Phase V of the single-breath washout test.

A downward-deflecting phase V is often seen following the phase IV terminal rise in the single-breath N2 washout test (SB N2). This phase V was studied in eight normal nonsmoking subjects aged 27-41, using both the SB N2 test and single-breath washouts of boluses of inert tracer gas slowly inhaled from residual volume (RV). All of the subjects showed a distinct phase V in both tests. Expiratory flow rates between 0.1 and 2.0 1/s were used; at each flow rate phase V appeared shortly after expiration became flow limited. Thus the volume above RV at which phase V began increased with increasing expiratory flow rate. The difference between the exhaled volumes at which flow became limited and phase V appeared was shown to be approximately equal to the anatomic dead space. This behavior is predicted by a model of lung emptying in a gravitational field. As expiration proceeds, flow limitation occurs first in the (tracer-poor) lower lung regions and then progresses toward the (tracer-rich) upper lung regions causing phase IV. When all lung regions have finally become flow limited, the amount of flow from the upper regions decreases relative to that of the lower regions, thereby causing phase V.