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2010 International Conference on Science and Social Research (CSSR 2010), December 5 - 7, 2010, Kuala Lumpur, Malaysia

2010 CSSR 2010 Initial Submission

The Effect of Mild Stenosis to Flow in Trachea


K. Osman, W.M.Basri, N.H. Johari*, M.Rafiq
Faculty of Mechanical Engineering
Universiti Teknologi Malaysia,
81300 Skudai, Johor, Malaysia
*Faculty of Mechanical Engineering
Universiti Malaysia Pahang,
26600 Pekan, Pahang,
Malaysia
Tel: (6019) 9111787
E-mail: nhadi@ump.edu.my

Abstract Flow in the trachea is essential to be properly


understood since it is the inlet to the lungs. Disturbance to
this flow will disrupt the inlet conditions to both bronchi. In
this study, disturbance of flow due to mild stenosis is
investigated via numerical models. The effect of various
stenosis sizes, at the middle of the trachea, to the flow
pattern is studied and analyzed. 3D simplified trachea
models were used and different flow conditions were
applied. The results show two stages of pressure drop
behavior appear as the size of the stenosis reaches fifty
percent of the airway size. The inlet condition to the bronchi
is also significantly disturbed as the stenosis reaches fifty
percent.
KeywordsCFD; Trachea Stenosis; Pressure; Velocity

I.
INTRODUCTION
The tracheobronchial tree in human lung has gained
attraction as a subject of research either from medicalbased researchers or their non-medical counterpart. This
breathing organ used to be a biological vent or tube to
move the airflow and particles to the lower human airways
when the diaphragm is expended. For the flow inside
trachea, it is essential to be properly understood since it is
the primary inlet to the lungs. Any disturbance to this flow
will disrupt and alter the inlet boundary conditions to both
main bronchi.
Tracheal stenosis is one of the respiratory diseases that
obstruct the flow from moving deep down into the lung.
The progressive increment of tracheal stenosis sizes
before clinically impairment always experienced by
patient and when the constriction reaches certain values,
the pressure drop becomes critical and symptoms rapidly
happen [1]. Thus, investigation on airflow in tracheal
stenosis is widely open to be understood.
The trachea consists of cartilaginous and membranous
tube. The shape is quite cylinder and being flattened
posterior with most common shape of elliptical, circular,
D-shaped, C-shaped, U-shaped and triangular [2]. It
measures about 9-12cm in length and about 2-2.5cm in
diameters from side to side. Beneath the basement
membrane there is a distinct layer of longitudinal elastic

978-1-4244-8986-2/10/$26.00 2010 IEEE

367

fibers with a small amount of intervening alveolar tissue.


The submucous layer is composed of a loose mesh-work
of connective tissue, containing large blood vessels,
nerves, and mucous glands; the ducts of the latter pierce
the overlying layers and open on the surface. The
description of complex anatomy of trachea gave limited
access of usage in modeling the realistic tracheobronchial
for research purpose. Due to the fact that human lung has
an extremely complex asymmetric and irregular shape
varying substantially per individual, [3] the investigations
of airflow and particles inside human lung were proceed
with idealized simplified model. For this study, the
idealized model with simplify of shape and smooth walls
based on Schlesinger and Lippman model (1972) [4] were
used because this model is described as asymmetric and
subsequent bifurcation with opening angles most likely
cadavers. The stenosis shape was also most easily applied
to the Schlesinger and Lippman model because it can be
modified and modeled according to the medical disease
trachea.
Parallel with the advancing of computing technology,
numerical method of Computational Fluid Dynamics
(CFD) has been an eminent choice of method to study
flow in human airways. There have been many numerical
studies involving idealized smooth wall models in
determining the airflow and particle deposition analysis.
[5- 9]. However, studies on diseases tracheal have received
relatively small numbers of researchers. Mark et al. (2006)
[1] has focused on the effect of stenosis at trachea on how
stenosis affects pressure drops. Farkas et al. (2007) [10]
has studied on simulation of the effect of local
obstructions and blockage on airflow and aerosol
deposition in central human airways.
For this paper, the objective was to determine the effect
of tracheal stenosis to the flow pattern, with different sizes
of stenosis and types of breathing. The pressure and
velocity distribution inside trachea and main bronchi were
observed clearly and finally the models will provide a
quick result of how severe the breathing difficulty due to
this stenosis effect.

2010 CSSR 2010 Initial Submission

II.

