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Dridi R, Dridi N, Gmada N, Laher I, Saeidi A, Granacher U, Zouhal H. Regular soccer training improves pulmonary diffusion capacity in 6 to 10 year old boys. BMC Sports Sci Med Rehabil 2023; 15:146. [PMID: 37919774 PMCID: PMC10621163 DOI: 10.1186/s13102-023-00757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Soccer is one of the most attractive sports around the globe for children and adolescents, and the benefits of soccer training are often shown. Due to the intermittent character of soccer with random changes between high-intensity activity and low-intensity play, athletes' aerobic (respiratory) capacity is specifically stimulated. However, little is known about the effects of regular soccer practice on pulmonary diffusion capacity (TL) in young players, even though it is the most popular sport in the world. OBJECTIVES To analyze the effects of 28 weeks of regular soccer training versus a non-activity control period on the TL, the alveolar-capillary membrane diffusion capacity (DM) as well as the capillary blood volume (Vc) in healthy prepubertal boys aged 6 to 10 years. METHODS For this purpose, boys were randomly assigned to a soccer training group (SG, n = 40) or a control group (CG, n = 40). Pre and post-intervention, all participants performed an all-out graded bicycle ergometer test to measure maximal oxygen uptake (VO2max) and maximal aerobic power (MAP). A respiratory maneuver was performed at rest and just at the end of the test to measure the TL for carbon monoxide (TLCO) and nitric oxide (TLNO), DM, as well as Vc. RESULTS There were no significant baseline between-group differences for any of the assessed parameters (p > 0.05). Significant group-by-time interactions were found for most pulmonary parameters measured at rest (p < 0.05), with effect size (ES) values ranging from small-to-large (0.2 < ES < 4.0), except for VA (p = 0.3, ES = 0.006). Post-hoc tests indicated significant DM (p < 0.05; 0.2 < ES < 4.0), TLNO (p < 0.01; 0.22 < ES < 4.0), TLCO (p < 0,01; 0.24 < ES < 4.0) and Vc (p = 0.01; 0.404 < ES < 0.6) improvements for SG but not CG. Significant group-by-time effects were identified for HRmax and VO2max (p < 0.001; ES = 0.5 and p = 0.005; ES = 0.23 respectively). The post-hoc analyses indicated a significant decrease in HRmax and a significant increase in VO2max in the SG (p < 0.001; ES = 0.5 and p = 0.005, ES = 0.23, respectively) but not in CG. Values for TLCO increased by almost 20%; Vc of 14% DM of 8% and VA of 10% at the end of maximal exercise in SG. Furthermore, the percentage improvement was less notable in the control group (7.5% for TLCO; 2% for Vc; 5% for DM and 4% for VA). CONCLUSION Regular soccer training significantly improves pulmonary vascular function and increases DM and Vc after exercise in prepubertal boys. The observed adaptations are most likely due to better recruitment of additional pulmonary capillary function. However, the stepwise linear regression analyses indicated that increases in pulmonary vascular function were not related to improvements in VO2max and MAP.
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Affiliation(s)
- Rim Dridi
- Research Laboratory LR23JS01 (Sport, Performance, Health and Society, Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Tunis, 2010, Tunisia.
| | - Nadia Dridi
- Research Laboratory LR23JS01 (Sport, Performance, Health and Society, Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Tunis, 2010, Tunisia
| | - Nabil Gmada
- Physical Education and Sport Sciences Department, Sultan Qaboos University, Muscat 123, Oman
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Kurdistan, Iran
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, Freiburg, Germany.
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Rennes, Santé, EA 1274, F-35000, France.
- Institut International des Sciences du Sport (2I2S), Irodouer, 35850, France.
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Brotto AR, Beaudry R, Rowland S, van Diepen S, Stickland MK. A single breath of nitric oxide does not alter pulmonary perfusion pressure. Exp Physiol 2022; 107:1422-1425. [PMID: 36114623 DOI: 10.1113/ep090716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is the amount of inhaled nitric oxide (NO) used during a diffusing capacity for inhaled NO manoeuvre sufficient to reduce pulmonary artery systolic pressure (PASP)? What is the main finding and its importance? These findings suggest that a single breath of inhaled NO does not change PASP, and combined with previous correlational work, further validates the use of the diffusing capacity for NO manoeuvre as a technique to determine pulmonary capillary blood volume and membrane diffusing capacity. ABSTRACT The measurement of diffusing capacity is an important pulmonary function test to evaluate gas exchange. Using both carbon monoxide and nitric oxide (NO), the diffusing capacity for nitric oxide (DL,NO ) technique allows for the partitioning of capillary blood volume and membrane diffusing capacity. However, inhaled NO is known to dilate pulmonary arterioles in both health and disease and therefore could alter the outcomes that the DL,NO technique aims to quantify. The purpose of the study was to determine if a DL,NO manoeuvre alters pulmonary perfusion pressure. Nine participants completed 12 simulated 10-s breath-hold DL,NO manoeuvres (n = 6 placebo inhalations and n = 6 with 40 ppm NO; order randomized) during which tricuspid regurgitant jet velocity was recorded continuously using Doppler ultrasound to estimate pulmonary artery systolic pressure (PASP) as a surrogate for pulmonary perfusion pressure. The PASP was not different between the placebo and NO conditions (P = 0.742). These data indicate that a single DL,NO manoeuvre does not alter PASP and therefore would not be expected to acutely alter pulmonary capillary blood volume or membrane diffusing capacity.
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Affiliation(s)
- Andrew R Brotto
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rhys Beaudry
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samira Rowland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dridi R, Dridi N, Govindasamy K, Gmada N, Aouadi R, Guénard H, Laher I, Saeidi A, Suzuki K, Hackney AC, Zouhal H. Effects of Endurance Training Intensity on Pulmonary Diffusing Capacity at Rest and after Maximal Aerobic Exercise in Young Athletes. Int J Environ Res Public Health 2021; 18:ijerph182312359. [PMID: 34886081 PMCID: PMC8656668 DOI: 10.3390/ijerph182312359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
This study compared the effects of varying aerobic training programs on pulmonary diffusing capacity (TLCO), pulmonary diffusing capacity for nitric oxide (TLNO), lung capillary blood volume (Vc) and alveolar-capillary membrane diffusing capacity (DM) of gases at rest and just after maximal exercise in young athletes. Sixteen healthy young runners (16-18 years) were randomly assigned to an intense endurance training program (IET, n = 8) or to a moderate endurance training program (MET, n = 8). The training volume was similar in IET and MET but with different work intensities, and each lasted for 8 weeks. Participants performed a maximal graded cycle bicycle ergometer test to measure maximal oxygen consumption (VO2max) and maximal aerobic power (MAP) before and after the training programs. Moreover, TLCO, TLNO and Vc were measured during a single breath maneuver. After eight weeks of training, all pulmonary parameters with the exception of alveolar volume (VA) and inspiratory volume (VI) (0.104 < p < 0889; 0.001 < ES < 0.091), measured at rest and at the end of maximal exercise, showed significant group × time interactions (p < 0.05, 0.2 < ES < 4.0). Post hoc analyses revealed significant pre-to-post decreases for maximal heart rates (p < 0.0001, ES = 3.1) and improvements for VO2max (p = 0.006, ES = 2.22) in the IET group. Moreover, post hoc analyses revealed significant pre-to-post improvements in the IET for DM, TLNO, TLCO and Vc (0.001 < p < 0.0022; 2.68 < ES < 6.45). In addition, there were increases in Vc at rest, VO2max, TLNO and DM in the IET but not in the MET participants after eight weeks of training with varying exercise intensities. Our findings suggest that the intensity of training may represent the most important factor in increasing pulmonary vascular function in young athletes.
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Affiliation(s)
- Rim Dridi
- Research Unit 17JS01 (Sport, Performance, Health and Society) Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Tunis 2010, Tunisia; (R.D.); (N.D.); (R.A.)
| | - Nadia Dridi
- Research Unit 17JS01 (Sport, Performance, Health and Society) Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Tunis 2010, Tunisia; (R.D.); (N.D.); (R.A.)
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur 603203, Tamilnadu, India;
| | - Nabil Gmada
- Physical Education and Sport Sciences Department, Sultan Qaboos University, Muscat 123, Oman;
| | - Ridha Aouadi
- Research Unit 17JS01 (Sport, Performance, Health and Society) Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Tunis 2010, Tunisia; (R.D.); (N.D.); (R.A.)
| | - Hervé Guénard
- Department of Physiology, Victor Segalen University, 33076 Bordeaux, France;
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, University of Kurdistan, Pasdaran St., Sanandaj 6617715175, Iran;
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (K.S.); (H.Z.)
| | - Anthony C. Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Hassane Zouhal
- M2S (Laboratoire Mouvement, Sport, Santé)—EA 1274, Université de Rennes, 35000 Rennes, France
- Institut International des Sciences du Sport (2I2S), 35850 Irodouer, France
- Correspondence: (K.S.); (H.Z.)
