scholarly journals Lung diffusing capacity for nitric oxide measured by two commercial devices: a randomised crossover comparison in healthy adults

2021 ◽  
pp. 00193-2021
Author(s):  
Thomas Radtke ◽  
Quintin de Groot ◽  
Sarah R. Haile ◽  
Marion Maggi ◽  
Connie C. W. Hsia ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Reference Values ◽  
Mixed Models ◽  
Fixed Effects ◽  
Healthy Adults ◽  
Test Interpretation ◽  
Diffusing Capacity ◽  
Alveolar Volume ◽  
Single Breath ◽  
Random Intercept

In Europe, two commercial devices are available to measure combined single-breath lung diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) in one maneuver. Reference values were derived by pooling datasets from both devices, but agreement between devices has not been established.We conducted a randomised crossover trial in 35 healthy adults (age 40.0±15.5 years, 51% female) to compare DLNO (primary endpoint) between MasterScreen™ (Vyaire Medical, USA) and HypAir (Medisoft, Belgium) devices during a single visit under controlled conditions. Linear mixed models were used adjusting for device and period as fixed effects and random intercept for each participant.Difference in DLNO between HypAir and MasterScreen was 24.0 mL·min−1·mmHg−1 (95% CI 21.7 to 26.3). There was no difference in DLCO (−0.03 mL·min−1·mmHg−1, 95% CI −0.57 to 0.12) between devices while alveolar volume (VA) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45 to 0.52). Disparity in the estimation of VA and the rate of NO uptake (KNO=DLNO/VA) could explain the discrepancy in DLNO between devices. Disparity in the estimation of VA and the rate of CO uptake (KCO=DLCO/VA) per unit of VA offset each other resulting in negligible discrepancy in DLCO between devices. Differences in methods of expiratory gas sampling and sensor specifications between devices likely explain these observations.These findings have important implications for derivation of DLNO reference values and comparison of results across studies. Until this issue is resolved reference values, established on the respective devices, should be used for test interpretation.

scholarly journals Diffusing capacity for nitric oxide: Reference values and dependence on alveolar volume

2007 ◽  
Vol 101 (7) ◽  
pp. 1579-1584 ◽  
Author(s):  
Ivo van der Lee ◽  
Pieter Zanen ◽  
Nadine Stigter ◽  
Jules M. van den Bosch ◽  
Jan-Willem J. Lammers
Keyword(s):  
Nitric Oxide ◽  
Reference Values ◽  
Diffusing Capacity ◽  
Alveolar Volume

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.

Diffusing capacity dependent on lung volume and age in normal subjects

1994 ◽  
Vol 76 (6) ◽  
pp. 2356-2363 ◽  
Author(s):  
H. Stam ◽  
V. Hrachovina ◽  
T. Stijnen ◽  
A. Versprille
Keyword(s):  
Reference Values ◽  
Linear Method ◽  
Hemoglobin Concentration ◽  
Normal Subjects ◽  
Random Coefficients ◽  
Diffusing Capacity ◽  
Alveolar Volume ◽  
Lung Volumes ◽  
Conversion Method ◽  
Older Subjects

In this study we determined reference values of total diffusing capacity of carbon monoxide (DLCO) and DLCO per liter alveolar volume (DLCO/VA) at total lung capacity (TLC) and at lung volumes below TLC in sitting position. In 55 healthy nonsmoking volunteers (20–85 yr old), we determined reference values at TLC level in which age was the only parameter. In a subgroup (n = 16) these references did not change by correction for normal variability in hemoglobin concentration. In all volunteers DLCO decreased and DLCO/VA increased with decreasing VA. The increase in DLCO/VA was linear and less in older subjects. We derived equations to calculate reference values of DLCO/VA for lung volumes at and below TLC with two methods: 1) “random coefficients linear” model, which calculates the reference values directly, and 2) a conversion method, which calculates DLCO/VA for lower VA levels from reference values at TLC. An advantage of the conversion method is the suitability of DLCO/VA reference values at TLC of other populations. A disadvantage is the greater standard deviation of these reference values compared with those obtained by the random coefficients linear method. DLCO can be found by multiplying DLCO/VA with VA.

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.

