The mechanism limiting forced expiratory flow is explained on the basis that a local flow velocity reaches the local speed of wave propagation at a point, called the choke point, in intrathoracic airways. This theoretical approach to the "waterfall effect" leads to selection of the analogy of constricted open-channel flow to apply to the elastic network of airway tubes. Quantitative results are derived for the case of negligible friction by use of the Bernoulli principle. Shapes predicted for the maximum-flow static recoil curves depend only upon the nature of the pressure-area curve at the choke point in the case of negligible friction; and the magnitude of the critical rate of flow depends on reference values of cross-sectional area and elastic modulus at the choke point, on gas density, and on the static recoil pressure. The present theoretical results are used to interpret previous experiments, but quantitative applicability is limited because of frictional effects and lack of knowledge of choke point conditions.

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A California Environmental Protection Agency (Cal/EPA) report concluded that a reasonable and likely explanation for the increased lung cancer rates in numerous epidemiological studies is a causal association between diesel exhaust exposure and lung cancer. A version of the present analysis, based on a retrospective study of a U.S. railroad worker cohort, provided the Cal/EPA report with some of its estimates of lung cancer risk associated with diesel exhaust. The individual data for that cohort study furnish information on age, employment, and mortality for 56,000 workers over 22 years. Related studies provide information on exposure concentrations. Other analyses of the original cohort data reported finding no relation between measures of diesel exhaust and lung cancer mortality, while a Health Effects Institute report found the data unsuitable for quantitative risk assessment. None of those three works used multistage models, which this article uses in finding a likely quantitative, positive relations between lung cancer and diesel exhaust. A seven-stage model that has the last or next-to-last stage sensitive to diesel exhaust provides best estimates of increase in annual mortality rate due to each unit of concentration, for bracketing assumptions on exposure. Using relative increases of risk and multiplying by the background lung cancer mortality rates for California, the 95% upper confidence limit of the 70-year unit risks for lung cancer is estimated to be in the range 2.1 x 10(-4) (microg/m3)(-1) to 5.5 x 10(-4) (microg/m3)(-1). These risks constitute the low end of those in the Cal/EPA report and are below those reported by previous investigators whose estimates were positive using human data.

The resistance and reactance of lower airways were measured as functions of the frequency and amplitude of periodic flow in three healthy subjects by relating flow, produced with a piston pump, to the difference between lateral tracheal and alveolar pressure, estimated plethysmorgraphically. Resistance consistently increased with frequency; reactance was small never exceeding resistance. This result cannot be explained by distortion of velocity profiles by inertia because, in long pipes, resistance increases only when inertial forces are large and reactance exceeds resistance. Theoretical analyses of airway resistance suggested that the results reflected inhomogeneity. In lung models which considered airway wall distensibility and inertial reactance of airways, resistance increased with frequency and inertial reactance was small. These results imply that in health, as in lung disease, resistance is determined by the distribution of resistance and reactance within the lung and is not simply the total resistance of the individual airways. As flow amplitude increased at constant frequency, flow-pressure relationships became distorted and resistance increased, due probably to motion of airway walls and further distortion of velocity profiles