Lung Diffusing Capacity for Nitric Oxide and Carbon Monoxide

Dressel, Holger; Filser, Laura; Fischer, Rainald; Motte, D. de la; Steinhaeusser, Werner; Huber, Rudolf M.; Nowak, Dennis; Jörres, Rudolf A.

doi:10.1378/chest.07-2388

Cited by 31 publications

(33 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The formula used is: Concerning breath hold time, we used 4 s, which is the same as Aguilaniu et al 8 used whose data were the basis of the normal standards for European equations for carbon monoxide (CO) and nitric oxide (NO). Anyway, with a longer breath hold time we would expect an underestimation of DLNO, as reported by Dressler et al, 9 and not an overestimation as suggested by Zavorsky and Borland. In fact as breath hold time is increased, NO expiratory concentration reduces, reaching the detection limit of the NO analyser.…”

supporting

confidence: 56%

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

Agostoni

Magini

Apostolo

2014

Eur J Prev Cardiolog

View full text Add to dashboard Cite

We read with interest the commentary by Gerald Zavorsky and Colin Borland on our paper on lung diffusion for nitric oxide (DLNO) vs lung diffusion for carbon monoxide (DLCO) in normal subjects and in patients with heart failure.1 Both authors are worldwide recognised experts. We are therefore indebted with them for the time and thought they gave to our work. The criticisms that they raise are both methodological and physiological. Indeed, DLNO measurement for clinical purposes has been introduced only a few years ago since the commercial apparatus has been available. Studies about simultaneous DLNO/DLCO evaluation have been conducted with different analysers and different NO concentrations so the method is still far from being standardised. However, we recognise that our DLNO values in normal subjects, obtained in a sizeable number of subjects, are lower than those previously reported by Zavorsky et al. 2 In any case the apparatus we used (Jaeger/Vyasis PFT Masterscreen) was calibrated for gas analysis using automated procedures and the linearity of analysers was factory checked. The formula used is: Concerning breath hold time, we used 4 s, which is the same as Aguilaniu et al. 8 used whose data were the basis of the normal standards for European equations for carbon monoxide (CO) and nitric oxide (NO). Anyway, with a longer breath hold time we would expect an underestimation of DLNO, as reported by Dressler et al., 9 and not an overestimation as suggested by Zavorsky and Borland. In fact as breath hold time is increased, NO expiratory concentration reduces, reaching the detection limit of the NO analyser. This is an issue when using electrochemical sensors, as we 1 and others did, 2,5,8 and not with a highsensitivity chemiluminescence NO analyser as other authors did. 10,11 As regards the membrane diffusion for carbon monoxide (DmCO), membrane diffusion for nitric oxide (DmNO) and capillary volume (Vcap), we prefer to call the capillary volume Vcap and not Vc as frequently done to avoid confusion with the vital capacity, and we do not agree with the Zavorsky and Borland critique. We recognise, however, that we erroneously quoted, and always have done so previously, the original paper by Roughton and Forster 12 but actually used the more recent description of DLCO partitioning.

show abstract

supporting

confidence: 56%

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

Agostoni

Magini

Apostolo

2014

Eur J Prev Cardiolog

View full text Add to dashboard Cite

show abstract

“…Breath holding time DRESSEL et al [28] found slightly higher TL,NO values at very low breath holding times of 4 s; this effect has not been reproduced by other researchers. No significant differences were seen between 6-and 8-s breath-holding times [28].…”

Section: Ageingmentioning

confidence: 83%

“…No significant differences were seen between 6-and 8-s breath-holding times [28]. Although there are advantages in sticking to the usual 10 s, for the sake of comparison with previous single breath TL,CO estimations, the sensitivity and response time of some NO analysers (table 2) will force some researchers into accepting a 6-or 8-s breath holding time.…”