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Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD. Simultaneous Measurement of Lung Diffusing Capacity and Pulmonary Hemodynamics Reveals Exertional Alveolar-Capillary Dysfunction in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e019950. [PMID: 34369164 PMCID: PMC8475049 DOI: 10.1161/jaha.120.019950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hemodynamic perturbations in heart failure with preserved ejection fraction (HFpEF) may alter the distribution of blood in the lungs, impair gas transfer from the alveoli into the pulmonary capillaries, and reduce lung diffusing capacity. We hypothesized that impairments in lung diffusing capacity for carbon monoxide (DLCO) in HFpEF would be associated with high mean pulmonary capillary wedge pressures during exercise. Methods and Results Rebreathe DLCO and invasive hemodynamics were measured simultaneously during exercise in patients with exertional dyspnea. Pulmonary pressure waveforms and breath‐by‐breath pulmonary gas exchange were recorded at rest, 20 W, and symptom‐limited maximal exercise. Patients with HFpEF (n=20; 15 women, aged 65±11 years, body mass index 36±8 kg/m2) achieved a lower symptom‐limited maximal workload (52±27 W versus 106±42 W) compared with controls with noncardiac dyspnea (n=10; 7 women, aged 55±10 years, body mass index 30±5 kg/m2). DLCO was lower in patients with HFpEF compared with controls at rest (DLCO 10.4±2.9 mL/min per mm Hg versus 16.4±6.9 mL/min per mm Hg, P<0.01) and symptom‐limited maximal exercise (DLCO 14.6±4.7 mL/min per mm Hg versus 23.8±10.8 mL/min per mm Hg, P<0.01) because of a lower alveolar‐capillary membrane conductance in HFpEF (rest 16.8±6.6 mL/min per mm Hg versus 28.4±11.8 mL/min per mm Hg, P<0.01; symptom‐limited maximal exercise 25.0±6.7 mL/min per mm Hg versus 45.5±22.2 mL/min per mm Hg, P<0.01). DLCO was lower in HFpEF for a given mean pulmonary artery pressure, mean pulmonary capillary wedge pressure, pulmonary arterial compliance, and transpulmonary gradient. Conclusions Lung diffusing capacity is lower at rest and during exercise in HFpEF due to impaired gas conductance across the alveolar‐capillary membrane. DLCO is impaired for a given pulmonary capillary wedge pressure and pulmonary arterial compliance. These data provide new insight into the complex relationships between hemodynamic perturbations and gas exchange abnormalities in HFpEF.
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Affiliation(s)
- Caitlin C Fermoyle
- Mayo Clinic Graduate School of Biomedical SciencesMayo Clinic Rochester MN
| | - Glenn M Stewart
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Barry A Borlaug
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Bruce D Johnson
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
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Magini A, Zavorsky GS, Apostolo A, Contini M, Barbieri S, Agostoni P. Week to week variability of pulmonary capillary blood volume and alveolar membrane diffusing capacity in patients with heart failure. Respir Physiol Neurobiol 2021; 290:103679. [PMID: 33962028 DOI: 10.1016/j.resp.2021.103679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alveolar-capillary membrane diffusing capacity for carbon monoxide (DMCO) and pulmonary capillary volume (Vcap) can be estimated by the multi-step Roughton and Foster (RF, original method from 1957) or the single-step NO-CO double diffusion technique (developed in the 1980s). The latter method implies inherent assumptions. We sought to determine which combination of the alveolar membrane diffusing capacity for nitric oxide (DMNO) to DMCO ratio, an specific conductance of the blood for NO (θNO) and CO (θCO) gave the lowest week-to-week variability in patients with heart failure. METHODS 44 heart failure patients underwent DMCO and Vcap measurements on three occasions over a ten-week period using both RF and double dilution NO-CO techniques. RESULTS When using the double diffusing method and applying θNO = infinity, the smallest week-to-week coefficient of variation for DMCO was 10 %. Conversely, the RF method derived DMCO had a much greater week-to-week variability (2x higher coefficient of variation) than the DMCO derived via the NO-CO double dilution technique. The DMCO derived from the double diffusion technique most closely matched the DMCO from the RF method when θNO = infinity and DMCO = DLNO/2.42. The Vcap measured week-to-week was unreliable regardless of the method or constants used. CONCLUSIONS In heart failure patients, the week-to-week DMCO variability was lowest when using the single-step NO-CO technique. DMCO obtained from double diffusion most closely matched the RF DMCO when DMCO/2.42 and θNO = infinity. Vcap estimation was unreliable with either method.
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Affiliation(s)
| | - Gerald S Zavorsky
- Pulmonary Services Laboratory, UC Davis Medical Center, Sacramento, California, United States
| | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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Neder JA, Berton DC, Muller PT, O'Donnell DE. Incorporating Lung Diffusing Capacity for Carbon Monoxide in Clinical Decision Making in Chest Medicine. Clin Chest Med 2020; 40:285-305. [PMID: 31078210 DOI: 10.1016/j.ccm.2019.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lung diffusing capacity for carbon monoxide (Dlco) remains the only noninvasive pulmonary function test to provide an integrated picture of gas exchange efficiency in human lungs. Due to its critical dependence on the accessible "alveolar" volume (Va), there remains substantial misunderstanding on the interpretation of Dlco and the diffusion coefficient (Dlco/Va ratio, Kco). This article presents the physiologic and methodologic foundations of Dlco measurement. A clinically friendly approach for Dlco interpretation that takes those caveats into consideration is outlined. The clinical scenarios in which Dlco can effectively assist the chest physician are discussed and illustrative clinical cases are presented.
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Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respirology and Sleep Medicine, Department of Medicine, Kingston Health Science Center, Queen's University, Richardson House, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Danilo C Berton
- Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo T Muller
- Division of Respirology, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology and Sleep Medicine, Kingston Health Science Center & Queen's University, Kingston, Ontario, Canada
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Abstract
Nitric oxide and carbon monoxide diffusing capacities (DLNO and DLCO ) obey Fick's First Law of Diffusion and the basic principles of chemical kinetic theory. NO gas transfer is dominated by membrane diffusion (DM ), whereas CO transfer is limited by diffusion plus chemical reaction within the red cell. Marie Krogh, who pioneered the single-breath measurement of DLCO in 1915, believed that the combination of CO with red cell hemoglobin (Hb) was instantaneous. Roughton and colleagues subsequently showed, in vitro, that the reaction rate was finite, and prolonged in the presence of high P O 2 . Roughton and Forster (R-F) proposed that the resistance to transfer (1/DL ) was the sum of the membrane resistance (1/DM ) and (1/θVc), the red cell resistance (θ being the CO or NO conductance for blood uptake and Vc the capillary volume). From this R-F equation, DM for CO and Vc can be solved with simultaneous NO and CO inhalation. At near maximum exercise, DMCO and Vc for normal subjects were 88% and 79%, respectively, of morphometric values. The validity of these calculations depends on the values chosen for θ for CO and NO, and on the diffusivity of NO versus CO. Recent mathematical modeling suggests that θ for NO is "effectively" infinite because NO reacts only with Hb in the outer 0.1 μM of the red cell. An "infinite θNO " recalculation reduced DMCO to 53% and increased Vc to 95% of morphometric values. © 2020 American Physiological Society. Compr Physiol 10:73-97, 2020.
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Affiliation(s)
| | - J Mike B Hughes
- National Heart and Lung Institute, Imperial College, London, UK
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Coffman KE, Curry TB, Dietz NM, Chase SC, Carlson AR, Ziegler BL, Johnson BD. The influence of pulmonary vascular pressures on lung diffusing capacity during incremental exercise in healthy aging. Physiol Rep 2019; 6. [PMID: 29368799 PMCID: PMC5789722 DOI: 10.14814/phy2.13565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022] Open
Abstract
Alveolar‐capillary surface area for pulmonary gas exchange falls with aging, causing a reduction in lung diffusing capacity for carbon monoxide (DLCO). However, during exercise additional factors may influence DLCO, including pulmonary blood flow and pulmonary vascular pressures. First, we sought to determine the age‐dependent effect of incremental exercise on pulmonary vascular pressures and DLCO. We also aimed to investigate the dependence of DLCO on pulmonary vascular pressures during exercise via sildenafil administration to reduce pulmonary smooth muscle tone. Nine younger (27 ± 4 years) and nine older (70 ± 3 years) healthy subjects performed seven 5‐min exercise stages at rest, 0 (unloaded), 10, 15, 30, 50, and 70% of peak workload before and after sildenafil. DLCO, cardiac output (Q), and pulmonary artery and wedge pressure (mPAP and mPCWP; subset of participants) were collected at each stage. mPAP was higher (P = 0.029) and DLCO was lower (P = 0.009) throughout exercise in older adults; however, the rate of rise in mPAP and DLCO with increasing Q was not different. A reduction in pulmonary smooth muscle tone via sildenafil administration reduced mPAP, mPCWP, and the transpulmonary gradient (TPG = mPAP–mPCWP) in younger and older subjects (P < 0.001). DLCO was reduced following the reduction in mPAP and TPG, regardless of age (P < 0.001). In conclusion, older adults successfully adapt to age‐dependent alterations in mPAP and DLCO. Furthermore, DLCO is dependent on pulmonary vascular pressures, likely to maintain adequate pulmonary capillary recruitment. The rise in pulmonary artery pressure with aging may be required to combat pulmonary vascular remodeling and maintain lung diffusing capacity, particularly during exercise.
