Most normal subjects do not exhibit expiratory flow limitation even during maximal exercise. In contrast, patients with severe chronic obstructive pulmonary disease (COPD) often exhibit it even at rest, i.e. they exhale tidally along their maximal flow-volume curve. This promotes dynamic hyperinflation with a concomitant increase in work of breathing and impairment of inspiratory muscle function. This contributes to dyspnea and is probably the main cause of ventilatory failure in patients with COPD.

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