Pattern of diffusion disturbance related to clinical diagnosis: The KCO has no diagnostic value next to the DLCO

Lee, I. Van Der; Zanen, Pieter; Bosch, Jules M.M. van den; Lammers, Jan Willem J.

doi:10.1016/j.rmed.2005.04.014

Cited by 20 publications

(10 citation statements)

References 31 publications

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“…In the present study, D LCO /VA was not sensitive, confirming the results of van der Lee et al [36] and Hughes & Pride [37] where the transmission coefficient D LCO / VA had no diagnostic added value compared to the parameters D LCO and VC for the detection of diffuse parenchymal diseases. In accordance, Schikowsky et al [38] showed no impairment of D LCO /VA and no reduction in VC in subjects formerly exposed to asbestos.…”

Section: Discussionsupporting

confidence: 89%

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

Preisser

Schlemmer

Herold

et al. 2020

J Occup Med Toxicol

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Background: Asbestos-related lung diseases are one of the leading diagnoses of the recognized occupational diseases in Germany, both in terms of their number and their socioeconomic costs. The aim of this study was to determine whether pulmonary function testing (spirometry and CO diffusion measurement (D LCO)) and computed tomography of the thorax (TCT) are relevant for the early detection of asbestos-related pleural and pulmonary fibrosis and the assessment of the functional deficiency. Methods: The records of 111 formerly asbestos-exposed workers who had been examined at the Institute for Occupational and Maritime Medicine, Hamburg, Germany, with data on spirometry, D LCO and TCT were reviewed. Workers with substantial comorbidities (cardiac, malignant, silicosis) and/or pulmonary emphysema (pulmonary hyperinflation and/or TCT findings), which, like asbestosis, can lead to a diffusion disorder were excluded. The remaining data of 41 male workers (mean 69.8 years ±6.9) were evaluated. The TCT changes were coded according to the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) by radiologists and ICOERD-scores for pleural and pulmonary changes were determined. Correlations (ρ), Cohens κ and accuracy were calculated. Results: In all 41 males the vital capacity (VC in % of the predicted value (% pred.)) showed only minor limitations (mean 96.5 ± 18.0%). The D LCO (in % pred.) was slightly reduced (mean 76.4 ± 16.6%; median 80.1%); the alveolar volume related value (D LCO /VA) was within reference value (mean 102 ± 22%). In the TCT of 27 workers pleural asbestos-related findings were diagnosed whereof 24 were classified as pulmonary fibrosis (only one case with honey-combing). Statistical analysis provided low correlations of VC (ρ = − 0.12) and moderate correlations of D LCO (− 0.25) with pleural plaque extension. The ICOERD-score for pulmonary fibrosis correlated low with VC (0.10) and moderate with D LCO (− 0.23); D LCO had the highest accuracy with 73.2% and Cohens κ with 0.45. D LCO /VA showed no correlations to the ICOERD-score. The newly developed score, which takes into account the diffuse pleural thickening, shows a moderate correlation with the D LCO (ρ = − 0.35, p < 0.05).

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Section: Discussionsupporting

confidence: 89%

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

Preisser

Schlemmer

Herold

et al. 2020

J Occup Med Toxicol

View full text Add to dashboard Cite

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“…Other significant issues with the index include the fact that diseases in which ventilation is uneven (such as emphysema) cannot be assumed to have the same diffusion properties as normal areas of the lung, making the index subject to a number of potentially inappropriate assumptions. In addition, some have questioned the value it adds to the DL CO itself, in the case of predicting desaturation with exercise71 or in adding to the diagnostic evaluation,72 for example. Others have pointed out the difficulty in standardizing the DL/V A in the face of an abnormal TLC 73…”

Section: Introductionmentioning

confidence: 99%

Interpretation of Pulmonary Function Tests: Beyond the Basics

Staitieh

Ioachimescu

2017

Journal of Investigative Medicine

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Although the general framework described in the joint American Thoracic Society/European Respiratory Society guidelines provides a useful and practical method for the interpretation of pulmonary function tests, several other measurements and functional indices, if understood correctly, may help in diagnosis and management of patients with respiratory diseases and in design of research protocols. This review provides information on the underlying physiology, interpretative caveats, and the evidence supporting the use of a number of these indices. Some of these measurements, such as the inspiratory fraction, inspiratory capacity/total lung capacity (IC/TLC), may offer additional prognostic information, while others, such as residual volume (RV)/TLC and forced expiratory volume in 3 s/forced vital capacity (FEV/FVC), may help fill in the gaps between patient symptoms and more traditional indices of pulmonary function. Although most studies of non-traditional indices focus on airflow-limiting disorders, many can be fruitfully applied in other settings. Understanding the physiology that catalyzed these investigations will undoubtedly enrich the functional assessment armamentarium of the practicing clinician and researcher.

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“…In theory, the decrease in DL CO may result from a fall in V A (mainly due to restrictive and/or obstructive defects) and/or a fall in K CO (due to alveolar/capillary damage or a microvascular disease). Few studies have focused on the significance of DL CO in diffuse parenchymal lung diseases (DPLD) [1–5], highlighting the prognostic value of its component K CO . No study to our knowledge has sought to assess the validity of the above mentioned theory in the context of DPLD.…”

Section: Introductionmentioning

confidence: 99%

Different KCO and VA combinations exist for the same DLCO value in patients with diffuse parenchymal lung diseases

et al. 2015

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BackgroundDLCO is the product of the CO transfer coefficient (KCO) by the “accessible” alveolar volume (VA). In theory, the same DLCO may result from various combinations of KCO and VA values, each of which reflect different injury sites and mechanisms. We sought to determine in this study the potential variability of both VA and KCO for fixed values of DLCO in diffuse parenchymal lung diseases (DPLD).MethodsTo this end, we designed a retrospective, cross-sectional study of three distinct types of DPLD and analysed pulmonary function test (PFT) datasets.ResultsWe show here that for the same value of DLCO (50 % predicted), KCO varied from 60 to 95 % predicted and VA from 55 to 85 % predicted in various types of DPLD idiopathic pulmonary fibrosis, sarcoidosis and connective tissue disease-associated DPLD, indicating distinct pathogenic mechanisms in these diseases. In addition, a comparison of VA with total lung capacity may help to evidence the distal airway obstruction sometimes associated with certain DPLD particularly sarcoidosis.ConclusionClinicians should take into account not only DLCO but also VA and KCO values when managing patients with DPLD.

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Pattern of diffusion disturbance related to clinical diagnosis: The KCO has no diagnostic value next to the DLCO

Abstract: In this study the pattern of diffusion disturbance is of limited use in establishing a diagnosis. The use of the K(CO) next to the DL(CO) has no additional diagnostic value. Regional ventilation-perfusion inequality probably forms an important underlying mechanism of decreased DL(CO).

Cited by 20 publications

References 31 publications

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

Interpretation of Pulmonary Function Tests: Beyond the Basics

Different KCO and VA combinations exist for the same DLCO value in patients with diffuse parenchymal lung diseases

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