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Affiliation(s)
- Kirsten E Coffman
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Niki M Dietz
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Steven C Chase
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Alex R Carlson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Briana L Ziegler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Wheatley CM, Baker SE, Daines CM, Phan H, Martinez MG, Morgan WJ, Snyder EM. Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis. Ther Adv Respir Dis 2019; 12:1753466618770997. [PMID: 29697011 PMCID: PMC5961921 DOI: 10.1177/1753466618770997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Vibralung Acoustical Percussor is a new airway clearance therapy (ACT) utilizing intrapulmonary sound waves in addition to positive expiratory pressure (PEP). We evaluated the safety of the Vibralung and collected preliminary data on its ability to mediate sputum expectoration in individuals with cystic fibrosis (CF). Methods: Over two separate studies, 10 and 11 mild to moderate CF patients were recruited for study I and II, respectively. Study I: Vibralung was used for 20 min with either no sound (NS: PEP only) or sound (S: PEP and sound) on randomized visits. Pulmonary function, diffusion capacity of the lungs for carbon monoxide and nitric oxide (DLCO/DLNO), symptoms, and peripheral oxygen saturation (SpO2) were measured at baseline and at 1 and 4 h post treatment. Expectorated sputum was collected over 4 h post treatment. Study II: over 5 days of in-hospital therapy, the Vibralung or vibratory vest therapy (Vest) were used for two therapy sessions per day, with sputum collected for 20 min following each therapy and pulmonary function accessed pre and post each 5-day period (days 1–5 or 7–11) in a randomized crossover design. Results: Vibralung usage resulted in no change from baseline to 4 h post in pulmonary function, SpO2 or symptoms (p > 0.05). At 4 h post therapy, the DLCO- and DLNO-derived measure of alveolar–capillary unit function (DM/VC) showed improvement (DM/VC = 12.5 ± 5.5 versus 7.3 ± 18.8% change, S versus NS) with no difference between S and NS (p = 0.74). Sputum expectoration was similar between S and NS conditions (wet sputum = 10.5 ± 4.6 versus 9.9 ± 3.2 g, S versus NS, p = 0.25). There were no differences in the improvement in pulmonary function between Vibralung and Vest during either 5-day period during the hospital stay. Conclusions: Vibralung was well tolerated and caused no detrimental changes in pulmonary function metrics. The Vibralung appears to be a safe ACT in individuals with CF.
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Affiliation(s)
- Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Cori M Daines
- Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA Banner-University Medical Center, Tucson, AZ, USA
| | - Hanna Phan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA
| | - Marina G Martinez
- Arizona Clinical Research Center, University of Arizona, Tucson, AZ, USA
| | - Wayne J Morgan
- Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA Banner-University Medical Center, Tucson, AZ, USA
| | - Eric M Snyder
- Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA; and Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
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Coffman KE, Boeker MG, Carlson AR, Johnson BD. Age-dependent effects of thoracic and capillary blood volume distribution on pulmonary artery pressure and lung diffusing capacity. Physiol Rep 2018; 6:e13834. [PMID: 30175463 PMCID: PMC6119697 DOI: 10.14814/phy2.13834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/29/2018] [Indexed: 12/05/2022] Open
Abstract
Aging is associated with pulmonary vascular remodeling and reduced distensibility. We investigated the influence of aging on changes in cardiac output (Q), mean pulmonary artery pressure (mPAP), and lung diffusing capacity in response to alterations in thoracic blood volume. The role of pulmonary smooth muscle tone was also interrogated via pulmonary vasodilation. Nine younger (27 ± 4 years) and nine older (71 ± 4 years) healthy adults reached steady-state in a Supine (0°), Upright (+20°), or Head-down (-20°) position in order to alter thoracic blood volume. In each position, echocardiography was performed to calculate mPAP and Q, and lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO) was assessed. Next, 100 mg sildenafil was administered to reduce pulmonary smooth muscle tone, after which the protocol was repeated. mPAP (P ≤ 0.029) and Q (P ≤ 0.032) were lower in the Upright versus Supine and Head-down positions, and mPAP was reduced following sildenafil administration (P = 0.019), in older adults only. SV was lower in the Upright versus Supine and Head-down positions in both younger (P ≤ 0.008) and older (P ≤ 0.003) adults. DLCO and DLNO were not greatly altered by position changes or sildenafil administration. However, the DLNO/DLCO ratio was lower in the Supine and/or Head-down positions (P ≤ 0.05), but higher following sildenafil administration (P ≤ 0.007), in both younger and older adults. In conclusion, older adults experience greater cardiopulmonary alterations following thoracic blood volume changes, and pulmonary smooth muscle tone plays a role in resting mPAP in older adults only. Furthermore, mPAP is an important determinant of pulmonary capillary blood volume distribution (DLNO/DLCO), regardless of age.
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Affiliation(s)
| | | | - Alex R. Carlson
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| | - Bruce D. Johnson
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
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Munkholm M, Marott JL, Bjerre-Kristensen L, Madsen F, Pedersen OF, Lange P, Nordestgaard B, Mortensen J. Reference equations for pulmonary diffusing capacity of carbon monoxide and nitric oxide in adult Caucasians. Eur Respir J 2018; 52:13993003.00677-2015. [DOI: 10.1183/13993003.00677-2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/19/2018] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine reference equations for the combined measurement of diffusing capacity of the lung for carbon monoxide (CO) and nitric oxide (NO) (DLCONO). In addition, we wanted to appeal for consensus regarding methodology of the measurement including calculation of diffusing capacity of the alveolo-capillary membrane (Dm) and pulmonary capillary volume (Vc).DLCONO was measured in 282 healthy individuals aged 18–97 years using the single-breath technique and a breath-hold time of 5 s (true apnoea period). The following values were used: 1) specific conductance of nitric oxide (θNO)=4.5 mLNO·mLblood−1·min−1·mmHg−1; 2) ratio of diffusing capacity of the membrane for NO and CO (DmNO/DmCO)=1.97; and 3) 1/red cell CO conductance (1/θCO)=(1.30+0.0041·mean capillary oxygen pressure)·(14.6/Hb concentration in g·dL−1).Reference equations were established for the outcomes of DLCONO, including DLCO and DLNO and the calculated values Dm and Vc. Independent variables were age, sex, height and age squared.By providing new reference equations and by appealing for consensus regarding the methodology, we hope to provide a basis for future studies and clinical use of this novel and interesting method.
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Jorgenson CC, Coffman KE, Johnson BD. Effects of intrathoracic pressure, inhalation time, and breath hold time on lung diffusing capacity. Respir Physiol Neurobiol 2018; 258:69-75. [PMID: 29885374 DOI: 10.1016/j.resp.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/25/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
The single breath hold maneuver for measuring lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO) incorporates multiple sources of variability. This study examined how changes in intrathoracic pressure, inhalation time, and breath hold time affect DLCO, DLNO, alveolar-capillary membrane conductance (DmCO) and pulmonary capillary blood volume (Vc) at rest and during submaximal exercise. Thirteen healthy subjects (mean ± SD; age = 26 ± 3y) performed duplicate tests at rest and during submaximal exercise. DLCO and Vc were lower with a positive versus negative intrathoracic pressure during the breath hold at rest (DLCO: 22.2 ± 5.5 vs. 22.7 ± 5.5 ml/min/mmHg, p = 0.028; Vc: 46.5 ± 11.6 vs. 48.2 ± 11.7 ml, p = 0.018). However, during exercise, DLCO and Vc were higher with positive versus negative pressure (DLCO: 26.7 ± 5.5 vs. 25.7 ± 5.7 ml/min/mmHg, p = 0.014; Vc: 56.2 ± 12.6 vs. 53.9 ± 13.1 ml, p = 0.039). The inhalation time did not significantly affect DLCO, DLNO, DmCO or Vc. Short breath hold times (<4s) may yield high DLNO/DLCO ratios and non-physiologic DmCO values. The single breath hold maneuver is useful for evaluating gas transfer at rest and during exercise, however intrathoracic pressure, inhalation time, and breath hold time should be kept consistent between repeated tests.
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Yamaguchi K, Tsuji T, Aoshiba K, Nakamura H. Simultaneous measurement of pulmonary diffusing capacity for carbon monoxide and nitric oxide. Respir Investig 2018; 56:100-110. [PMID: 29548647 DOI: 10.1016/j.resinv.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 02/07/2023]
Abstract
In Europe and America, the newly-developed, simultaneous measurement of diffusing capacity for CO (DLCO) and NO (DLNO) has replaced the classic DLCO measurement for detecting the pathophysiological abnormalities in the acinar regions. However, simultaneous measurement of DLCO and DLNO is currently not used by Japanese physicians. To encourage the use of DLNO in Japan, the authors reviewed aspects of simultaneously-estimated DLCO and DLNO from previously published manuscripts. The simultaneous DLCO-DLNO technique identifies the alveolocapillary membrane-related diffusing capacity (membrane component, DM) and the blood volume in pulmonary microcirculation (VC); VC is the principal factor constituting the blood component of diffusing capacity (DB,DB=θ·VC where θ is the specific gas conductance for CO or NO in the blood). As the association velocity of NO with hemoglobin (Hb) is fast and the affinity of NO with Hb is high in comparison with those of CO, θNO can be taken as an invariable simply determined by diffusion limitation inside the erythrocyte. This means that θNO is independent of the partial pressure of oxygen (PO2). However, θCO involves the limitations by diffusion and chemical reaction elicited by the erythrocyte, resulting in θCO to be a PO2-dependent variable. Furthermore, DLCO is determined primarily by DB (∼77%), while DLNO is determined equally by DM (∼55%) and DB (∼45%). This suggests that DLCO is more sensitive for detecting microvascular diseases, while DLNO can equally identify alveolocapillary membrane and microcirculatory abnormalities.
