The mechanism of breath aerosol formation.

BACKGROUND Aerosol production during normal breathing is often attributed to turbulence in the respiratory tract. That mechanism is not consistent with a high degree of asymmetry between aerosol production during inhalation and exhalation. The objective was to investigate production symmetry during breathing. METHODS The aerosol size distribution in exhaled breath was examined for different breathing patterns including normal breathing, varied breath-holding periods, and contrasting inhalation and exhalation rates. The aerosol droplet size distribution measured in the exhaled breath was examined in real time using an aerodynamic particle sizer. RESULTS AND CONCLUSIONS The dependence of the particle concentration decay rate on diameter during breath holding was consistent with gravitational settling in the alveolar spaces. Also, deep exhalation resulted in a four- to sixfold increase in concentration, and rapid inhalation produced a further two- to threefold increase in concentration. In contrast, rapid exhalation had little effect on the measured concentration. A positive correlation of the breath aerosol concentration with subject age was observed. The results were consistent with the breath aerosol being produced through fluid film rupture in the respiratory bronchioles in the early stages of inhalation and the resulting aerosol being drawn into the alveoli and held before exhalation. The observed asymmetry of production in the breathing cycle with very little aerosol being produced by exhalation is inconsistent with the widely assumed turbulence-induced aerosolization mechanism.