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Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Medicine

Dual Test Gas Pulmonary Diffusing Capacity Measurement During Exercise in Humans Using the Single-Breath Method

Published: February 2nd, 2024

DOI:

10.3791/65871

1Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, 2Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, 4Department of Anesthesiology and Intensive Care, Hvidovre Hospital, 5Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 6Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales

This protocol presents a method to assess pulmonary alveolar-capillary reserve measured by combined single-breath measurement of the diffusing capacity to carbon monoxide (DL,CO) and nitric oxide (DL,NO) during exercise. Assumptions and recommendations for using the technique during exercise form the foundation of this article.

The combined single-breath measurement of the diffusing capacity of carbon monoxide (DL,CO) and nitric oxide (DL,NO) is a useful technique to measure pulmonary alveolar-capillary reserve in both healthy and patient populations. The measurement provides an estimate of the participant's ability to recruit and distend pulmonary capillaries. The method has recently been reported to exhibit a high test-retest reliability in healthy volunteers during exercise of light to moderate intensity. Of note, this technique permits up to 12 repeated maneuvers and only requires a single breath with a relatively short breath-hold time of 5 s. Representative data are provided showing the gradual changes in DL,NO and DL,CO from rest to exercise at increasing intensities of up to 60% of maximal workload. The measurement of diffusing capacity and evaluation of alveolar-capillary reserve is a useful tool to evaluate the lung's ability to respond to exercise both in the healthy population as well as in patient populations such as those with chronic lung disease.

Exercise leads to a considerable increase in energy demand compared to the resting state. The heart and lungs respond by increasing cardiac output and ventilation resulting in an expansion of the alveolar-capillary bed, mainly the recruitment and distention of pulmonary capillaries1. This ensures a sufficient pulmonary gas exchange, which can be measured by an increase in pulmonary diffusing capacity (DL)2,3,4. The first attempts to measure DL during exercise date back more than a century5,

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The Scientific Ethical Committee for the Capital Region of Denmark has previously approved the measurement of DL,CO/NO at rest, during exercise, and in the supine position in both healthy volunteers and patients with chronic obstructive pulmonary disease (COPD) at our institution (protocols H-20052659, H-21021723, and H-21060230).

NOTE: Before DL,CO/NO is measured during exercise, a dynamic spirometry, and a cardiopulmonary exercise test (CPET) must be performed. The dyna.......

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The protocol was implemented in 2021 and at the time of writing a total of 124 measurements during exercise (i.e., 51 in healthy volunteers and 73 in patients with COPD of various severities) had been performed. The maneuvers, as well as data on fulfilled acceptability and repeatability criteria, and the failure rate are all provided in Table 3.

Calculations
As an example, calculations from a single DL,CO/NO maneuver are .......

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The protocol provides a standardized approach to the measurement of DL,CO/NO during exercise using the dual test gas single-breath technique. Since the obtained DL,CO/NO-metrics increase due to pulmonary capillary recruitment and distension, the method provides a physiologically meaningful measure of the alveolar-capillary reserve.

Critical steps in the protocol
The method requires an exhalation to residual volume followed by an inspiration to total.......

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The study received financial support from The Svend Andersen Foundation. The Centre for Physical Activity Research is supported by TrygFonden Grants ID 101390, ID 20045, and ID 125132. JPH is funded by HelseFonden and Copenhagen University Hospital, Rigshospitalet, while HLH is funded by the Beckett Foundation.

....

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NameCompanyCatalog NumberComments
HemoCue Hb 201+ HemoCue, Brønshøj, DenmarkUnkownFor measurements of hemoglobin
Jaeger MasterScreen PFT pro (Lung Function Equipment)CareFusion, Höchberg, GermanyUnkownFor measurements of DLCO/NO
MouthpieceSpiroBac, Henrotech, Aartselaar, BelgiumUnkownUsed together with the Lung Fuction Equipment. (dead space 56 ml, resistance to flow at 12 L s−1 0.9 cmH2O) 
Nose-clipIntraMedic, Gentofte, DenmarkJAE-892895
PhenumotachIntraMedic, Gentofte, DenmarkJAE-705048Used together with the Lung Fuction Equipment
SentrySuite Software SolutionVyaire's Medical GmbH, Leibnizstr. 7, D-97204 Hoechberg GermanyUnkown
Test gassesIntraMedic, Gentofte, DenmarkUnkownConcentrations: 0.28% CO, 20.9% O2, 69.52% N2 and 9.3% He

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