Correction of single-breath helium lung volumes in patients with airflow obstruction.

STUDY OBJECTIVE To determine whether alveolar volume (V(A)) measured during the single-breath diffusing capacity for carbon monoxide (DCO) can be used as a substitute measure for the multiple-breath total lung capacity (TLC) in subjects with and without airways obstruction. DESIGN Retrospective review of pulmonary function test (PFT) results. SETTING Pulmonary function laboratories at the Johns Hopkins Hospital (JHH) and the Johns Hopkins Asthma and Allergy Center (HAAC). PARTICIPANTS Patients referred for spirometry, helium lung volumes, and Dco during a single visit between November 1993 and November 1996. RESULTS JHAAC patients (n=2,477) were used to assess the relationship between V(A) and TLC. In patients with an FEV1/FVC > or = 0.70, there was good agreement between V(A) and TLC (V(A)/TLC=0.97 to 0.99). However, in patients with an FEV1/FVC <0.70, V(A) systematically underestimated TLC (V(A)/TLC=0.67 to 0.94). The degree of underestimation was related to the severity of airflow obstruction. To predict TLC using V(A) a regression equation was used to "correct" V(A) for the severity of obstruction. This equation was used to predict the multiple-breath TLC for JHH patients (n=2,892). Patients with an FEV1/FVC > or = 0.70 showed a high degree of correlation between V(A) and TLC (Pearson's correlation coefficient [r]=0.96 to 0.99; p<0.05). After adjusting for the severity of airflow obstruction, patients with an FEV1/FVC in the range of 0.40 to 0.70 also had a strong correlation between the corrected V(A) and the multiple-breath TLC (r=0.83 to 0.94; p<0.05). CONCLUSIONS V(A) accurately predicts TLC in patients with mild or no airflow obstruction. For patients with moderate to severe obstruction, correcting V(A) for the severity of obstruction improves the accuracy of this relatively simple and rapid technique for measuring TLC.

[1]  A. Gulsvik,et al.  Accuracy and precision of helium dilution technique and body plethysmography in measuring lung volumes. , 1973, Scandinavian journal of clinical and laboratory investigation.

[2]  E. R. Mcfadden,et al.  Influence of abdominal gas on the Boyle's law determination of thoracic gas volume. , 1978, Journal of applied physiology: respiratory, environmental and exercise physiology.

[3]  D. Rodenstein,et al.  Reassessment of lung volume measurement by helium dilution and by body plethysmography in chronic air-flow obstruction. , 1982, The American review of respiratory disease.

[4]  W. Seed,et al.  Multi-breath and single breath helium dilution lung volumes as a test of airway obstruction. , 1990, The European respiratory journal.

[5]  E. R. Mcfadden,et al.  Problems in the plethysmographic assessment of changes in total lung capacity in asthma. , 2015, The American review of respiratory disease.

[6]  J. Martin,et al.  Effect of panting frequency on the plethysmographic determination of thoracic gas volume in chronic obstructive pulmonary disease. , 2015, The American review of respiratory disease.

[7]  H. J. Barnhard,et al.  Roentgenographic determination of total lung capacity. A new method evaluated in health, emphysema and congestive heart failure. , 1960, The American journal of medicine.

[8]  Critical evaluation of computerised x ray planimetry for the measurement of lung volumes. , 1995, Thorax.

[9]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[10]  T. Hassard,et al.  Applied Linear Regression , 2005 .

[11]  A. Renzetti,et al.  Evaluation of a single-breath method of measuring total lung capacity. , 1968, The American review of respiratory disease.

[12]  Kendrick Ah.  Comparison of methods of measuring static lung volumes. , 1996 .

[13]  D. Rodenstein,et al.  Frequency dependence of plethysmographic volume in healthy and asthmatic subjects. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[14]  J. Hankinson,et al.  American Thoracic Society. Single-breath carbon monoxide diffusing capacity (transfer factor). Recommendations for a standard technique--1995 update. , 1995, American journal of respiratory and critical care medicine.

[15]  Burns Cb,et al.  Evaluation of single-breath helium dilution total lung capacity in obstructive lung disease. , 1984 .

[16]  K. Kilburn,et al.  Measuring lung volumes in advanced asbestosis: comparability of plethysmographic and radiographic versus helium rebreathing and single breath methods. , 1993, Respiratory medicine.

[17]  F Comhaire,et al.  Residual volume determined by single breath dilution of helium at various apnoea times. , 1970, Scandinavian journal of respiratory diseases.

[18]  K. P. Van de Woestijne,et al.  Failure of body plethysmography in bronchial asthma. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[19]  J H Wilmore,et al.  A simplified method for determination of residual lung volumes. , 1969, Journal of applied physiology.

[20]  K. Kilburn,et al.  Total lung capacity measured by roentgenograms. , 1971, The American journal of medicine.

[21]  J. Martin,et al.  Reassessment of body plethysmographic technique for the measurement of thoracic gas volume in asthmatics. , 2015, The American review of respiratory disease.

[22]  I. Bernstein,et al.  Comparison of the components of diffusing capacity utilizing the effective alveolar volume in patients with emphysema and chronic asthma. , 1968, The American journal of the medical sciences.

[23]  P. Paré,et al.  Errors in the measurement of total lung capacity in chronic obstructive lung disease. , 1983, Thorax.