METHODOLOGY

A. Airway Model
The geometry of the models used for this study is
based on human airway casts by Schlesinger and
Lippmann [4] study. This geometry was obtained from
the autopsy specimens of the human trachea and lungs
with no gross abnormalities. The cylinder shaped with
uniformed in diameter of trachea and main bronchi was
used because of the inconsistent shape of trachea and
main bronchi of an actual human airway. Asymmetric
shape between left and right bronchi begins at bifurcation
region. Detailed dimensions of the model are shown
Table 1. Referring to Figure 1, noted that left and right
refer to the anatomical orientation of the human body and
the location of the stenosis. This location of stenosis is
located at the middle of trachea region and it is parallel
with the proposal of stenosis location by L.Freitag (2007)
[11] as one of the regular locations of central tracheal
stenosis.
Table I: Dimensions used for the model based on
Schlesinger and Lippman geometry.
Diametera
(cm)
2.17
1.7

Length
(cm)
9.2
4.2

Right

Left

Stenosis
location

Fig. 1: A reconstructed model of normal trachea and


main bronchi with the indication of stenosis location

Angleb
(degree)

10%

Trachea
Right
15
bronchi
Left
1.26
5.3
30
bronchi
a
These values represent the mean of transverse diameters
at the midpoint of each branch
b
These values represent the angle of branching between
the indicated branch and its parent branch

20%

30%

40%
The Schlesinger model was then modified with
different sizes of mild stenosis (10% up to 50% out of
original trachea diameter). The mild stenosis was chosen
in this study for the purpose of early warning detection on
disturbed flow inside the trachea patient. According to
M.Brouns (2006) [1], patients of stenosis always referred
for treatment typically are asymptomatic until critical
narrowing of the airways occurs. Thus, the mild stenosis is
completed the objective of flow parameters analysis in
order to provide early warning detection. Shape of the
stenosis is developed with semi-circle shaped and placed
at around the location. This shaped is based on a simple
types of stenosis, quite similar with tapered transition and
scar stricture [11].
B. Boundary Conditions
The velocity inlet was used and applied at the inflow
boundary at trachea. It was assumed that the volume
distal to the respiratory bronchioles was the same through
the lung and the change in volume was the same at any
location. The temperature effect was assumed isothermal;
steady state condition with the used of constant Re.
Incompressible flow is assumed as this flow has low
March number. Also, no-slip boundary condition was
assumed [12] and the airways walls were assumed to be a
rigid body.

368

50%

Fig.2: Size of stenosis growth by diameter percentages at


predefined location of stenosis. Narrowing of diameter
sizes is made from 10 up to 50%
For a human breathing system, the frequency of
breathing differs based on the types of activity which
simultaneously resulting different values of Re. For this
study, there are three types of breathing condition which
are simulated based on different range of Re. These three
breathing conditions are resting, moderate and extreme.
Zheng Li et al. (2007) [13] had studied the human airway
flow of resting condition with Re of 1201. For moderate
breathing condition, Luo et al. (2004) [5] had made a
study by using the value of 3012 for Re that imposed this
condition of moderate. This study also used the velocity
inlet from Calay et al (2002) [14] for extreme breathing

2010 CSSR 2010 Initial Submission

condition with 4.66x104 of Re. The extreme breathing


condition occurred when heavy exercise activity took
place. From those three previous studies, Re for each
condition was collected and used in defining the
boundary conditions of this study. The air physical
properties and boundary condition parameters used for
this study are summarized in following Table 2 and Table
3 respectively.
Table II: Physical properties of airflow
Operating pressure (kPa)
101
Physical properties,
Density (kg/m3)
1.19
Viscosity (kg/ms-1)
1.82 x 10-5

Pressure Along the Model of Resting Condition With Stenosis


Constriction
1.000010

1.000000

0.999990

0.999980

P/Po

0.999970

20%
30%

0.999950

40%
50%

0.999940

0.999930

0.999920

0.999910

Table III: Summarized boundary condition parameters for


each condition of breathing
Moderate
Extreme
Parameters
Resting
(Luo et al.) (Calay et
(Zheng Li
al.)
et al.)
Re
1.201x103
3.012x103
4.66x104
Inlet diameter
0.0217
0.0217
0.0217
(m)
Inlet velocity
0.85
2.03
32.84
(m/s)
Inspiratory
18.7719
45
726
rate (l/min)
Pressure
101325
101325
101325
outlet (Pa)