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Affiliation(s)
- Kazuhiro Yamaguchi
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Takao Tsuji
- Respiratory Medicine, Institute of Geriatrics Tokyo Women's Medical University, 2-15-1 Sibuya, Shibuya-ku, 150-0002 Tokyo, Japan.
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami-machi, Inashiki-gun, 300-0395 Ibaraki, Japan.
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami-machi, Inashiki-gun, 300-0395 Ibaraki, Japan.
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Olson TP, Johnson BD, Borlaug BA. Impaired Pulmonary Diffusion in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2017; 4:490-8. [PMID: 27256752 DOI: 10.1016/j.jchf.2016.03.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The purpose of this study was to compare measures of gas exchange at rest and during exercise in patients with heart failure and preserved ejection fraction (HFpEF) with age- and sex-matched control subjects. BACKGROUND Patients with HFpEF display elevation in left heart pressures, but it is unclear how this affects pulmonary gas transfer or its determinants at rest and during exercise. METHODS Patients with HFpEF (n = 20) and control subjects (n = 26) completed a recumbent cycle ergometry exercise test with simultaneous measurement of ventilation and gas exchange. Diffusion of the lungs for carbon monoxide (DLCO) and its subcomponents, pulmonary capillary blood volume (VC) and alveolar-capillary membrane conductance (DM), were measured at rest, and matched for low-intensity (20 W) and peak exercise. Stroke volume was measured by transthoracic echocardiography to calculate cardiac output. RESULTS Compared with control subjects, patients with HFpEF displayed impaired diastolic function and reduced exercise capacity. Patients with HFpEF demonstrated a 24% lower DLCO at rest (11.0 ± 2.3 ml/mm Hg/min vs. 14.4 ± 3.3 ml/mm Hg/min; p < 0.01) related to reductions in both DM (18.1 ± 4.9 ml/mm Hg/min vs. 23.1 ± 9.1 ml/mm Hg/min; p = 0.04), and VC (45.9 ± 15.2. ml vs. 58.9 ± 16.2 ml; p = 0.01). DLCO was lower in patients with HFpEF compared with control subjects in all stages of exercise, yet its determinants showed variable responses. With low-level exercise, patients with HFpEF demonstrated greater relative increases in VC, coupled with heightened ventilatory drive and more severe symptoms of dyspnea compared with control subjects. At 20-W exercise, DM was markedly reduced in patients with HFpEF compared with control subjects. From 20 W to peak exercise, there was no further increase in VC in patients with HFpEF, which in tandem with reduced DM, led to a 30% reduction in DLCO at peak exercise (17.3 ± 4.2 ml/mm Hg/min vs. 24.7 ± 7.1 ml/mm Hg/min; p < 0.01). CONCLUSIONS Subjects with HFpEF display altered pulmonary function and gas exchange at rest and especially during exercise, which contributes to exercise intolerance. Novel therapies that improve gas diffusion may be effective to improve exercise tolerance in patients with HFpEF.
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Affiliation(s)
- Thomas P Olson
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Minnesota.
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Minnesota
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Minnesota
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Behnia M, Wheatley CM, Avolio A, Johnson BD. Alveolar-capillary reserve during exercise in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:3115-3122. [PMID: 29123389 PMCID: PMC5661445 DOI: 10.2147/copd.s142523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Factors limiting exercise in patients with COPD are complex. With evidence for accelerated pulmonary vascular aging, destruction of alveolar-capillary bed, and hypoxic pulmonary vasoconstriction, the ability to functionally expand surface area during exercise may become a primary limitation. Purpose To quantify measures of alveolar-capillary recruitment during exercise and the relationship to exercise capacity in a cohort of COPD patients. Methods Thirty-two subjects gave consent (53% male, with mean ± standard deviation age 66±9 years, smoking 35±29 pack-years, and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of 0-4: 2.3±0.8), filled out the St George's Respiratory Questionnaire (SGRQ) to measure quality of life, had a complete blood count drawn, and underwent spirometry. The intrabreath (IB) technique for lung diffusing capacity for carbon monoxide (IBDLCO) and pulmonary blood flow (IBQc, at rest) was also performed. Subsequently, they completed a cycle ergometry test to exhaustion with measures of oxygen saturation and expired gases. Results Baseline average measures were 44±21 for SGRQ score and 58±11 for FEV1/FVC. Peak oxygen consumption (VO2) was 11.4±3.1 mL/kg/min (49% predicted). The mean resting IBDLCO was 9.7±5.4 mL/min/mmHg and IBQc was 4.7±0.9 L/min. At the first workload, heart rate (HR) increased to 92±11 bpm, VO2 was 8.3±1.4 mL/kg/min, and IBDLCO and IBQc increased by 46% and 43%, respectively, compared to resting values (p,0.01). The IBDLCO/Qc ratio averaged 2.0±1.1 at rest and remained constant during exercise with marked variation across subjects (range: 0.8-4.8). Ventilatory efficiency plateaued at 37±5 during exercise, partial pressure of mix expired CO2/partial pressure of end tidal CO2 ratio ranged from 0.63 to 0.67, while a noninvasive index of pulmonary capacitance, O2 pulse × PetCO2 (GxCap) rose to 138%. The exercise IBDLCO/Qc ratio was related to O2 pulse (VO2/HR, r=0.58, p<0.01), and subjects with the highest exercise IBDLCO/Qc ratio or the greatest rise from rest had the highest peak VO2 values (r=0.65 and 0.51, respectively, p<0.05). Of the noninvasive gas exchange measures of pulmonary vascular function, GxCap was most closely associated with DLCO, DLCO/Qc, and VO2 peak. Conclusion COPD patients who can expand gas exchange surface area as assessed with DLCO during exercise relative to pulmonary blood flow have a more preserved exercise capacity.
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Affiliation(s)
- Mehrdad Behnia
- Division of Critical Care, Florida Hospital, Orlando, FL
| | | | - Alberto Avolio
- Australian School of Advanced Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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Wheatley CM, Baker SE, Taylor BJ, Keller-Ross ML, Chase SC, Carlson AR, Wentz RJ, Snyder EM, Johnson BD. Influence of Inhaled Amiloride on Lung Fluid Clearance in Response to Normobaric Hypoxia in Healthy Individuals. High Alt Med Biol 2017; 18:343-354. [PMID: 28876128 DOI: 10.1089/ham.2017.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wheatley, Courtney M., Sarah E. Baker, Bryan J. Taylor, Manda L. Keller-Ross, Steven C. Chase, Alex R. Carlson, Robert J. Wentz, Eric M. Snyder, and Bruce D. Johnson. Influence of inhaled amiloride on lung fluid clearance in response to normobaric hypoxia in healthy individuals. High Alt Med Biol 18:343-354, 2017. AIM To investigate the role of epithelial sodium channels (ENaC) on lung fluid clearance in response to normobaric hypoxia, 20 healthy subjects were exposed to 15 hours of hypoxia (fraction of inspired oxygen [FiO2] = 12.5%) on two randomized occasions: (1) inhaled amiloride (A) (1.5 mg/5 mL saline); and (2) inhaled saline placebo (P). Changes in lung fluid were assessed through chest computed tomography (CT) for lung tissue volume (TV), and the diffusion capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO) for pulmonary capillary blood volume (VC). Extravascular lung water (EVLW) was derived as TV-VC and changes in the CT attenuation distribution histograms were reviewed. RESULTS Normobaric hypoxia caused (1) a reduction in EVLW (change from baseline for A vs. P, -8.5% ± 3.8% vs. -7.9% ± 5.2%, p < 0.05), (2) an increase in VC (53.6% ± 28.9% vs. 53.9% ± 52.3%, p < 0.05), (3) a small increase in DLCO (9.6% ± 29.3% vs. 9.9% ± 23.9%, p > 0.05), and (4) CT attenuation distribution became more negative, leftward skewed, and kurtotic (p < 0.05). CONCLUSION Acute normobaric hypoxia caused a reduction in lung fluid that was unaffected by ENaC inhibition through inhaled amiloride. Although possible amiloride-sensitive ENaC may not be necessary to maintain lung fluid balance in response to hypoxia, it is more probable that normobaric hypoxia promotes lung fluid clearance rather than accumulation for the majority of healthy individuals. The observed reduction in interstitial lung fluid means alveolar fluid clearance may not have been challenged.
