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Evaluation of Diffusing Capacity in Patients With a Restrictive Lung Disease^*

^* From the Pathophysiology Laboratory of the Department of Pulmonary Diseases (Drs. Stam and Versprille), Erasmus University; and the Department of Medical Oncology (Dr. Splinter), University Hospital Dijkzigt, Rotterdam, The Netherlands.

Correspondence to: Henk Stam, Phd, Lung Function Department, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Background: In healthy volunteers, the single-breath diffusing capacity of the lung for carbon monoxide (DLCO) decreases and DLCO normalized per liter alveolar volume (VA; DLCO/VA) increases if VA is decreased. We hypothesized that comparison of DLCO/VA with its predicted value at predicted total lung capacity (TLC) will result in an underestimation of the diffusion disorder in patients with a restrictive lung disease, if a similar relationship exists between DLCO/VA and lung volume as found in healthy volunteers.

Objective: To test this hypothesis, we studied total gas transfer DLCO and DLCO/VA as functions of VA in patients who developed a restrictive lung disease and a diffusion disorder in a short period of time.

Design: An observational survey.

Setting: Pulmonary function department.

Patients: Thirteen patients without any initial pulmonary pathology who developed the mentioned pulmonary pathology due to bleomycin treatment.

Interventions: Bleomycin treatment.

Measurements and results: We performed the single-breath test at various VA levels before, during, and after bleomycin treatment. In the majority of the patients, the DLCO vs VA relationship remained parabolic, but shifted downwards during therapy. Therefore, the linear DLCO/VA vs VA relationship shifted downwards, while the negative slope was not changed, indicating the development of a decreased gas transfer. Six patients also developed a volume restriction.

Conclusions: The agreement of the data with the hypothesis increased its probability. Consequently, to evaluate a diffusion disorder, DLCO/VA at a lower actual TLC of patients with a lung restriction should be compared to a reference DLCO/VA at a lung volume equal to the actual TLC.

Key Words: alveolar volume • bleomycin • chemotherapy • diffusing capacity • restrictive lung disease

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