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Review Article

Time Constant: What Do We Need to Know to Use It?

Madhuragauri S. Shevade1,2
1
Training Programmes Division, Chest Research Foundation, Symbiosis Center for Research and Innovation, Symbiosis International (Deemed) University,
2

Pune, Maharashtra, India

Abstract
Mechanical ventilation is an important strategy to manage patients with respiratory ailments in the acute as well as chronic setups. To be able
to do so, we need a good understanding of the physiology of the respiratory system and the disease pattern. Two major components of the
lung physiology are compliance and resistance and these define time constants (TCs). Compliance is the measure of distensibility of lungs. It
is the change in pressure by the change in volume. Resistance is the opposing force that is created when air flows in the airway. Compliance
and resistance together produce an entity called TC. TC defines the amount of time taken in seconds for the lung unit to fill or empty. TCs
normally vary within the lungs and do more so in the diseased lungs. This article gives an overview of TCs and its components for the better
understanding of the reader.

Keywords: Compliance, resistance, time constant

Introduction Compliance
In India, millions of patients suffer from respiratory Compliance is nothing but the measure of how stretchable
diseases such as asthma, chronic obstructive pulmonary or elastic the lungs are. It is determined by the change in
diseases (COPDs), acute respiratory distress syndrome volume (ΔV) by the change in pressure (ΔP) in the lungs as
(ARDS), tuberculosis, pneumonia, and lung cancer.[1,2] follows:[3]
Management of these diseases involves pharmacological ∆V
Compliance = L / cmH 2 O
management and adjunct therapies such as mechanical ∆P
ventilation, pulmonary rehabilitation, nutrition, and
counseling. Out of all these therapies, mechanical ventilation Normal lung compliance is 60–100 ml/cmH2O.[4] In general, a
is definitely an important aspect of managing patients with high compliance is seen in disease conditions such as COPD,
acute as well as chronic respiratory illnesses. It reduces the where the lungs can easily stretch but do not recoil back to normal
due to the obstruction within the airways. It takes a longer amount
work required for the lungs to breathe, thereby allowing
of time to exhale the volume out. In such cases, air is unable to
them to rest and resolve the underlying issue. Every decision
effectively come out from the lungs causing air trapping and
right from the selection of the ventilator to choosing the
hyperinflation. Poor compliance or low compliance is seen in
mode and its settings depends on the patient’s history, age,
diseases such as cystic fibrosis where the lung parenchyma is
gender, pathophysiology of the disease as well as the severity stiff and does not easily stretch. This abnormal lung compliance
of the disease. It is therefore pertinent for clinicians to have results in an increased work of breathing. With high compliance,
a thorough understanding of the basic physiology of the it takes more work for the lungs to remove the air, whereas, with
respiratory system before proceeding to decide the mode low compliance, more effort is required to fill air in the lungs.
and its settings. The fundamental characteristics of lung
physiology, compliance, and resistance determine how the Address for correspondence: Ms. Madhuragauri S. Shevade,
lungs inflate or deflate and the amount of time required for Chest Research Foundation, 15, Marigold Premises, Kalyani Nagar,
Pune ‑ 411 014, Maharashtra, India.
it is known as the time constant (TC). This article discusses
E‑mail: [email protected]
these characteristics and the concept of TC.
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DOI:
10.4103/ijrc.ijrc_7_18 How to cite this article: Shevade MS. Time constant: What do we need to
know to use it? Indian J Respir Care 2019;8:4-7.