20

40

60

80

100

120

140

160

180

200

L/Lo

Fig. 3:Pressure distribution across the airway model of


resting condition (Re=1.201x103)

RESULTS

Simulations were made on the airway models with


stenosis constriction and the results of these simulations
were analyzed in pressure and velocity driven
respectively.
A. Pressure Distribution
The effect of growth stenosis varies the pressure
distribution inside the airway model. In Fig. 3, pressure
distribution over the cross section along the airway model
is plotted as a function of length for flow of resting
condition. The effect of the constriction which is located
at L/Lo=63.0+1.0 is observed to be in same pattern of
curve but varied in magnitude and it shows significant
changes in pressure distribution in the respiratory system.
From Fig 3, pressure begins to drop as flow passes
through the stenosis constriction area. At 10% of stenosis
constriction, pressure distribution shows a very small
change as it passes through the constriction area. As size
of stenosis constriction increases to 20%, pressure starts to
drop after passing through stenosis constriction. This
event of pressure drop is repeated at 30% where at 30%
the pressure drop records even larger difference of
pressure from its previous sizes. As stenosis constriction is
increased in size, the pressure drop as flow passes through
the stenosis constriction also increases in magnitude.
Therefore, as observed from this study on resting
condition with stenosis constriction from 10 to 50% of
constricted size, the highest pressure drop is observed at
the downstream of 50% which it produces the higher
pressure gradient.

369

The same pattern of curve was obtained as referred to


Fig. 4 and Fig. 5 which is also the plot of pressure
distribution along the airway model as a function of length
for moderate and extreme breathing condition
respectively. Note that by comparing Fig. 3 with Fig. 4
and Fig. 5, the obtained range of maximum and minimum
of P/Po is different. Moderate breathing condition is larger
in range than the resting condition. This shows that
moderate condition experiences more pressure drop as
flow passes through the stenosis constriction, compared to
resting condition. Meanwhile, extreme condition has even
larger range than the moderate and resting condition. The
same event of pressure drop can be interpreted from Fig. 5
of extreme condition when comparison with resting and
moderate condition is made where extreme condition has
more pressure drop than resting and moderate condition.
Pressure Along the Model of Moderate Condition With Stenosis
Constriction
1.000100

1.000000

0.999900

P/Po

III.

10%
0.999960

10%
0.999800

20%
30%
40%
50%

0.999700

0.999600

0.999500
0

20

40

60

80

100

120

140

160

180

200

L/Lo

Fig. 4:Pressure distribution across the airway model of


moderate condition (Re=3.012x103)
As flow passes through the constriction area, pressure is
reduced which then resulting the pressure that enters the
main bronchi. The pressure at a location just before the
inlet of main bronchi was then plotted in Fig. 6 and Fig. 7
where for each size is compared with 10% of stenosis
constriction. The losses of pressure as the stenosis were
made increased show that the ratio of pressure drop at the
inlet of bronchi was also increased. The same pattern was
obtained as referred to Fig. 7 for moderate and extreme
condition.

2010 CSSR 2010 Initial Submission

condition. Referring to these figures, two trends of curve


were identified which it is denoted by the linear fitting
equations for each line. From 10 to 30% of stenosis
constriction for all three conditions, it is put in a group so
that it fits the equation of linear fitting. The same goes to
stenosis from 40 to 50%. Slope for each line is calculated
so that the risk of pressure drop can be determined
approximately as the stenosis constriction increases. By
comparing the slopes between those three conditions, it is
obtained that resting condition produces the lowest slopes
for both lines (10 to 30% and 40 to 50%). For moderate
condition, the acquired slopes are higher than slopes for
resting condition. This shows that the risk of pressure drop
increases as Re increases. The pattern of the slope is then
influenced by the size of stenosis constriction. Extreme
condition (with the highest in Re than resting and
moderate condition) generates the highest slopes,
compared to resting and moderate.