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Affiliation(s)
- Courtney M Wheatley
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Sarah E Baker
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Bryan J Taylor
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | | | - Steven C Chase
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Alex R Carlson
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Robert J Wentz
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Eric M Snyder
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Bruce D Johnson
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
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Zavorsky GS, van der Lee I. Can the measurement of pulmonary diffusing capacity for nitric oxide replace the measurement of pulmonary diffusing capacity for carbon monoxide? Respir Physiol Neurobiol 2017; 241:9-16. [DOI: 10.1016/j.resp.2016.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
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Borland C, Patel S, Zhu Q, Vuylsteke A. Hypothesis: Why θNO could be finite in vitro but infinite in vivo. Respir Physiol Neurobiol 2017; 241:58-61. [DOI: 10.1016/j.resp.2017.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/24/2022]
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Zavorsky GS, Smoliga JM. The association between cardiorespiratory fitness and pulmonary diffusing capacity. Respir Physiol Neurobiol 2017; 241:28-35. [DOI: 10.1016/j.resp.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 11/29/2022]
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Hughes J, Dinh-Xuan A. The DL NO /DL CO ratio: Physiological significance and clinical implications. Respir Physiol Neurobiol 2017; 241:17-22. [DOI: 10.1016/j.resp.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Borland C, Hughes JMB, Guénard H. The blood transfer conductance for CO and NO. Respir Physiol Neurobiol 2017; 241:53-7. [DOI: 10.1016/j.resp.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/18/2017] [Accepted: 02/19/2017] [Indexed: 11/16/2022]
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Coffman KE, Carlson AR, Miller AD, Johnson BD, Taylor BJ. The effect of aging and cardiorespiratory fitness on the lung diffusing capacity response to exercise in healthy humans. J Appl Physiol (1985) 2017; 122:1425-1434. [PMID: 28336536 DOI: 10.1152/japplphysiol.00694.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022] Open
Abstract
Aging is associated with deterioration in the structure and function of the pulmonary circulation. We characterized the lung diffusing capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO), and pulmonary-capillary blood volume (Vc) response to discontinuous incremental exercise at 25, 50, 75, and 90% of peak work (Wpeak) in four groups: 1) Young [27 ± 3 yr, maximal oxygen consumption (V̇o2max): 110 ± 18% age predicted]; 2) Young Highly Fit (27 ± 3 yr, V̇o2max: 147 ± 8% age predicted); 3) Old (69 ± 5 yr, V̇o2max: 116 ± 13% age predicted); and 4) Old Highly Fit (65 ± 5 yr, V̇o2max: 162 ± 18% age predicted). At rest and at 90% Wpeak, DLCO, DmCO, and Vc were decreased with age. At 90% Wpeak, DLCO, DmCO, and Vc were greater in Old Highly Fit vs. Old adults. The slope of the DLCO-cardiac output (Q̇) relationship from rest to end exercise at 90% Wpeak was not different between Young, Young Highly Fit, Old, and Old Highly Fit (1.35 vs. 1.44 vs. 1.10 vs. 1.35 mlCO·mmHg-1·liter blood-1, P = 0.388), with no evidence of a plateau in this relationship during exercise; this was also true for DmCO-Q̇ and Vc-Q̇. V̇o2max was positively correlated with 1) DLCO, DmCO, and Vc at rest; and 2) the rest to end exercise change in DLCO, DmCO, and Vc. In conclusion, these data suggest that despite the age-associated deterioration in the structure and function of the pulmonary circulation, expansion of the pulmonary capillary network does not become limited during exercise in healthy individuals regardless of age or cardiorespiratory fitness level.NEW & NOTEWORTHY Healthy aging is a crucial area of research. This article details how differences in age and cardiorespiratory fitness level affect lung diffusing capacity, particularly during high-intensity exercise. We conclude that highly fit older adults do not experience a limit in lung diffusing capacity during high-intensity exercise. Interestingly, however, we found that highly fit older individuals demonstrate greater values of lung diffusing capacity during high-intensity exercise than their less fit age-matched counterparts.
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Affiliation(s)
| | - Alex R Carlson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Andrew D Miller
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Bryan J Taylor
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; and .,School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
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Affiliation(s)
- Gerald S Zavorsky
- Department of Respiratory Therapy, Georgia State University, Georgia State University Urban Life Building, Room 1229 (12th Floor), 140 Decatur Street SE, Atlanta, GA, 30302-4019, United States.
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Zavorsky GS, Hsia CCW, Hughes JMB, Borland CDR, Guénard H, van der Lee I, Steenbruggen I, Naeije R, Cao J, Dinh-Xuan AT. Standardisation and application of the single-breath determination of nitric oxide uptake in the lung. Eur Respir J 2017; 49:49/2/1600962. [PMID: 28179436 DOI: 10.1183/13993003.00962-2016] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/26/2016] [Indexed: 01/03/2023]
Abstract
Diffusing capacity of the lung for nitric oxide (DLNO), otherwise known as the transfer factor, was first measured in 1983. This document standardises the technique and application of single-breath DLNO This panel agrees that 1) pulmonary function systems should allow for mixing and measurement of both nitric oxide (NO) and carbon monoxide (CO) gases directly from an inspiratory reservoir just before use, with expired concentrations measured from an alveolar "collection" or continuously sampled via rapid gas analysers; 2) breath-hold time should be 10 s with chemiluminescence NO analysers, or 4-6 s to accommodate the smaller detection range of the NO electrochemical cell; 3) inspired NO and oxygen concentrations should be 40-60 ppm and close to 21%, respectively; 4) the alveolar oxygen tension (PAO2 ) should be measured by sampling the expired gas; 5) a finite specific conductance in the blood for NO (θNO) should be assumed as 4.5 mL·min-1·mmHg-1·mL-1 of blood; 6) the equation for 1/θCO should be (0.0062·PAO2 +1.16)·(ideal haemoglobin/measured haemoglobin) based on breath-holding PAO2 and adjusted to an average haemoglobin concentration (male 14.6 g·dL-1, female 13.4 g·dL-1); 7) a membrane diffusing capacity ratio (DMNO/DMCO) should be 1.97, based on tissue diffusivity.
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Affiliation(s)
- Gerald S Zavorsky
- Dept of Respiratory Therapy, Georgia State University, Atlanta, GA, USA
| | - Connie C W Hsia
- Dept of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Colin D R Borland
- Dept of Medicine, University of Cambridge, Hinchingbrooke Hospital, Huntingdon, UK
| | - Hervé Guénard
- Dept of Physiology and Pulmonary Laboratory, University of Bordeaux and CHU, Bordeaux, France
| | - Ivo van der Lee
- Dept of Pulmonary Diseases, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Robert Naeije
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium
| | - Jiguo Cao
- Dept of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Anh Tuan Dinh-Xuan
- Dept of Physiology, Cochin Hospital, Paris Descartes University, Paris, France
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Coffman KE, Chase SC, Taylor BJ, Johnson BD. The blood transfer conductance for nitric oxide: Infinite vs. finite θ NO. Respir Physiol Neurobiol 2016; 241:45-52. [PMID: 28013060 DOI: 10.1016/j.resp.2016.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Whether the specific blood transfer conductance for nitric oxide (NO) with hemoglobin (θNO) is finite or infinite is controversial but important in the calculation of alveolar capillary membrane conductance (DmCO) and pulmonary capillary blood volume (VC) from values of lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO). In this review, we discuss the background associated with θNO, explore the resulting values of DmCO and VC when applying either assumption, and investigate the mathematical underpinnings of DmCO and VC calculations. In general, both assumptions yield reasonable rest and exercise DmCO and VC values. However, the finite θNO assumption demonstrates increasing VC, but not DmCO, with submaximal exercise. At relatively high, but physiologic, DLNO/DLCO ratios both assumptions can result in asymptotic behavior for VC values, and under the finite θNO assumption, DmCO values. In conclusion, we feel that the assumptions associated with a finite θNO require further in vivo validation against an established method before widespread research and clinical use.
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Affiliation(s)
- Kirsten E Coffman
- Mayo Graduate School, Mayo Clinic, 200 1(st) St. SW, Rochester, MN, USA
| | - Steven C Chase
- Mayo Graduate School, Mayo Clinic, 200 1(st) St. SW, Rochester, MN, USA
| | - Bryan J Taylor
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, UK
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 1(st) St. SW, Rochester, MN, USA.
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Jones JH, Zelt JT, Hirai DM, Diniz CV, Zaza A, O'Donnell DE, Neder JA. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD. COPD 2016; 14:210-218. [PMID: 27997255 DOI: 10.1080/15412555.2016.1253670] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO2 output ([Formula: see text]CO2) nadir. Pulmonary blood flow (PBF) in a submaximal test was calculated by inert gas rebreathing. Emphysema was quantified as % of attenuation areas below 950 HU. Patients typically presented with centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/total lung ratio = 0.82 ± 0.04). They had lower peak oxygen uptake ([Formula: see text]O2), higher [Formula: see text]E/[Formula: see text]CO2 nadir, and greater dyspnea scores than controls (p < 0.05). Lower peak [Formula: see text]O2 and worse dyspnea were found in patients with higher [Formula: see text]E/[Formula: see text]CO2 nadirs (≥30). Patients had blunted increases in PBF from rest to iso-[Formula: see text]O2 exercise (p < 0.05). Higher [Formula: see text]E/[Formula: see text]CO2 nadir in COPD was associated with emphysema severity (r = 0.63) which, in turn, was related to reduced lung diffusing capacity (r = -0.72) and blunted changes in PBF from rest to exercise (r = -0.69) (p < 0.01). Ventilation "wasted" in emphysematous areas is associated with impaired exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (DLCO) to a key clinical outcome (poor exercise tolerance) in COPD patients with only modest spirometric abnormalities.
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Affiliation(s)
- Joshua H Jones
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Joel T Zelt
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Daniel M Hirai
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Camilla V Diniz
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Aida Zaza
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Denis E O'Donnell
- b Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - J Alberto Neder
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
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Borland C, Guénard H. The history of the pulmonary diffusing capacity for nitric oxide DL,NO. Respir Physiol Neurobiol 2016; 241:3-6. [PMID: 27916736 DOI: 10.1016/j.resp.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
The DL,NO (TL,NO) had its unexpected origins in the Paris "events" of 1968 and the unsuccessful efforts of the UK tobacco industry in the 1970's to create a "safer cigarette". Adoption of the technique has been slow due to the instability of NO in air, lack of standardisation of the technique and lack of agreement as to whether DL,NO is equal to or merely reflects membrane diffusing capacity (DM). With the availability of inexpensive analysers, standardisation of the technique and publication of reference equations we believe that its worldwide use will increase.