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Shevade: Time constant

Resistance
The resistance or opposing frictional forces to the flow of
air during respiration are known as airway resistance.[5,6] It
is the difference in pressure at the mouth and pressure in the
alveoli (ΔP), divided by the flow of air (V ).
Airway resistance (Raw) is generally calculated by using
∆P
R aw = cmH2O/L/s.
V
According to fluid dynamics, resistance can be calculated using
the Hagen–Poiseuille equation as shown below:[6]
8ηlV
∆P =
πr 4
where
Figure 1: The pattern of laminar flow versus turbulent airflow
• ΔP is pressure difference between two ends of a
cylinder (alveoli and mouth)
• Ƞ is the viscosity of the gas that both lung compliance and airway resistance are affected
• l is the length of the airway by external factors such as the endotracheal tube and ventilator
settings.
• V is airflow
• r4 is the radius raised to the power of 4. With increased obstruction in the lungs, the airway resistance
increases. Obstruction may be caused by excessive mucous
8hl secretions, inflammation in the airway, contraction of the
Thus, Raw =
πr 4 smooth muscle during an asthma exacerbation, or tumors in the
Normally, some amount of resistance of about 0.5 cm wall of airway or outside the surrounding airway. Resistance
H2O/L/s–2.5 cm H2O/L/s[7] is always present in the airways. tends to reduce with bronchodilation.
This means, to move 1 L/s flow of gas in or out of the lungs,
Clinically, resistance is measured with the advanced pulmonary
a healthy individual requires to generate a pressure of about
function test called the body plethysmography and the values
0.5 cmH2O–2.5 cmH2O less than the atmospheric pressure.[7]
obtained help understand the extent of the disease.[6]
This resistance changes through the various generations of
the airways within the lungs due to the structural differences.
What is Time Constant?
Raw depends on multiple factors that either increase or decrease
resistance. One of the factors is the radius or the cross‑sectional TC is the amount of time taken by the lung unit to
area of the airway. Raw is high when the diameter of the airway fill during inhalation (inspiratory TC) or empty during
is small and as per Hagen–Poiseuille equation discussed exhalation (expiratory TC) at a stable pressure.[7,8] TC is a
previously in this article, a reduction in the radius increases single parameter that can tell us about the overall respiratory
the resistance multifold. characteristics. It is measured in seconds and is a product of
compliance and resistance.
Laminar airflow or turbulent airflow also determines the
amount of resistance that is created in the airway. When the TC = CL × Raw
air tends to flow in a straight or linear fashion, it is said to be where
laminar flow. Laminar airflow has less resistance and generally • TC is 1 TC
seems to be present in the smaller airways. Turbulent flow • CL is the lung compliance
is created when there is a high flow of gas passing through • Raw is the airway resistance.
a large diameter airway. The flow of the air is nonlinear or
random [Figure 1]. One TC is the time required to fill or empty 63% of the lung
Airway resistance is varied throughout the airway and tends unit.[7,9] Two TCs fill 86% of the lung unit and three TCs fill
to be highest in the midsized airways in the 4–8 generations.[3] 95% of the lung unit.[7,9] At the end of five TCs, the lung is
Further, along the generations of airway, even though the said to be 100% full.[7,9] This happens when the lung is free
diameter reduces, the resistance also tends to reduce as the from any disease condition. For normal lungs with a total
airways are shorter with multiple branches. Thus the resistance compliance of 0.1 L/cmH2O and Raw of 1.0 cmH2O/L/s, the
is distributed within the small airways making the combined TC is 0.1 s.[8]
resistance effectively small.
Exponential functions
These characteristics help us understand the variations that are Respiratory system correlates with exponential functions
seen in various disease conditions. It must also be remembered which are mathematical expressions that give an account of an