Reference Values And Determinants Of Nasal Nitric Oxide In Healthy Adults

2011 ◽  
Vol 127 (2) ◽  
pp. AB53-AB53
Author(s):  
S. Kim ◽  
T. Kim ◽  
H. Kwak ◽  
S. Song ◽  
J. Sohn ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Reference Values ◽  
Healthy Adults ◽  
Nasal Nitric Oxide

Pulmonary diffusing capacities for oxygen-labeled CO2 and nitric oxide in rabbits

1998 ◽  
Vol 84 (2) ◽  
pp. 606-611 ◽  
Author(s):  
Hartmut Heller ◽  
Gabi Fuchs ◽  
Klaus-Dieter Schuster
Keyword(s):  
Nitric Oxide ◽  
Mass Spectrometry ◽  
Mean Value ◽  
Breath Holding ◽  
Breath Hold ◽  
Diffusing Capacity ◽  
Membrane Component ◽  
Single Breath ◽  
Partial Pressures

Heller, Hartmut, Gabi Fuchs, and Klaus-Dieter Schuster. Pulmonary diffusing capacities for oxygen-labeled CO2 and nitric oxide in rabbits. J. Appl. Physiol. 84(2): 606–611, 1998.—We determined the pulmonary diffusing capacity (Dl) for18O-labeled CO2(C18O2) and nitric oxide (NO) to estimate the membrane component of the respective gas conductances. Six anesthetized paralyzed rabbits were ventilated by a computerized ventilatory servo system. Single-breath maneuvers were automatically performed by inflating the lungs with gas mixtures containing 0.9% C18O2or 0.05% NO in nitrogen, with breath-holding periods ranging from 0 to 1 s for C18O2and from 2 to 8 s for NO. The alveolar partial pressures of C18O2and NO were determined by using respiratory mass spectrometry. Dl was calculated from gas exchange during inflation, breath hold, and deflation. We obtained values of 14.0 ± 1.1 and 2.2 ± 0.1 (mean value ± SD) ml ⋅ mmHg−1 ⋅ min−1for[Formula: see text]and Dl NO, respectively. The measured[Formula: see text]/Dl NOratio was one-half that of the theoretically predicted value according to Graham’s law (6.3 ± 0.5 vs. 12, respectively). Analyses of the several mechanisms influencing the determination of[Formula: see text]and Dl NOand their ratio are discussed. An underestimation of the membrane diffusing component for CO2 is considered the likely reason for the low[Formula: see text]/Dl NOratio obtained.

scholarly journals Reference equations for pulmonary diffusing capacity of carbon monoxide and nitric oxide in adult Caucasians

2018 ◽  
Vol 52 (1) ◽  
pp. 1500677 ◽  
Author(s):  
Mathias Munkholm ◽  
Jacob Louis Marott ◽  
Lars Bjerre-Kristensen ◽  
Flemming Madsen ◽  
Ole Find Pedersen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Carbon Monoxide ◽  
Hold Time ◽  
Specific Conductance ◽  
Breath Hold ◽  
Diffusing Capacity ◽  
Single Breath ◽  
Capillary Membrane ◽  
Reference Equations ◽  
Hb Concentration

The aim of this study was to determine reference equations for the combined measurement of diffusing capacity of the lung for carbon monoxide (CO) and nitric oxide (NO) (DLCONO). In addition, we wanted to appeal for consensus regarding methodology of the measurement including calculation of diffusing capacity of the alveolo-capillary membrane (Dm) and pulmonary capillary volume (Vc).DLCONO was measured in 282 healthy individuals aged 18–97 years using the single-breath technique and a breath-hold time of 5 s (true apnoea period). The following values were used: 1) specific conductance of nitric oxide (θNO)=4.5 mLNO·mLblood−1·min−1·mmHg−1; 2) ratio of diffusing capacity of the membrane for NO and CO (DmNO/DmCO)=1.97; and 3) 1/red cell CO conductance (1/θCO)=(1.30+0.0041·mean capillary oxygen pressure)·(14.6/Hb concentration in g·dL−1).Reference equations were established for the outcomes of DLCONO, including DLCO and DLNO and the calculated values Dm and Vc. Independent variables were age, sex, height and age squared.By providing new reference equations and by appealing for consensus regarding the methodology, we hope to provide a basis for future studies and clinical use of this novel and interesting method.

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