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Affiliation(s)
- Colin Borland
- Department of Medicine University of Cambridge, UK and Hinchingbrooke Hospital, Huntingdon, UK.
| | - Hervé Guénard
- Physiologie et EFR, Université Bordeaux 2 et CHU Bordeaux, France.
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Taylor NE, Baker SE, Olson TP, Lalande S, Johnson BD, Snyder EM. Albuterol Improves Alveolar-Capillary Membrane Conductance in Healthy Humans. Clin Med Insights Circ Respir Pulm Med 2016; 10:19-25. [PMID: 27773996 PMCID: PMC5063752 DOI: 10.4137/ccrpm.s30251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Beta-2 adrenergic receptors (β2ARs) are located throughout the body including airway and alveolar cells. The β2ARs regulate lung fluid clearance through a variety of mechanisms including ion transport on alveolar cells and relaxation of the pulmonary lymphatics. We examined the effect of an inhaled β2-agonist (albuterol) on alveolar-capillary membrane conductance (DM) and pulmonary capillary blood volume (VC) in healthy humans. METHODS We assessed the diffusing capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO) at baseline, 30 minutes, and 60 minutes following nebulized albuterol (2.5 mg, diluted in 3 mL normal saline) in 45 healthy subjects. Seventeen subjects repeated these measures following nebulized normal saline (age = 27 ± 9 years, height = 165 ± 21 cm, weight = 68 ± 12 kg, BMI = 26 ± 9 kg/m2). Cardiac output (Q), heart rate, systemic vascular resistance (SVR), blood pressure, oxygen saturation, forced expiratory volume at one-second (FEV1), and forced expiratory flow at 50% of forced vital capacity (FEF50) were assessed at baseline, 30 minutes, and 60 minutes following the administration of albuterol or saline. RESULTS Albuterol resulted in a decrease in SVR, and an increase in Q, FEV1, and FEF50 compared to saline controls. Albuterol also resulted in a decrease in VC at 60 minutes post albuterol. Both albuterol and normal saline resulted in no change in DLCO or DM when assessed alone, but a significant increase was observed in DM when accounting for changes in VC. CONCLUSION These data suggest that nebulized albuterol improves pulmonary function in healthy humans, while nebulization of both albuterol and saline results in an increase in DM/VC.
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Affiliation(s)
- Natalie E Taylor
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah E Baker
- Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Thomas P Olson
- Assistant Professor of Medicine, Consultant, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sophie Lalande
- Assistant Professor, Department of Kinesiology, University of Toledo, OH, USA
| | - Bruce D Johnson
- Professor of Medicine and Physiology, Consultant, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Eric M Snyder
- Assistant Professor, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
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Tedjasaputra V, Bouwsema MM, Stickland MK. Effect of aerobic fitness on capillary blood volume and diffusing membrane capacity responses to exercise. J Physiol 2016; 594:4359-70. [PMID: 26959808 PMCID: PMC4967759 DOI: 10.1113/jp272037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/22/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Endurance trained athletes exhibit enhanced cardiovascular function compared to non-athletes, although it is considered that exercise training does not enhance lung structure and function. An increased pulmonary capillary blood volume at rest is associated with a higher V̇O2 max . In the present study, we compared the diffusion capacity, pulmonary capillary blood volume and diffusing membrane capacity responses to exercise in endurance-trained males compared to non-trained males. Exercise diffusion capacity was greater in athletes, secondary to an increased membrane diffusing capacity, and not pulmonary capillary blood volume. Endurance-trained athletes appear to have differences within the pulmonary membrane that facilitate the increased O2 demand needed for high-level exercise. ABSTRACT Endurance-trained athletes exhibit enhanced cardiovascular function compared to non-athletes, allthough it is generally accepted that exercise training does not enhance lung structure and function. Recent work has shown that an increased resting pulmonary capillary blood volume (VC ) is associated with a higher maximum oxygen consumption (V̇O2 max ), although there have been no studies to date examining how aerobic fitness affects the VC response to exercise. Based on previous work, we hypothesized that endurance-trained athletes will have greater VC compared to non-athletes during cycling exercise. Fifteen endurance-trained athletes (HI: V̇O2 max 64.6 ± 1.8 ml kg(-1) min(-1) ) and 14 non-endurance trained males (LO: V̇O2 max 45.0 ± 1.2 ml kg(-1) min(-1) ) were matched for age and height. Haemoglobin-corrected diffusion capacity (DLCO), VC and diffusing membrane capacity (DM ) were determined using the Roughton and Forster () multiple fraction of inspired O2 (FI O2 )-DLCO method at baseline and during incremental cycle exercise up to 90% of peak O2 consumption. During exercise, both groups exhibited increases in DLCO, DM and VC with exercise intensity. Athletes had a greater DLCO and greater DM at 80 and 90% of V̇O2 max compared to non-athletes. However, VC was not different between groups during exercise. In contrast to our hypothesis, exercise VC was not greater in endurance-trained subjects compared to controls; rather, the increased DLCO in athletes at peak exercise was secondary to an enhanced DM . These findings suggest that endurance-trained athletes appear to have differences within the pulmonary membrane that facilitate the increased O2 demand needed for high-level exercise.
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Affiliation(s)
- Vincent Tedjasaputra
- Pulmonary Division, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Melissa M Bouwsema
- Pulmonary Division, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Pulmonary Division, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- GF MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada
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Oppenheimer BW, Berger KI, Ali S, Segal LN, Donnino R, Katz S, Parikh M, Goldring RM. Pulmonary Vascular Congestion: A Mechanism for Distal Lung Unit Dysfunction in Obesity. PLoS One 2016; 11:e0152769. [PMID: 27035663 DOI: 10.1371/journal.pone.0152769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Obesity is characterized by increased systemic and pulmonary blood volumes (pulmonary vascular congestion). Concomitant abnormal alveolar membrane diffusion suggests subclinical interstitial edema. In this setting, functional abnormalities should encompass the entire distal lung including the airways. OBJECTIVES We hypothesize that in obesity: 1) pulmonary vascular congestion will affect the distal lung unit with concordant alveolar membrane and distal airway abnormalities; and 2) the degree of pulmonary congestion and membrane dysfunction will relate to the cardiac response. METHODS 54 non-smoking obese subjects underwent spirometry, impulse oscillometry (IOS), diffusion capacity (DLCO) with partition into membrane diffusion (DM) and capillary blood volume (VC), and cardiac MRI (n = 24). Alveolar-capillary membrane efficiency was assessed by calculation of DM/VC. MEASUREMENTS AND MAIN RESULTS Mean age was 45±12 years; mean BMI was 44.8±7 kg/m2. Vital capacity was 88±13% predicted with reduction in functional residual capacity (58±12% predicted). Despite normal DLCO (98±18% predicted), VC was elevated (135±31% predicted) while DM averaged 94±22% predicted. DM/VC varied from 0.4 to 1.4 with high values reflecting recruitment of alveolar membrane and low values indicating alveolar membrane dysfunction. The most abnormal IOS (R5 and X5) occurred in subjects with lowest DM/VC (r2 = 0.31, p<0.001; r2 = 0.34, p<0.001). Cardiac output and index (cardiac output / body surface area) were directly related to DM/VC (r2 = 0.41, p<0.001; r2 = 0.19, p = 0.03). Subjects with lower DM/VC demonstrated a cardiac output that remained in the normal range despite presence of obesity. CONCLUSIONS Global dysfunction of the distal lung (alveolar membrane and distal airway) is associated with pulmonary vascular congestion and failure to achieve the high output state of obesity. Pulmonary vascular congestion and consequent fluid transudation and/or alterations in the structure of the alveolar capillary membrane may be considered often unrecognized causes of airway dysfunction in obesity.
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Abstract
Structural and functional complexities of the mammalian lung evolved to meet a unique set of challenges, namely, the provision of efficient delivery of inspired air to all lung units within a confined thoracic space, to build a large gas exchange surface associated with minimal barrier thickness and a microvascular network to accommodate the entire right ventricular cardiac output while withstanding cyclic mechanical stresses that increase several folds from rest to exercise. Intricate regulatory mechanisms at every level ensure that the dynamic capacities of ventilation, perfusion, diffusion, and chemical binding to hemoglobin are commensurate with usual metabolic demands and periodic extreme needs for activity and survival. This article reviews the structural design of mammalian and human lung, its functional challenges, limitations, and potential for adaptation. We discuss (i) the evolutionary origin of alveolar lungs and its advantages and compromises, (ii) structural determinants of alveolar gas exchange, including architecture of conducting bronchovascular trees that converge in gas exchange units, (iii) the challenges of matching ventilation, perfusion, and diffusion and tissue-erythrocyte and thoracopulmonary interactions. The notion of erythrocytes as an integral component of the gas exchanger is emphasized. We further discuss the signals, sources, and limits of structural plasticity of the lung in alveolar hypoxia and following a loss of lung units, and the promise and caveats of interventions aimed at augmenting endogenous adaptive responses. Our objective is to understand how individual components are matched at multiple levels to optimize organ function in the face of physiological demands or pathological constraints.