Section: Ageingmentioning

confidence: 97%

TheT_L,NO/T_L,COratio in pulmonary function test interpretation

Hughes

Lee

2012

Eur Respir J

View full text Add to dashboard Cite

The transfer factor of the lung for nitric oxide (TL,NO) is a new test for pulmonary gas exchange. The procedure is similar to the already well-established transfer factor of the lung for carbon monoxide (TL,CO). Physiologically, TL,NO predominantly measures the diffusion pathway from the alveoli to capillary plasma. In the Roughton-Forster equation, TL,NO acts as a surrogate for the membrane diffusing capacity (DM). The red blood cell resistance to carbon monoxide uptake accounts for ,50% of the total resistance from gas to blood, but it is much less for nitric oxide.TL,NO and TL,CO can be measured simultaneously with the single breath technique, and DM and pulmonary capillary blood volume (Vc) can be estimated. TL,NO, unlike TL,CO, is independent of oxygen tension and haematocrit. The TL,NO/TL,CO ratio is weighted towards the DM/Vc ratio and to a; where a is the ratio of physical diffusivities of NO to CO (a51.97). The TL,NO/TL,CO ratio is increased in heavy smokers, with and without computed tomography evidence of emphysema, and reduced in the voluntary restriction of lung expansion; it is expected to be reduced in chronic heart failure. The TL,NO/TL,CO ratio is a new index of gas exchange that may, more than derivations from them of DM and Vc with their in-built assumptions, give additional insights into pulmonary pathology.

show abstract

“…Only one recent study to our best knowledge has reported values of Vc available for gas exchange and TL,NO/TL,CO ratio in CF patients [27]. Our results are in agreement with the DRESSEL et al [27] study results, showing a preserved Vc and a slightly decreased ratio, which may suggest an increased thickness of the alveolar blood barrier [18]. At rest, CA,NO correlated positively with Vc/ VA, which may argue for both NO-related vasodilation or vascular release of NO [12].…”

Section: Transfer Of Gas In Cf Lungmentioning

confidence: 99%

Exhaled nitric oxide in cystic fibrosis: relationships with airway and lung vascular impairments

Hubert

Aubourg²,

Fauroux³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

A reduction of exhaled nitric oxide (NO) fraction and endothelial-mediated dysfunction have been reported in cystic fibrosis (CF). The aims of the present study were to search for relationships between flow-independent NO exchange parameters (bronchial NO flux (J9aw,NO) and alveolar NO concentration (CA,NO)) and lung function tests characterising airflow limitation and pulmonary vascular bed (capillary blood volume and physiological dead space/tidal volume (VD/VT) ratio on exercise).In total, 34 patients (16 children, 18 adults) with CF, without resting pulmonary hypertension, underwent spirometry, exhaled NO measurement (multiple constant flow analytical method), gas transfer assessment (carbon monoxide and NO, allowing the calculation of capillary volume and membrane conductance) and a graded exercise test with oxygen uptake (V9O 2 ), carbon dioxide production (V9CO 2 ) and arterial blood gas evaluations.Both J9aw,NO and CA,NO correlated positively with airflow limitation. CA,NO correlated positively with capillary/alveolar volume. During exercise, criteria of mild pulmonary vascular disease were evidenced in some patients that participated in exercise limitation (negative correlation between physiological VD/VT and peak V9O 2 ). CA,NO at rest correlated positively with these parameters of wasted ventilation during exercise (physiological VD/VT, minute ventilation (V9E)/V9CO 2 at ventilatory threshold and V9E/V9CO 2 slope).Flow-independent exhaled NO parameters are linked to airway and early vascular diseases in patients with CF.

show abstract

Lung Diffusing Capacity for Nitric Oxide and Carbon Monoxide

Cited by 31 publications

References 20 publications

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

TheT_L,NO/T_L,COratio in pulmonary function test interpretation

Exhaled nitric oxide in cystic fibrosis: relationships with airway and lung vascular impairments

Contact Info

Product

Resources

About

Lung Diffusing Capacity for Nitric Oxide and Carbon Monoxide

Cited by 31 publications

References 20 publications

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide

TheTL,NO/TL,COratio in pulmonary function test interpretation

Exhaled nitric oxide in cystic fibrosis: relationships with airway and lung vascular impairments

Contact Info

Product

Resources

About

TheT_L,NO/T_L,COratio in pulmonary function test interpretation