1","first-page":"3","volume-title":"Tests of forced expiration and inspiration","year":"1999"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.6.2075"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2006.12.012"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.09.009"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1081\/COPD-120028700"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-006-0389-0"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2007.10.001"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00113204"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2010.497515"},{"issue":"6","key":"10","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1164\/ajrccm.154.6.8970362","volume":"154","year":"1996","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.98.12040799"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.6.528"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.56.9.713"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3003.2000.16b14.x"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.01.00057801"},{"issue":"5","key":"16","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1164\/ajrccm.164.5.2012122","volume":"164","year":"2001","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"issue":"3","key":"17","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1152\/jappl.1997.82.3.723","volume":"82","year":"1997","journal-title":"Journal of Applied Physiology"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1183\/9031936.99.14224599"},{"issue":"5","key":"19","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1152\/jappl.2001.91.5.2190","volume":"91","year":"2001","journal-title":"Journal of Applied Physiology"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.5.1625"},{"key":"21","first-page":"83","volume-title":"Ventilation","year":"1986"},{"issue":"1","key":"22","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/0002-9343(54)90325-3","volume":"16","year":"1954","journal-title":"American Journal of Medicine"},{"key":"23","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1152\/jappl.1953.5.12.779","volume":"5","year":"1953","journal-title":"Journal of Applied Physiology"},{"key":"24","first-page":"676","volume":"83","year":"1961","journal-title":"American Review of Respiratory Disease"},{"key":"25","first-page":"23","volume":"77","year":"1971","journal-title":"Scandinavian Journal of Respiratory Diseases. 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