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Affiliation(s)
- Connie C.W. Hsia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dallas M. Hyde
- California National Primate Research Center, University of California at Davis, Davis, California, USA
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Lee MJ, Coast JR, Hempleman SC, Baldi JC. Type 1 Diabetes Duration Decreases Pulmonary Diffusing Capacity during Exercise. Respiration 2016; 91:164-70. [PMID: 26756740 DOI: 10.1159/000443181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 12/02/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Diabetes damages peripheral tissues; however, its effects on the lung are less known. Lung diffusing capacity (DLCO) is influenced by alveolar-capillary membrane conductance (DM) and pulmonary capillary blood volume (VC), both of which are reduced in adults with type 1 diabetes (T1D). OBJECTIVE We sought to determine if diabetes duration affects DLCO, DM, VC, and cardiac output (Q). METHODS 24 T1D patients (10.7-52.8 years) and 24 non-diabetic controls were recruited and had DLCO, DM, VC, and Q measured at rest and during exercise (40, 70 and 90% VO2max). RESULTS When stratified into two groups based on age (young, <20.6 years old), there were no significant differences in DLCO, DM, VC, or Q (all of which were normalized to body surface area [BSA]) in the young group or in the old group. When stratified by diabetes duration (short duration, 0.33-8.9 years vs. long duration, 9.6-28 years), the T1D patients in the long duration group had lower DLCO/BSA and DM/BSA compared to the controls (p < 0.05). There were no differences in any of the variables in the short duration group. CONCLUSIONS This study has shown that duration of diabetes is associated with decrements in diffusing capacity and its components.
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Taylor BJ, Coffman KE, Summerfield DT, Issa AN, Kasak AJ, Johnson BD. Pulmonary capillary reserve and exercise capacity at high altitude in healthy humans. Eur J Appl Physiol 2016; 116:427-37. [PMID: 26614507 DOI: 10.1007/s00421-015-3299-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/11/2015] [Indexed: 11/22/2022]
Abstract
Purpose We determined whether well-acclimatized humans have a reserve to recruit pulmonary capillaries in response to exercise at high altitude. Methods At sea level, lung diffusing capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO), and pulmonary capillary blood volume (Vc) were measured at rest before maximal oxygen consumption (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max) was determined in seven adults. Then, DLCO, DmCO and Vc were measured pre- and post-exhaustive incremental exercise at 5150 m after ~40 days of acclimatization. Results Immediately after exercise at high altitude, there was an increase in group mean DmCO (14 ± 10 %, P = 0.040) with no pre- to post-exercise change in group mean DLCO (46.9 ± 5.8 vs. 50.6 ± 9.6 ml/min/mmHg, P = 0.213) or Vc (151 ± 28 vs. 158 ± 37 ml, P = 0.693). There was, however, a ~20 % increase in DLCO from pre- to post-exercise at high altitude (51.2 ± 0.2 vs. 61.1 ± 0.2 ml/min/mmHg) with a concomitant increase in DmCO (123 ± 2 vs. 156 ± 4 ml/min/mmHg) and Vc (157 ± 3 vs. 180 ± 8 ml) in 2 of the 7 participants. There was a significant positive relationship between the decrease in \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max from sea level to high altitude and the change in DLCO and lung diffusing capacity for nitric oxide (DLNO) from rest to end-exercise at high altitude. Conclusion These data suggest that recruitment of the pulmonary capillaries in response to exercise at high altitude is limited in most well-acclimatized humans but that any such a reserve may be associated with better exercise capacity.
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Coffman KE, Taylor BJ, Carlson AR, Wentz RJ, Johnson BD. Optimizing the calculation of DM,CO and VC via the single breath single oxygen tension DLCO/NO method. Respir Physiol Neurobiol 2015; 221:19-29. [PMID: 26521031 DOI: 10.1016/j.resp.2015.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/08/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
Alveolar-capillary membrane conductance (D(M,CO)) and pulmonary-capillary blood volume (V(C)) are calculated via lung diffusing capacity for carbon monoxide (DL(CO)) and nitric oxide (DL(NO)) using the single breath, single oxygen tension (single-FiO2) method. However, two calculation parameters, the reaction rate of carbon monoxide with blood (θ(CO)) and the D(M,NO)/D(M,CO) ratio (α-ratio), are controversial. This study systematically determined optimal θ(CO) and α-ratio values to be used in the single-FiO2 method that yielded the most similar D(M,CO) and V(C) values compared to the 'gold-standard' multiple-FiO2 method. Eleven healthy subjects performed single breath DL(CO)/DL(NO) maneuvers at rest and during exercise. D(M,CO) and V(C) were calculated via the single-FiO2 and multiple-FiO2 methods by implementing seven θ(CO) equations and a range of previously reported α-ratios. The RP θ(CO) equation (Reeves, R.B., Park, H.K., 1992. Respiration Physiology 88 1-21) and an α-ratio of 4.0-4.4 yielded DM,CO and VC values that were most similar between methods. The RP θ(CO) equation and an experimental α-ratio should be used in future studies.
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Affiliation(s)
- Kirsten E Coffman
- Mayo Graduate School, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Bryan J Taylor
- Sport & Health Sciences, University of Exeter, Heavitree Road, Exeter, UK; Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Alex R Carlson
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Robert J Wentz
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
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Agostoni P, Magini A, Apostolo A. Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide. Eur J Prev Cardiol 2015; 22:314-6. [DOI: 10.1177/2047487314528873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
- Dipartimento di Malattie Cardiovascolari, Università di Milano, Italy
| | - Alessandra Magini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
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Wheatley CM, Baker SE, Morgan MA, Martinez MG, Morgan WJ, Wong EC, Karpen SR, Snyder EM. Effects of exercise intensity compared to albuterol in individuals with cystic fibrosis. Respir Med 2014; 109:463-74. [PMID: 25749641 DOI: 10.1016/j.rmed.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although exercise is a vital component of the therapy prescribed to individuals with cystic fibrosis (CF), it is not a priority due to a finite amount of treatment time and the view that exercise is not as beneficial as pharmacological treatments by many individuals with CF. We sought to compare the therapeutic benefits of exercise and their prescribed bronchodilator albuterol. METHODS CF (n = 14) and healthy (n = 16) subjects completed three visits, a baseline screening with VO2 max test and two treatment visits. On the two treatment visits, subjects completed spirometry and diffusing capacity of the lungs for nitric oxide (DLNO) maneuvers either at baseline, 60, and 110 min post-albuterol administration, or at baseline and the midway point of three separate 15 min exercise bouts at low, moderate and vigorous intensity (25, 50 and 65% of the maximum workload, respectively). RESULTS With moderate exercise the increase in DLNO was double (39 ± 8 vs 15 ± 6% change) and the level of bronchodilation similar (23% change) when compared to 110 min post-albuterol in individuals with CF. During exercise FVC became reduced (-309 ± 66 mL with moderate exercise) and the increase in FEV1 was attenuated (103 ± 39 vs 236 ± 58 mL, exercise vs. albuterol) when compared with the response to albuterol in individuals with CF. Epinephrine (EPI) release increased 39, 72 and 144% change with low, moderate and vigorous intensity exercise respectively for individuals with CF, but this increase was blunted when compared to healthy subjects. CONCLUSION Our results suggest that moderate intensity exercise is the optimal intensity for individuals with CF, as low intensity exercise increases EPI less than 50% and vigorous intensity exercise is over taxing, such that airflow can be restricted. Although the duration of the beneficial effect is uncertain, exercise can promote greater improvements in gas diffusion and comparable bronchodilation when compared to albuterol.
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Affiliation(s)
- Courtney M Wheatley
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Sarah E Baker
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
| | - Mary A Morgan
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Marina G Martinez
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Wayne J Morgan
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, AZ, USA.
| | - Eric C Wong
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Stephen R Karpen
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Eric M Snyder
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
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Kim CH, Fuglestad MA, Richert MLC, Shen WK, Johnson BD. Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure. Respir Physiol Neurobiol 2014; 202:75-81. [PMID: 25128641 DOI: 10.1016/j.resp.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED It is unclear how dynamic changes in pulmonary-capillary blood volume (Vc), alveolar lung volume (derived from end-inspiratory lung volume, EILV) and interstitial fluid (ratio of alveolar capillary membrane conductance and pulmonary capillary blood volume, Dm/Vc) influence lung impedance (Z(T)). The purpose of this study was to investigate if positional change and exercise result in increased EILV, Vc and/or lung interstitial fluid, and if Z(T) tracks these variables. METHODS 12 heart failure (HF) patients underwent measurements (Z(T), EILV, Vc/Dm) at rest in the upright and supine positions, during exercise and into recovery. Inspiratory capacity was obtained to provide consistent measures of EILV while assessing Z(T). RESULTS Z(T) increased with lung volume during slow vital capacity maneuvers (p<0.05). Positional change (upright→supine) resulted in an increased Z(T) (p<0.01), while Vc increased and EILV and Dm/Vc decreased (p<0.05). Moreover, during exercise Vc and EILV increased and Dm/Vc decreased (p<0.05), whereas, Z(T) did not change significantly (p>0.05). CONCLUSION Impedance appears sensitive to changes in lung volume and body position which appear to generally overwhelm small acute changes in lung fluid when assed dynamically at rest or during exercise.
