Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection

Carbon monoxide diffusion capacity (DLCO) is negatively associated with patient survival in idiopathic pulmonary hypertension (PH), but is not included in the risk stratification score proposed by the 2015 European guidelines. Since 2015, several new stratification scores based on a 3- or 4-severity scale have been explored. This retrospective cohort single-center study sought to investigate the association between DLCO and PH severity and survival. We included 85 treatment-naive patients with precapillary PH and DLCO measurement at diagnosis. DLCO status, based on lower and upper quartiles ranges, was added to a 3- and a 4-strata modified-risk assessment. DLCO was strongly associated with transplant-free survival (HR 0.939, 95% CI: 0.908–0.971, p < 0.001). In the intermediate and high-risk categories, DLCO was associated with transplant-free survival, irrespective of the risk category (HR 0.934, 95% CI: 0.880–0.980, p = 0.005). The correlation between modified-risk category and transplant-free survival was significant (HR 4.60, 95% CI: 1.294–16.352, p = 0.018). Based on the Akaike information criterion (AIC) levels, the 3- and 4-strata modified-risk stratification fits our results better than the conventional stratification. Low DLCO is associated with patient transplant-free survival, independently of the risk category. Inclusion of DLCO into a PH risk stratification score seems promising and needs further investigation.

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The COPD Assessment Test as a Prognostic Marker in Interstitial Lung Disease

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.4137/ccrpm.s40792 ◽

2016 ◽

Vol 10 ◽

pp. CCRPM.S40792 ◽

Cited By ~ 5

Author(s):

Fujiko Someya ◽

Takao Nakagawa ◽

Naoki Mugii

Keyword(s):

Carbon Monoxide ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Rank Test ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Lung Diffusion ◽

Diffusion Capacity ◽

Copd Assessment Test ◽

One Year

The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT), which was developed to measure the health status of patients with COPD, was applied to patients with interstitial lung disease, aiming to examine the CAT as a predictor of outcome. Over a follow-up period of more than one year, 101 consecutive patients with interstitial lung disease were evaluated by the CAT. The CAT scores of 40 in total were categorized into four subsets according to the severity. Patients with higher (more severe) scores exhibited lower forced vital capacity and lung diffusion capacity for carbon monoxide. The survival rate was significantly lower in patients with higher scores (log-rank test, P = 0.0002), and the hazard ratios for death of the higher scores and lower lung diffusion capacity for carbon monoxide were independently significant. These findings suggest that CAT can indicate the risk of mortality in patients with interstitial lung disease.

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Risk factors for prolonged air leak and need for intervention following lung resection

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab243 ◽

2021 ◽

Author(s):

Aaron R Dezube ◽

Daniel P Dolan ◽

Emanuele Mazzola ◽

Suden Kucukak ◽

Luis E De Leon ◽

...

Keyword(s):

Risk Factors ◽

Carbon Monoxide ◽

Length Of Stay ◽

Wedge Resection ◽

Lung Resection ◽

Forced Expiratory Volume ◽

Air Leak ◽

Steroid Use ◽

Diffusion Capacity ◽

Prolonged Air Leak

Abstract OBJECTIVES Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention. METHODS Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution. Bronchoplastic reconstructions and lung-volume reduction surgeries were excluded. Incidence and risk factors for PAL and PAL requiring intervention were evaluated. RESULTS In total, 2384 patients were included. PAL incidence was 5.4% (129/2384); 22.5% (29/129) required intervention. PAL patients were more commonly male (56.6% vs 39.7%), older (mean age 69 vs 65 years) and underwent lobectomy or thoracotomy (all P < 0.001). Patients with PAL had longer length of stay (9 vs 3 days), more discharge needs and increased odds of complication (all P < 0.050). Twenty-nine patients required intervention (9 chest tubes; 4 percutaneous drains; 16 operations). In 50% of operative interventions, an air leak source was identified; however, the median time from intervention to resolution was 13 days. Patients requiring intervention had increased steroid use, lower diffusion capacity for carbon monoxide and twice the length of stay versus PAL patients (all P < 0.050). On univariable analysis, forced expiratory volume in 1 s (FEV1) <40%, diffusion capacity for carbon monoxide <50%, steroid use and albumin <3 had increased odds of intervention (P < 0.050). CONCLUSIONS Age, gender and operative technique were related to PAL development. Patients with worse forced expiratory volume in 1 s or diffusion capacity for carbon monoxide, steroid use or poor nutrition were less likely to heal on their own, indicating a population that could benefit from earlier intervention.

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Lung diffusion capacity for nitric oxide and carbon monoxide is impaired similarly following short-term graded exercise

Nitric Oxide ◽

10.1016/j.niox.2004.11.002 ◽

2005 ◽

Vol 12 (1) ◽

pp. 31-38 ◽

Cited By ~ 18

Author(s):

Gerald S. Zavorsky ◽

Larry C. Lands

Keyword(s):

Nitric Oxide ◽

Carbon Monoxide ◽

Short Term ◽

Lung Diffusion ◽

Diffusion Capacity ◽

Graded Exercise

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Progressive Reduction Of Diffusion Capacity Without Airflow Limitation: A Frequent Clinical Phenotype In Susceptible Smokers

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5882 ◽

2012 ◽

Author(s):

Ben-Gary Harvey ◽

Jacqueline Salit ◽

Ronald G. Crystal

Keyword(s):

Clinical Phenotype ◽

Airflow Limitation ◽

Progressive Reduction ◽

Diffusion Capacity

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Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease

Vojnosanitetski pregled ◽

10.2298/vsp1001036c ◽

2010 ◽

Vol 67 (1) ◽

pp. 36-41

Author(s):

Ivan Cekerevac ◽

Zorica Lazic ◽

Ljiljana Novkovic ◽

Marina Petrovic ◽

Vojislav Cupurdija ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Function ◽

Exercise Tolerance ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Diffusion Capacity ◽

Tolerance Level ◽

Lung Hyperinflation ◽

Copd Patients

Background/Aim. Peripheral muscle weakness and nutritional disorders, firstly loss of body weight, are common findings in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the impact of pulmonary function parameters, nutritional status and state of peripheral skeletal muscles on exercise tolerance and development of dyspnea in COPD patients. Methods. Thirty COPD patients in stable state of disease were analyzed. Standard pulmonary function tests, including spirometry, body pletysmography, and measurements of diffusion capacity were performed. The 6-minute walking distance test (6MWD) was done in order to assess exercise tolerance. Level of dyspnea was measured with Borg scale. In all patients midthigh muscle cross-sectional area (MTCSA) was measured by computerized tomography scan. Nutritional status of patients was estimated according to body mass index (BMI). Results. Statistically significant correlations were found between parameters of pulmonary function and exercise tolerance. Level of airflow limitation and lung hyperinflation had significant impact on development of dyspnea at rest and especially after exercise. Significant positive correlation was found between MTCSA and exercise tolerance. Patients with more severe airflow limitation, lung hyperinflation and reduced diffusion capacity had significantly lower MTCSA. Conclusion. Exercise tolerance in COPD patients depends on severity of bronchoobstruction, lung hyperinflation and MTCSA. Severity of bronchoobstruction and lung hyperinflation have significant impact on dyspnea level.

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