Pressure Along the Model of Extreme Condition With Stenosis


Constriction
1.020000

1.000000

0.980000

0.960000

0.940000
P/Po

10%
20%

0.920000

30%
40%
50%

0.900000

0.880000

0.860000

0.840000
0

20

40

60

80

100

120

140

160

180

200

L/Lo

Fig. 5:Pressure distribution across the airway model of


extreme condition (Re=4.66x104)

Correlation of (P/Po) Over Stenosis Constriction for Resting Condition

Comparison of Pressure at the Inlet of Bronchi for Each Size with 10% of
Stenosis Constriction (Resting and Moderate Condition)

0.00010

y=0.5470e-06x+0.7518e-06

y=0.0050e-03x-0.1625e-03

0.03
0.00009

2.12E-02

0.00007

0.00006

0.02

(P/Po)

Difference of Pressure at Bronchi Inlet Percentage (%)

0.00008

0.02

0.00005

Resting
Moderate

0.01
7.81E-03

0.00004

0.00003

6.92E-03
0.00002

0.01

3.57E-03
1.84E-03
0.00E+00

0.00
0

2.69E-03

0.00001

2.69E-03

3.49E-04

10

0.00000

20

30

40

50

10

20

30

40

50

Stenosis Constriction (%)

Stenosis Size (%)

Fig. 6:Pressure at a location just before the inlet of main


bronchi for each size, compared with pressure inlet at
main bronchi of 10% (resting and moderate
condition)

Fig. 8:Range of (P/Po) between maximum and minimum


for each stenosis constriction size of resting condition
Correlation of (P/Po) Over Stenosis Constriction for Moderate
Condition
0.00050

Comparison of Pressure at the Inlet of Bronchi for Each Size with 10% of
Stenosis Constriction (Moderate and Extreme Condition)

y=0.2985e-05x-0.9325e-05

y=0.0269e-03x-0.8911e-03

0.00045

6.00

0.00040

5.62E+00

0.00035

0.00030
(P/Po)

Difference of Pressure at Bronchi Inlet Percentage (%)

5.00

4.00

0.00025

0.00020
3.00

0.00015

Moderate
Extreme

0.00010
1.82E+00

2.00

0.00005

0.00000

1.00
6.07E-01

2.65E-01
0.00E+00

1.84E-03

10

20

7.81E-03

2.12E-02

30

40

50

0.00
0

10

20

30

40

50

Stenosis Constriction (%)


3.57E-03

Stenosis Size (%)

Fig. 7: Pressure at a location just before the inlet of main


bronchi for each size, compared with pressure inlet at
main bronchi of 10% ( moderate condition and
extreme condition)
From Fig. 3, 4 and 5, graphs of correlation were made
for those three conditions. The differences between
maximum and minimum of P/Po for each size of stenosis
constriction were calculated and plotted in Fig. 8 for
resting, Fig. 9 for moderate and Fig. 10 for extreme

370

Fig. 9:Range of (P/Po) between maximum and minimum


for each stenosis constriction size of moderate condition
By comparing the slope of 10 to 30% and 40 to 50%,
the severity of pressure drop for each condition can be
summarized as in Fig. 11. As observed from Fig. 11, the
severity of pressure drop for extreme condition shows the
highest in risk whereas the slope of 40 to 50% has
approximately 12 times higher of pressure drop than the
slope of 10 to 30%. More reduction in pressure due to
stenosis constriction means that the difficulty of breathing
is getting harder to perform.

2010 CSSR 2010 Initial Submission

Velocity Along the Model of Resting Condition With Stenosis


Constriction
Correlation of (P/Po) Over Stenosis Constriction for Extreme Condition
0.16000

y=0.0087x-0.3031

5.00

y=0.0007x-0.0038
4.50

0.14000

4.00

3.50

0.12000

3.00

(P/Po)

V/Vo

0.10000

10%
2.50

20%
30%

0.08000

2.00

40%
50%

1.50

0.06000

1.00
0.04000

0.50
0.02000

0.00
0

20

40

60

80

100

120

140

160

180

200

L/Lo

0.00000
0

10

20

30

40

50

Fig. 12: Velocity distribution along the airway model for


resting condition (Re=1.201x103)

Stenosis Constriction (%)

Fig. 10: Range of (P/Po) between maximum and


minimum for each stenosis constriction size of extreme
condition

Velocity Along the Model of Moderate Condition With Stenosis


Constriction
5.00

Comparison of Pressure Drop Between Slopes for Each Condition


(Interpreted from Fig. 8, 9 and 10)

4.50

1.40E+01

4.00

1.24E+01
3.50

1.20E+01
3.00

Risk of Pressure Drop

V/Vo

1.00E+01

10%
2.50

20%
30%

2.00

8.00E+00

40%
50%

1.50

6.00E+00
1.00

4.00E+00

0.50

0.00
0

2.00E+00

20

40

60

80

100

120

140

160

180

200

L/Lo

1.09E-01

1.11E-01

Fig. 13: Velocity distribution along the airway model for


moderate condition (Re=3.012x103)