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Shevade: Time constant

event where the rate of change of one variable is proportional increase in the airway resistance.[8] Thus, it takes a longer time
to its magnitude.[10,11] to fill or empty the lung unit, giving rise to a longer TC. Such
patients require higher expiratory times typically followed
For example, the flow at the beginning of the expiration
while setting respiratory rates on the mechanical ventilator. If
is greater than that at the end of expiration. In mechanical
longer expiratory times are not given to these patients, it may
ventilation, there are two functions that are of clinical
lead to incomplete exhalation causing breath stacking and air
significance. The rising exponential function denotes an
trapping.[8] The resultant hyperinflation leads to an increase
increase in one variable as a function of time.[10,11] For example, in the work of breathing, making the patients breathless and
in a pressure‑controlled mode, the rate of change of volume at fatigued. This hyperinflation also increases the workload on
the beginning of expiration is greater than that at the end. The the heart leading to heart failure. Bronchodilator therapy also
exact opposite happens in decaying exponential function where improves TC by reducing Raw in an asthmatic lung and reduces
there is a decrease in one variable as a function of time.[10,11] the severity of sleep apnea.[13]
This information forms the basis of TC and has a major impact Fibrotic lung disease
on disease management such as diagnosing a lung condition In fibrotic lung diseases such as cystic fibrosis and interstitial
and selection of appropriate settings on the mechanical lung diseases, the compliance of the lungs is low. This results
ventilator. Certain ventilators are manufactured with an inbuilt in lungs filling with air quicker than lungs with normal
setting that can display a real‑time TC value.[12] This is helpful compliance. In the same way, they empty quickly due to the
while the patient is in the prone position for lung recruitment. high elastic recoil. Thus, the resultant TC is smaller.
Kinking, biting, dislodged tube, or secretions in the Obstructive sleep apnea
endotracheal tube can also be identified by assessing TC. In disease conditions such as obstructive sleep apnea (OSA), which
are often found overlapping with COPD, lung characteristics
What Role Does TC Play on the Respiratory affect the severity of the disease.[13] Interestingly, increased CL
along with hyperinflation proves to be a protective mechanism
System and Disease Management? from sleep apnea. However, an increase in Raw alleviates sleep
There are various factors that govern how much time it takes to apnea and its symptoms.[13] High CL and Raw in such patients
fill the lung. As mentioned above, TC depends on the person’s delay the lung emptying leading to an increased TC. A recent
lung compliance and airway resistance. Normally, these study has shown that an increased expiratory TC of more than
factors vary throughout the lungs. This variation affects how 0.5 s is associated with 11 times more chances of developing
ventilation takes place in the lungs. The pressures and volumes severe sleep apnea.[13] Thus, strategies to reduce increased Raw
will differ depending on TC of the lung unit [Figure 2]. will perhaps be an important key in the management of OSA.
Obstructive airway disease Acute respiratory distress syndrome
When obstruction and inflammation is present in the airways Conventionally, TC is calculated using the single breath
of patients with diseases such as COPD and asthma, there is an technique with the assumption that all lung units have
homogeneous TC. However, as discussed above, TC varies
with external factors such as disease state, the resistance
caused by endotracheal tube, the ventilator circuit, and the
expiratory valve of the ventilator.[14] These variables are flow
dependent, so an increase in flow leads to elongated expiratory
time leading to increased TC.[14] ARDS is a very heterogeneous
disease condition with a significant amount of lung injury, and
the time needed to inflate and deflate the lung unit is different.
As compared to the uninjured lung, the heterogeneity within
the lung characteristics and TC is much greater.[15] To determine
the inflation/deflation time more accurately, imaging studies of
the lung using computed tomography scans have proven to be
a better method in animal studies.[15] These imaging studies can
calculate the actual values of TC, which can perhaps be used
in clinical practice as a disease management tool. With this
technique, difference between localized TC and the overall TC
of the lung can also be seen.[15] Further research is warranted
to have a better clarity of this area.

Figure 2: The effect of obstruction and restriction on the breath and Mechanical ventilation
time constant during inspiration and expiration (Adapted from West JB, The type of mechanical ventilatory mode (volume vs. pressure)
Respiratory Physiology: The essentials, 4th Ed, 2000, Williams and Wilkins) that is set results in different TCs and its effects.[7] In disease

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Shevade: Time constant

conditions leading to abnormal compliance and resistance, Financial support and sponsorship
TCs vary even more. Nil.
It is important to know the TC and the variations in it while Conflicts of interest
managing the patient on the mechanical ventilator. There are no conflicts of interest.
For example, if the compliance is 0.1 L/cmH2O and resistance
is 2 cmH2O/L/sec, the TC is TC = C × Raw = 0.1 × 2 = 0.2 s. References
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