Errors in the measurement of total lung capacity in chronic obstructive lung disease.

Paré, Peter D.; Wiggs, Barry; Coppin, Catherine A.

doi:10.1136/thx.38.6.468

Cited by 22 publications

(6 citation statements)

References 7 publications

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“…The current findings do not define to what extent the small degree of measured discrepancy between TLC RB and TLC pleth represents inability of plethysmography to reflect regions of lung with long time constants (Brown et al 1998), or overestimation of thoracic gas volume using mouth occlusion pressure changes in the presence of airflow obstruction (Brown et al 1978; Rodenstein et al 1982a; Brown et al 1984). The current data provide documentation to the clinician that TLC pleth reflects to a great extent available gas dilutional thoracic volume even in patients with severe emphysema by pulmonary function and GOLD staging criteria (Rodenstein et al 1982a; Pare et al 1983; Andersson et al 1988). …”

Section: Discussionmentioning

confidence: 84%

Quantification of single-breath underestimation of lung volume in emphysema

Milite

Lederer

Weingarten

et al. 2009

Respiratory Physiology & Neurobiology

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The extent to which a single breath measurement represents available gas dilutional as well as compressible thoracic volume in emphysema patients has not been quantified. We therefore measured single breath (TLC SB ) and rebreathe helium dilution (TLC RB ), and plethysmographic lung volume (TLC pleth ), in fifty-five outpatients with clinical and radiographic emphysema, and in twenty-one normal controls. Among emphysema patients, TLC SB increasingly underestimated both TLC pleth and TLC RB as FEV 1 % predicted decreased (p for interaction = 0.001 for both) by a mean of 1.7 liters for TLC RB (p < 0.001) and 2.2 liters for TLC pleth (p < 0.001). In contrast, TLC RB underestimated TLC pleth by a mean of 0.5 liters (p < 0.001) regardless of FEV1% (p for interaction = 0.25). TLC SB , TLC RB , and TLC pleth showed strong agreement among normal subjects. We conclude that TLC SB underestimates available gas dilutional and compressible lung volume as physiologic emphysema severity increases. In contrast, TLC RB and TLC pleth show closer agreement which is unaffected by physiologic emphysema severity.

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Section: Discussionmentioning

confidence: 84%

Quantification of single-breath underestimation of lung volume in emphysema

Milite

Lederer

Weingarten

et al. 2009

Respiratory Physiology & Neurobiology

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“…However, such a study would be limited by the inability to undertake CT scanning in acutely ill, breathless patients. Moreover, measurement of lung volumes, both by helium dilution and by body plethysmography are potentially erroneous in patients with severe airflow limitation [33]. Radiographic planimetry [34] or contiguous CT slices [35] could have been used to avoid such errors in the measurement of lung volume but would have involved a greater radiation burden for the patients.…”

Section: Discussionmentioning

confidence: 99%

Measurement of CT lung density in patients with chronic asthma

Biernacki¹,

Redpath²,

Best³

et al. 1997

Eur Respir J

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All subjects underwent CT scanning of the lungs and respiratory function testing within 2 days of each other. In five of the asthmatic patients a CT scan was performed on two occasions before and after treatment with nebulized bronchodilator. In a different group of five asthmatics these measurements were performed at the end of and 6 weeks after an exacerbation.The mean value of the lowest fifth percentile of the CT lung density in the patients with chronic obstructive pulmonary disease (COPD) was -942 (SD 36) Hounsfield units (HU), in the 17 asthmatic patients was -912 (34) HU, and in normal subjects was -880 (13). Despite a significant increase in peak expiratory flow rate from 266 (SD 102) to 406 (83) L·s -1 (p<0.02) following nebulized β 2 -agonist in five patients with chronic asthma, there was no significant change in CT lung density (p>0.05) Our study indicates that at least some patients with chronic, stable asthma develop a reduction in computed tomography lung density, similar to that in patients with emphysema.

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“…In patients with high airway resistance, plethysmography may overestimate lung volume. In these subjects, the flow resulting from the motion of upper airway walls during panting may be responsible for a substantial pressure difference between mouth and alveoli [4,26]. In the present subjects, no changes in airway resistance were noted during pregnancy (table 1).…”

Section: Discussionmentioning

confidence: 44%

“…The two most widely used are multibreath helium equilibration and body plethysmography [1,2]. Classically, it is accepted that in normal individuals and in patients with interstitial lung disease, these two techniques produce equivalent mean values [2][3][4], whereas the helium dilution method underestimates the absolute lung volumes in patients with obstructive lung disease to an extent that depends on the severity of airway obstruction [2,[3][4][5]. Pregnancy could be an exception to this general principle.…”

mentioning

confidence: 99%

Comparison of helium dilution and plethysmographic lung volumes in pregnant women

García‐Río

Pino-Garcia²,

Serrano³

et al. 1997

Eur Respir J

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The multibreath helium equilibration method is the technique recommended for routine measurement of static lung volumes in normal subjects. However, pregnancy could be an exception to this general rule, due to airway closure during the second half of gestation. The aim of this study was to compare the measurements of lung volumes by plethysmography and helium dilution during pregnancy.Twenty three healthy women were studied at 12, 24 and 36 weeks of pregnancy, and 4 months postpartum. Total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV) were measured by multibreath helium equilibration (TLCHe, FRCHe and RVHe) and by plethysmography (TLCbox, FRCbox and RVbox).Only at 36 weeks were there differences between the two methods. RVbox was significantly larger than RVHe We conclude that using the multibreath helium equilibration method to measure lung volumes in at-term pregnant women results in underestimation of functional residual capacity and total lung capacity.

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Errors in the measurement of total lung capacity in chronic obstructive lung disease.

Cited by 22 publications

References 7 publications

Quantification of single-breath underestimation of lung volume in emphysema

Quantification of single-breath underestimation of lung volume in emphysema

Measurement of CT lung density in patients with chronic asthma

Comparison of helium dilution and plethysmographic lung volumes in pregnant women

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