0.00E+00
Resting

Moderate

Extreme

Breathing Condition

Fig. 11: Severity of pressure drop analyzed from slopes of


10 to 30% and 40 to 50%
B. Velocity Profile
Fig. 12, 13 and 14 demonstrate the velocity distribution
along the airway model. Basically, the results of velocity
distribution are conversed with the results of pressure
distribution. Again, the effect of stenosis growth varies
the velocity distribution inside the airway model. As flow
passes through the constricted area, velocity increases
dramatically. This event of increasing velocity when flow
passes through constricted area of stenosis is agreed with
the flow through orifice concept. Then, as flow travels
after stenosis through the remaining part of trachea,
velocity starts to reduce with slightly small in magnitude.
Reaching the bifurcation area, flow is then divided into
the division of bronchi where here it is clearly noted that
the velocity of flow (as it enters bronchi) shows a really
significant velocity reduction. Passing the main bronchi
and heading to the outlets, velocity seems to fluctuate.
This event of fluctuation is maybe due to the grid of
meshing used in the simulation.

371

Comparison is made on differences of velocity


magnitude at a location just before flow enters main
bronchi with velocity of 10% stenosis constriction.
Generally from Fig. 15 and 16, the plot of velocity tends
to decrease which is meant that the velocity at the location
just before flow enters the main bronchi is higher than its
velocity at 10% stenosis constriction for each condition.
Also, it is observed that velocity at the location before
flow enters the main bronchi is always higher than inlet
velocity at trachea and the accumulating magnitude of
velocity as it passes through stenosis constriction is
influenced by the size of stenosis constriction. The
dramatic raise of velocity as flow passes through stenosis
constriction simultaneously reduces pressure and as
pressure is reduced in the human airway, the driving force
for respiratory system is also reduced. This results in
difficulty of breathing.

2010 CSSR 2010 Initial Submission

from 10 to 50%. The results showed a series of pressure


drop as flow passes through the constriction area. As the
stenosis size increased, the range of pressure drop between
maximum and minimum of P/Po was also increased. For
10 to 50% of stenosis constriction, the severity of pressure
drop for extreme condition was approximately 12 times
higher than resting and moderate condition. As for
velocity distribution, flow showed increment in velocity
magnitude as it passed through the constriction. The
increment of velocity at larger size of constriction was
higher than the smaller size of constriction. Also, flow as
it entered the main bronchi was higher than its magnitude
at trachea inlet.
In conclusion, the size of stenosis constriction gives a
significant effect to the flow in an obstructed human
airway. Due to this constriction, the higher in magnitude
of pressure drop produces a harder condition in difficulty
of breathing. The interpretation of pressure drop is agreed
with the results of velocity distribution of this study.

Velocity Along the Model of Extreme Condition With Stenosis


Constriction
5.00

4.50

4.00

3.50

V/Vo

3.00
10%
2.50

20%
30%

2.00

40%
50%

1.50

1.00

0.50

0.00
0

20

40

60

80

100

120

140

160

180

200

L/Lo

Fig. 14:Velocity distribution along the airway model for


extreme condition (Re=4.66x104)
Comparison of Velocity at the Inlet of Bronchi for Each Size with 10% of
Stenosis
Constriction (Resting and Moderate Condition)
0.00E+00

ACKNOWLEDGMENT
Aid from Computational Fluid Mechanics Lab, UTM is
very much appreciated in the completion of this study.

0
0

10

20
-2.28E+01

30

40

50

-2.12E+01

Difference of Velocity at Bronchi Inlet Percentage (%)

-50

-6.08E+01
-6.08E+01

REFERENCES

-100
-1.14E+02
-1.14E+02

-1.14E+02

[1]

Resting
Moderate
-150

[2]
-1.98E+02

-200

[3]
-250

Stenosis Size (%)

Fig. 15: Velocity at a location just before the inlet of main


bronchi for each size, compared with velocity inlet at
main bronchi of 10% (resting and moderate condition)

[4]

[5]
Comparison of Velocity at the Inlet of Bronchi for Each Size with 10% of
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Difference of Velocity at Bronchi Inlet Percentage (%)

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Fig. 16: Velocity at a location just before the inlet of main


bronchi for each size, compared with velocity inlet at
main bronchi of 10% (moderate and extreme condition)

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IV. CONCLUSIONS
Firstly, this CFD method had solved a fluid dynamic in
the simplified model of human airway. The effects of
stenosis constriction at a predefined location were then
analyzed. The size of constriction was made increased

372

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