On the mechanics of inhaled bronchial transmission of pathogenic microdroplets generated from the upper respiratory tract, with implications for infection onset

TL;DR

This study uses detailed airway modeling and airflow simulations to show that larger respiratory droplets from the upper airway can penetrate deep into the lungs, potentially explaining rapid infection onset.

Contribution

It combines CT-based 3D airway reconstruction with LES airflow simulation and mathematical modeling to analyze the transport of mucus-derived microdroplets during inhalation.

Findings

Deep lung penetration of 10-15 micron droplets is significant.

URT-derived droplets can carry high viral loads to the bronchial spaces.

Numerical results align with simplified mathematical models.

Abstract

Could the microdroplets formed by viscoelastic stretching and break-up of mucosal liquids in the upper respiratory tract (URT), when inhaled further downwind, explain the brisk pace at which deep lung infections emerge following onset of initial infection at the URT? While it is well-established that particulates inhaled from outside can possibly penetrate to the lower airway only if they are < 5 microns, the fate of particulates (many > 5-microns in diameter) sheared away from the intra-URT mucosa during inhalation remains an open question. These particulates predominantly originate at the nasopharynx, oropharynx, and laryngeal chamber with the vocal folds. To resolve the posed question, this study considers a CT-based 3D anatomical airway reconstruction and isolates the tract from the laryngeal vocal fold region, mapping the entire tracheal cavity and concluding at generation 2 of the tracheobronchial tree. Through the delineated geometry, airflow simulation is conducted using the LES scheme to replicate relaxed inhalation at 15 L/min. Against the ambient air flux, numerical experiments have been performed to monitor the transport of liquid particulates with diameters 1-30 microns, bearing physical properties akin to aerosolized mucus with embedded virions. The full-scale numerical transmission trends to the lower airway were found consistent with the findings from a reduced-order mathematical model that conceptualized the impact of intra-airway vortex instabilities on local particle transport through point vortex idealization in an anatomy-guided 2D potential flow domain. The results collectively demonstrate markedly elevated trends of deep lung penetration by the URT-derived particulates, even if they are as large as 10- and 15 microns. The high viral load carried by such droplets to the bronchial spaces could mechanistically explain the accelerated seeding of infection in the lungs.