Serial Estimations of Carbon Monoxide Diffusing Capacity in Intrapulmonary Haemorrhage

1981 ◽  
Vol 60 (5) ◽  
pp. 507-512 ◽  
Author(s):  
A. P. Greening ◽  
J. M. B. Hughes
Keyword(s):  
Carbon Monoxide ◽  
Haemoglobin Concentration ◽  
Diffusing Capacity ◽  
Clinical Context ◽  
Alveolar Volume ◽  
X Ray ◽  
Single Breath ◽  
Patients At Risk ◽  
Chest X Ray ◽  
Baseline Values

1. Serial estimations of the diffusing capacity for carbon monoxide, with a standard single-breath technique, were used to assist the monitoring of disease activity in patients at risk from intrapulmonary haemorrhage. 2. A reversible rise in diffusing capacity for carbon monoxide per unit alveolar volume (DLco/VA) of 50% or more above baseline values was detected on 61 occasions and in the diffusing capacity for carbon monoxide (DLco) alone on 45 occasions in 39 patients. 3. Concurrent with these rises in DLco/VA or DLco, two or more traditional indicators of intrapulmonary haemorrhage (haemoptysis, abrupt fall in haemoglobin concentration, chest X-ray opacities) were found on 47 occasions. 4. In the appropriate clinical context, acute reversible rises in DLco/VA or DLco reflect active intrapulmonary haemorrhage.

The effect of conductive ventilation heterogeneity on diffusing capacity measurement

2008 ◽  
Vol 104 (4) ◽  
pp. 1094-1100 ◽  
Author(s):  
Sylvia Verbanck ◽  
Daniel Schuermans ◽  
Sophie Van Malderen ◽  
Walter Vincken ◽  
Bruce Thompson
Keyword(s):  
Carbon Monoxide ◽  
Vital Capacity ◽  
Experimental Situation ◽  
Normal Subjects ◽  
Diffusing Capacity ◽  
Capacity Measurement ◽  
Alveolar Volume ◽  
Estimation Errors ◽  
Single Breath ◽  
Ventilation Heterogeneity

It has long been assumed that the ventilation heterogeneity associated with lung disease could, in itself, affect the measurement of carbon monoxide transfer factor. The aim of this study was to investigate the potential estimation errors of carbon monoxide diffusing capacity (DlCO) measurement that are specifically due to conductive ventilation heterogeneity, i.e., due to a combination of ventilation heterogeneity and flow asynchrony between lung units larger than acini. We induced conductive airway ventilation heterogeneity in 35 never-smoker normal subjects by histamine provocation and related the resulting changes in conductive ventilation heterogeneity (derived from the multiple-breath washout test) to corresponding changes in diffusing capacity, alveolar volume, and inspired vital capacity (derived from the single-breath DlCO method). Average conductive ventilation heterogeneity doubled ( P < 0.001), whereas DlCO decreased by 6% ( P < 0.001), with no correlation between individual data ( P > 0.1). Average inspired vital capacity and alveolar volume both decreased significantly by, respectively, 6 and 3%, and the individual changes in alveolar volume and in conductive ventilation heterogeneity were correlated ( r = −0.46; P = 0.006). These findings can be brought in agreement with recent modeling work, where specific ventilation heterogeneity resulting from different distributions of either inspired volume or end-expiratory lung volume have been shown to affect DlCO estimation errors in opposite ways. Even in the presence of flow asynchrony, these errors appear to largely cancel out in our experimental situation of histamine-induced conductive ventilation heterogeneity. Finally, we also predicted which alternative combination of specific ventilation heterogeneity and flow asynchrony could affect DlCO estimate in a more substantial fashion in diseased lungs, irrespective of any diffusion-dependent effects.

The Effect of Human Pregnancy on the Pulmonary Transfer Factor for Carbon Monoxide as Measured by the Single-Breath Method

1977 ◽  
Vol 53 (3) ◽  
pp. 271-276 ◽  
Author(s):  
J. A. Milne ◽  
R. J. Mills ◽  
J. R. T. Coutts ◽  
M. C. Macnaughton ◽  
F. Moran ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Transfer Factor ◽  
Post Partum ◽  
Previous History ◽  
Haemoglobin Concentration ◽  
First Trimester ◽  
Alveolar Volume ◽  
Single Breath ◽  
Pregnant State ◽  
Single Breath Method

1. The pulmonary transfer factor for carbon monoxide was measured by the single-breath method in 21 pregnant women with no previous history of cardiac or respiratory disease. Measurements were made at monthly intervals throughout pregnancy and once post partum. 2. The transfer factor was higher in the first trimester of pregnancy than in the non-pregnant state. There was a fall in the transfer factor during pregnancy until 26 weeks gestation, after which no further decrease was observed. 3. The changes in transfer factor were not explained by alterations in haemoglobin concentration or alveolar volume. 4. Simultaneous serial estimations of plasma 17β-oestradiol were performed in all the subjects. There was no obvious direct relation between changes in the concentration of this hormone and transfer factor measurements.

