Intra-session and inter-session variability of nitric oxide pulmonary diffusing capacity in adults with cystic fibrosis

Radtke, Thomas; Benden, Christian; Maggi-Beba, Marion; Kriemler, Susi; Lee, Ivo van der; Dressel, Holger

doi:10.1016/j.resp.2017.08.002

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…This randomised crossover study was designed to directly compare D LNO (primary end-point) measurements in healthy, non-smoking adults using two devices commercially available in Europe. The intrasession variability characteristics for D LNO and D LCO were comparable between the two devices and similar to previous studies in healthy people [ 9 , 14 ] and those with chronic lung disease [ 15 ], indicating that both devices are internally consistent in measuring lung diffusing capacity outcomes. However, there are substantial differences in D LNO between the MasterScreen and HypAir devices, with values on average 17% higher by HypAir than MasterScreen.…”

Section: Discussionsupporting

confidence: 86%

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

et al. 2021

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In Europe, two commercial devices are available to measure combined single-breath lung diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) in one maneuver. 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 DLNO (primary endpoint) between MasterScreen™ (Vyaire Medical, USA) and HypAir (Medisoft, 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 DLNO between HypAir and MasterScreen was 24.0 mL·min−1·mmHg−1 (95% CI 21.7 to 26.3). There was no difference in DLCO (−0.03 mL·min−1·mmHg−1, 95% CI −0.57 to 0.12) between devices while alveolar volume (VA) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45 to 0.52). Disparity in the estimation of VA and the rate of NO uptake (KNO=DLNO/VA) could explain the discrepancy in DLNO between devices. Disparity in the estimation of VA and the rate of CO uptake (KCO=DLCO/VA) per unit of VA offset each other resulting in negligible discrepancy in DLCO 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 DLNO 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.

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Section: Discussionsupporting

confidence: 86%

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

et al. 2021

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“…Therefore, the procedure of measurements followed previous approaches published by van der Lee et al [ 31 ] and Dressel et al [ 21 ]. Irrespective of this, the measurements were in accordance with recent recommendations for single-breath DLCO [ 20 , 32 ] as well as DLNO [ 13 ], taking into account that breath-hold time was within the range, in which diffusing capacity is not markedly affected by different breath-hold times [ 33 ].…”

Section: Discussionmentioning

confidence: 72%

Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation

et al. 2018

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BackgroundThere is a need for non-invasive parameters that are sensitive to the development of the bronchiolitis obliterans syndrome (BOS) in lung transplantation (LTx) patients. We studied whether the pulmonary diffusing capacity for inhaled nitric oxide is capable of detecting BOS stages.MethodsSixty-one LTx patients were included into this cross-sectional study (19/29/7/3/3 in BOS stages 0/0-p/1/2/3). For analysis stages 0/0-p versus 1/2/3 (“BOS binary-early”), and stages 0/0-p/1 versus 2/3 (“BOS binary-late”) were summarized. Measurements of the combined diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were compared with spirometry and bodyplethysmography, and their relative importance was evaluated by discriminant analysis.ResultsRegarding the recognition of “BOS binary-early”, among spirometric parameters forced expiratory volume in 1 s (FEV1) was best, among bodyplethysmographic parameters airway resistance, and among diffusing parameters DLNO. Regarding “BOS binary-late”, DLNO was inferior to bodyplethysmographic parameters.ConclusionAlthough the study comprised only measurements at a single time point and no follow-up, DLNO outperformed FEV1, the time course of which is used in detecting BOS. Together with its pathophysiological plausibility, this result suggests that the measurement of DLNO, possibly over time, could be an easily applicable tool for the monitoring of LTx patients and should be evaluated in larger studies.

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“…Well, we must consider the week-to-week variability in pulmonary diffusing capacity. For example, the week-to-week variability (reproducibility) of DLCO is at least 3.8 mL/min/mm Hg in those with a cardiopulmonary disease52–54 and at least 3.6 mL/min/mm Hg in healthy individuals,53 55–57 but the differences in the LLN for DLCO between both models that equal to or exceeds 3.6 mL/min/mm Hg occurred in only 1.7% of the pooled data (18/1076). Furthermore, the 95% CI of the SD of the residuals multiplied by two between both models is less than its reproducibility (ie, <3.6 mL/min/mm Hg) (online supplemental figures S9A,B, S10A,B).…”

Section: Discussionmentioning

confidence: 99%

“…What about the ability of the two models to identify the LLN for DLNO? Since the week-to-week variability of DLNO is approximately 13 mL/min/mm Hg in those with cardiopulmonary disease,53 54 and around 20 mL/min/mm Hg in healthy individuals,55 56 the differences in the LLN between for DLNO models that were equal to or exceeded 13 mL/min/mm Hg occurred in 10% of the pooled data (111/1076) (online supplemental figures S11A,B, S12A,B). Additionally, the differences in the LLN between DLNO models that equal to or exceed 20 mL/min/mm Hg occurred in only 3% of the pooled data (34/1076).…”

Section: Discussionmentioning

confidence: 99%

Reference equations for pulmonary diffusing capacity using segmented regression show similar predictive accuracy as GAMLSS models

Zavorsky

Cao

2022

BMJ Open Resp Res

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PurposeTo determine whether generalised additive models of location, scale and shape (GAMLSS) developed for pulmonary diffusing capacity are superior to segmented (piecewise) regression models, and to update reference equations for pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), which may be affected by the equipment used for its measurement.MethodsData were pooled from five studies that developed reference equations for DLCO and DLNO (n=530 F/546 M; 5–95 years old, body mass index 12.4–39.0 kg/m2). Reference equations were created for DLCO and DLNO using both GAMLSS and segmented linear regression. Cross-validation was applied to compare the prediction accuracy of the two models as follows: 80% of the pooled data were used to create the equations, and the remaining 20% was used to examine the fit. This was repeated 100 times. Then, the root-mean-square error was compared between both models.ResultsIn males, GAMLSS models were 7% worse to 3% better compared to segmented regression for DLCO and DLNO. In females, GAMLSS models were 2% worse to 5% better compared to segmented linear regression for DLCO and DLNO. The Hyp'Air Compact measured DLNO and alveolar volume (VA) that was approximately 16–20 mL/min/mm Hg and 0.2–0.4 L higher, respectively, compared to the Jaeger MasterScreen Pro. The measured DLCO was similar between devices after controlling for altitude.ConclusionsFor the development of pulmonary function reference equations, we propose that segmented linear regression can be used instead of GAMLSS due to its simplicity, especially when the predictive accuracy is similar between the two models, overall.

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Intra-session and inter-session variability of nitric oxide pulmonary diffusing capacity in adults with cystic fibrosis

Cited by 7 publications

References 27 publications

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

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

Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation

Reference equations for pulmonary diffusing capacity using segmented regression show similar predictive accuracy as GAMLSS models

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