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

ABSTRACT: In Europe, two commercial devices are available to measure combined single-breath diffusing capacity of the lung for nitric oxide (D _LNO) and carbon monoxide (D _LCO) in one manoeuvre. 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 D _LNO (primary end-point) between MasterScreen™ (Vyaire Medical, Mettawa, IL, USA) and HypAir (Medisoft, Dinant, 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 D _LNO between HypAir and MasterScreen was 24.0 mL·min^-1·mmHg^-1 (95% CI 21.7-26.3). There was no difference in D _LCO (-0.03 mL·min^-1·mmHg^-1, 95% CI -0.57-0.12) between devices while alveolar volume (V _A) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45-0.52). Disparity in the estimation of V _A and the rate of NO uptake (K_NO=D _LNO/V _A) could explain the discrepancy in D _LNO between devices. Disparity in the estimation of V _A and the rate of CO uptake (K_CO=D _LCO/V _A) per unit of V _A offset each other resulting in negligible discrepancy in D _LCO 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 D _LNO 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.

SUBMITTER: Radtke T

PROVIDER: S-EPMC8381155 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:New findingsWhat is the central question in this study? How reliable is the combined measurement of the pulmonary diffusing capacity to carbon monoxide and nitric oxide (DLCO/NO ) during exercise and in the resting supine position, respectively? What is the main finding and its importance? The DLCO/NO technique is reliable with a very low day-to-day variability both during exercise and in the resting supine position, and may thus provide a useful physiological outcome that reflects the alveolar-capillary reserve in humans.AbstractDLCO/NO , the combined single-breath measurement of the diffusing capacity to carbon monoxide (DLCO ) and nitric oxide (DLNO ) measured either during exercise or in the resting supine position may be a useful physiological measure of alveolar-capillary reserve. In the present study, we investigated the between-day test-retest reliability of DLCO/NO -based metrics. Twenty healthy volunteers (10 males, 10 females; mean age 25 (SD 2) years) were randomized to repeated DLCO/NO measurements during upright rest followed by either exercise (n = 11) or resting in the supine position (n = 9). The measurements were repeated within 7 days. The smallest real difference (SRD), defined as the 95% confidence limit of the standard error of measurement (SEM), the coefficient of variance (CV), and intraclass correlation coefficients were used to assess test-retest reliability. SRD for DLNO was higher during upright rest (5.4 (95% CI: 4.1, 7.5) mmol/(min kPa)) than during exercise (2.7 (95% CI: 2.0, 3.9) mmol/(min kPa)) and in the supine position (3.0 (95% CI: 2.1, 4.8) mmol/(min kPa)). SRD for DLCOc was similar between conditions. CV values for DLNO were slightly lower than for DLCOc both during exercise (1.5 (95% CI: 1.2, 1.7) vs. 3.8 (95% CI: 3.2, 4.3)%) and in the supine position (2.2 (95% CI: 1.8, 2.5) vs. 4.8 (95% CI: 3.8, 5.4)%). DLNO increased by 12.3 (95% CI: 11.1, 13.4) and DLCOc by 3.3 (95% CI: 2.9, 3.7) mmol/(min kPa) from upright rest to exercise. The DLCO/NO technique provides reliable indices of alveolar-capillary reserve, both during exercise and in the supine position.

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

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