Effect of Blood Transfusion on the Carbon Monoxide Transfer Factor of the Lung in Man

1978 ◽  
Vol 54 (6) ◽  
pp. 627-631 ◽  
Author(s):  
Elizabeth H. Clark ◽  
R. L. Woods ◽  
J. M. B. Hughes
Keyword(s):  
Carbon Monoxide ◽  
Transfer Factor ◽  
Haemoglobin Concentration ◽  
Blood Transfusions ◽  
Alveolar Volume ◽  
Single Breath ◽  
The Mean ◽  
Haematological Disorders ◽  
Predicted Values ◽  
Normal Lungs

1. Ten studies were performed on nine patients with haematological disorders but with normal lungs, who required intermittent blood transfusions. The transfer factor for carbon monoxide and uptake of carbon monoxide per unit lung volume (KCO) were measured with the single breath technique before and at various intervals after transfusion. 2. The mean haemoglobin concentration increased from 7·7 to 11·1 g/dl. 3. The TLCO increased according to a formula based on the Roughton & Forster (1957) diffusion equations, TLCO (standardized) = TLCO (observed). (10·2 + Hb)/1·7 Hb, where haemoglobin (Hb) is expressed as g/dl. 4. The correlation between measured and predicted values was slightly better if changes in alveolar volume were taken into account, by using the KCO value.

Carbon monoxide diffusing capacity is a poor predictor of clinically significant bleomycin lung. New Zealand Clinical Oncology Group.

1990 ◽  
Vol 8 (5) ◽  
pp. 779-783 ◽  
Author(s):  
M J McKeage ◽  
B D Evans ◽  
C Atkinson ◽  
D Perez ◽  
G V Forgeson ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Respiratory Symptoms ◽  
Lung Toxicity ◽  
Lung Function Tests ◽  
Diffusing Capacity ◽  
Pretreatment Level ◽  
X Ray ◽  
Poor Predictor ◽  
Chest X Ray ◽  
Clinically Significant

In a retrospective analysis, serial lung function tests from 81 patients receiving bleomycin were studied to determine the accuracy of carbon monoxide diffusing capacity (DLCO) as a predictor of clinically significant bleomycin lung. Six of 81 patients developed clinically significant bleomycin lung, and the DLCO predicted its development in only one patient (sensitivity, one of six patients; 16.7%). Respiratory symptoms and chest x-ray abnormalities were the earliest manifestations in the other five patients. Seventy-five of 81 patients did not develop clinically significant bleomycin lung, and 12 of these had major falls (greater than or equal to 35% pretreatment level) in DLCO (specificity, 63 of 75 patients; 84.0%). In eight patients, bleomycin was continued after a major fall in DLCO, and none developed clinically significant lung toxicity. In this study, the DLCO failed to predict the development of serious bleomycin lung toxicity in all but one case. Furthermore, in some patients, it would appear that bleomycin may be stopped inappropriately after low DLCO measurements. It is important to monitor for respiratory symptoms and chest x-ray abnormalities during bleomycin treatment as these will be the earliest signs of lung toxicity in most cases.

AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1422.3-1423
Author(s):  
T. Hoffmann ◽  
P. Oelzner ◽  
F. Marcus ◽  
M. Förster ◽  
J. Böttcher ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Sensitivity And Specificity ◽  
Lung Function Test ◽  
Inflammatory Rheumatic Diseases ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray

Background:Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.Objectives:The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.Methods:The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.Results:The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.Conclusion:The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.Disclosure of Interests:None declared

A Theoretical Analysis of the Single Breath Diffusing Capacity for Carbon Monoxide

1980 ◽  
Vol BME-27 (4) ◽  
pp. 221-227 ◽  
Author(s):  
B. L. Graham ◽  
J. A. Dosman ◽  
D. J. Cotton
Keyword(s):  
Carbon Monoxide ◽  
Theoretical Analysis ◽  
Diffusing Capacity ◽  
Single Breath

Single Breath Carbon Monoxide Diffusing Capacity

1988 ◽  
Vol 137 (5) ◽  
pp. 1244-1244
Author(s):  
Edith Rosenberg ◽  
Margaret R. Becklake
Keyword(s):  
Carbon Monoxide ◽  
Diffusing Capacity ◽  
Single Breath

THE SINGLE BREATH DIFFUSING CAPACITY AND THE PERMEABILITY OF THE LUNGS OF NORMAL MAN

1963 ◽  
Vol 41 (1) ◽  
pp. 1283-1292
Author(s):  
Edith Rosenberg
Keyword(s):  
Molecular Sieve ◽  
The Other ◽  
Breath Holding ◽  
Diffusing Capacity ◽  
Alveolar Volume ◽  
Lung Volumes ◽  
Test Gas ◽  
Single Breath ◽  
Normal Man ◽  
Molecular Sieve Column

The single breath diffusing capacity for CO, DL, and the permeability of the lungs, K, were measured in six male and two female medical students at various lung volumes. The subjects rested 15 minutes before each test and the expired alveolar volume as well as breath-holding time and inspired volume were recorded on a spirogram. The test gas used consisted of 0.3% CO, 0.3% SF6, 20% O2, and the balance N2. The sample of alveolar gas expired after breath-holding was analyzed for CO and SF6 on a vapor fractometer using a 2-meter molecular sieve column. DL varied with the surface area of the subjects as well as with the alveolar volume at which the test was performed. K, on the other hand, was independent of the size of the subjects and decreased towards a constant value as lung volume became large. K should, therefore, be more reproducible than DL. The average permeability of the eight subjects used in this study was 0.0715 ml CO per second per ml of alveolar volume. In every experiment, alveolar volumes were also calculated from the SF6 dilution. These values, VD, were compared to alveolar volumes calculated from the maximum lung volumes, VA. For the males there was no measurable difference between alveolar volumes calculated by these two methods when 2 liters or more of test gas were inspired. It is suggested that the replacement of the measurement of DL in pulmonary function laboratories by an evaluation of K and VD may transform the single breath diffusing capacity test into a useful diagnostic tool.

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