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Affiliation(s)
- Chul-Ho Kim
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
| | - Matthew A Fuglestad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | | | - Win K Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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Rouatbi S, Khemis M, Garrouch A, Ben Saad H. Reference values of capillary blood volume and pulmonary membrane diffusing capacity in North African boys aged 8 to 16 years. Egyptian Journal of Chest Diseases and Tuberculosis 2014. [DOI: 10.1016/j.ejcdt.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Idorn L, Hanel B, Jensen AS, Juul K, Reimers JI, Nielsen KG, Søndergaard L. New insights into the aspects of pulmonary diffusing capacity in Fontan patients. Cardiol Young 2014; 24:311-20. [PMID: 23552344 DOI: 10.1017/S1047951113000358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with a functionally univentricular heart, palliated a.m. Fontan, consequently have non-pulsatile pulmonary blood flow and are known to have a reduced pulmonary diffusing capacity. However, the cause of this reduction remains unclear. We aimed to assess the possible determinants in the aetiology of a reduced diffusing capacity and also to assess whether it could be increased. Furthermore, we aimed to search for predictors of a reduced diffusing capacity. MATERIAL AND METHODS A total of 87 Fontan patients (mean age 16.3 ± 7.6 years) performed advanced pulmonary function tests and maximal cycle ergometer tests. A total of 10 Fontan patients and nine matched controls performed a supine pulmonary function test after a supine rest. RESULTS In the sitting pulmonary function test, the mean z-scores were: diffusing capacity, 2.38 ± 1.20; pulmonary capillary blood volume, 2.04 ± 0.80; and alveolar capillary membrane diffusing capacity, 0.14 ± 0.84. In the supine compared with the sitting pulmonary function test, the diffusing capacity increased by 51.7 ± 11.9% in the Fontan group and by 23.3 ± 17.7% in the control group (p < 0.001); moreover, the pulmonary capillary blood volume increased by 48.3 ± 17.4% in the Fontan group and by 20.2 ± 13.9% in the control group (p = 0.001). In a multiple linear regression analysis including the explanatory variables of surgical data and exercise data at rest and peak exercise, the resting cardiac index was an independent predictor of the diffusing capacity (regression coefficient: 0.18, p < 0.001). CONCLUSIONS The pulmonary diffusing capacity was reduced in Fontan patients because of a reduced pulmonary capillary blood volume, whereas the alveolar capillary membrane diffusing capacity was preserved. The diffusing capacity was highly increasable in Fontan patients compared with controls, and the resting cardiac index was an independent predictor of the diffusing capacity.
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Al Dandachi G, Londner C, Caumont-Prim A, Plantier L, Chevalier-Bidaud B, Toussaint JF, Desgorces FD, Delclaux C. Ageing and endurance training effects on quantity and quality of pulmonary vascular bed in healthy men. Respir Res 2014; 15:8. [PMID: 24460636 PMCID: PMC3903017 DOI: 10.1186/1465-9921-15-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/23/2014] [Indexed: 12/21/2022] Open
Abstract
It has recently been demonstrated that in healthy individuals, peak oxygen consumption is associated with a greater pulmonary capillary blood volume and a more distensible pulmonary circulation. Our cross-sectional study suggests that, in healthy men aged 20 to 60 years (n = 63), endurance sport practice (vigorous-intensity domain of the International Physical Activity Questionnaire) is associated with better quantity (pulmonary capillary blood volume) and quality (slope of increase in lung diffusion for carbon monoxide on exercise) of the pulmonary vascular bed, partly counterbalancing the deleterious effects of ageing, which remains to be demonstrated in a prospective longitudinal design.
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Affiliation(s)
| | | | | | | | | | | | | | - Christophe Delclaux
- AP-HP, Hôpital européen Georges-Pompidou, Service de Physiologie - Clinique de la Dyspnée, 75015 Paris, France.
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Wheatley CM, Morgan WJ, Cassuto NA, Foxx-Lupo WT, Daines CL, Morgan MA, Phan H, Snyder EM. Exhaled breath condensate detects baseline reductions in chloride and increases in response to albuterol in cystic fibrosis patients. Clin Med Insights Circ Respir Pulm Med 2013; 7:79-90. [PMID: 24367235 PMCID: PMC3869628 DOI: 10.4137/ccrpm.s12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Impaired ion regulation and dehydration is the primary pathophysiology in cystic fibrosis (CF) lung disease. A potential application of exhaled breath condensate (EBC) collection is to assess airway surface liquid ionic composition at baseline and in response to pharmacological therapy in CF. Our aims were to determine if EBC could detect differences in ion regulation between CF and healthy and measure the effect of the albuterol on EBC ions in these populations. Baseline EBC Cl−, DLCO and SpO2 were lower in CF (n = 16) compared to healthy participants (n = 16). EBC Cl− increased in CF subjects, while there was no change in DLCO or membrane conductance, but a decrease in pulmonary-capillary blood volume in both groups following albuterol. This resulted in an improvement in diffusion at the alveolar-capillary unit, and removal of the baseline difference in SpO2 by 90-minutes in CF subjects. These results demonstrate that EBC detects differences in ion regulation between healthy and CF individuals, and that albuterol mediates increases in Cl− in CF, suggesting that the benefits of albuterol extend beyond simple bronchodilation.
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Affiliation(s)
- Courtney M Wheatley
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Wayne J Morgan
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Nicholas A Cassuto
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - William T Foxx-Lupo
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Cori L Daines
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Mary A Morgan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Hanna Phan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona. ; Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Eric M Snyder
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
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Linnarsson D, Hemmingsson TE, Frostell C, Van Muylem A, Kerckx Y, Gustafsson LE. Lung diffusing capacity for nitric oxide at lowered and raised ambient pressures. Respir Physiol Neurobiol 2013; 189:552-7. [DOI: 10.1016/j.resp.2013.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/23/2013] [Accepted: 08/15/2013] [Indexed: 01/13/2023]
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Magini A, Apostolo A, Salvioni E, Italiano G, Veglia F, Agostoni P. Alveolar-capillary membrane diffusion measurement by nitric oxide inhalation in heart failure. Eur J Prev Cardiol 2013; 22:206-12. [PMID: 24165475 DOI: 10.1177/2047487313510397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In heart failure, lung diffusion is reduced, it correlates with prognosis and exercise capacity, and it is a therapy target. DESIGN Diffusion is measured as CO total diffusion (DL(CO)), which has two components: membrane diffusion (Dm) and capillary volume, the latter related to CO and O2 competition for hemoglobin. DL(CO) needs to be corrected for hemoglobin. Diffusion can also be measured with NO (DL(NO)), which has a very high affinity for hemoglobin, and thus, the resistance of hemoglobin being trivial, it directly represents Dm. Therefore, Dm is directly calculated from DL(NO) through a correction factor. DL(NO) has never been measured in heart failure. The study aims at determining, in heart failure, DL(NO), Dm correction factor, and whether Dm(NO) provides Dm estimates comparable to Dm(CO). METHODS We measured DL(CO), Dm(CO) by multi-maneuver Roughton-Forster method, and DL(CO) and DL(NO) by single-breath maneuver in 50 heart failure and 50 healthy subjects. RESULTS DL(CO) was 21.9 ± 4.8 ml/mmHg per min and 16.8 ± 5.1 in healthy subjects and heart failure subjects, respectively (p < 0.001). DL(NO) was 88.6 ± 20.5 ml/mmHg per min and 72.5 ± 22.3, respectively (p < 0.001). The correction factors to obtain Dm from DL(NO) were 2.68 (entire population), 2.63 (healthy subjects) and 2.75 (heart failure subjects). Dm(CO) and Dm(NO) were 34.7 ± 10.9 ml/mmHg per min and 33.8 ± 7.6 in healthy subjects and 25.9 ± 2.0 and 26.4 ± 8.1 in heart failure subjects. CONCLUSIONS DL(NO) and Dm(NO) measurements are feasible in heart failure. Dm(CO) and Dm(NO) provide comparable results. The correction factor to calculate Dm from DL(NO) in heart failure is 2.75, which is little different from the 2.63 value we observed in healthy subjects.
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Affiliation(s)
| | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, USA
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van Ooij PJAM, Hollmann MW, van Hulst RA, Sterk PJ. Assessment of pulmonary oxygen toxicity: relevance to professional diving; a review. Respir Physiol Neurobiol 2013; 189:117-28. [PMID: 23886638 DOI: 10.1016/j.resp.2013.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/07/2023]
Abstract
When breathing oxygen with partial oxygen pressures PO₂ of between 50 and 300 kPa pathological pulmonary changes develop after 3-24h depending on the PO₂. This kind of injury (known as pulmonary oxygen toxicity) is not only observed in ventilated patients but is also considered an occupational hazard in oxygen divers or mixed gas divers. To prevent these latter groups from sustaining irreversible lesions adequate prevention is required. This review summarizes the pathophysiological effects on the respiratory tract when breathing oxygen with PO₂ of 50-300 kPa (hyperoxia). We discuss to what extent the most commonly used lung function parameters change after exposure to hyperoxia and its role in monitoring the onset and development of pulmonary oxygen toxicity in daily practice. Finally, new techniques in respiratory medicine are discussed with regard to their usefulness in monitoring pulmonary oxygen toxicity in divers.
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Affiliation(s)
- P J A M van Ooij
- Diving Medical Center, Royal Netherlands Navy, The Netherlands; Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Baker SE, Wong EC, Wheatley CM, Foxx-Lupo WT, Martinez MG, Morgan MA, Sprissler R, Morgan WJ, Snyder EM. Genetic variation of SCNN1A influences lung diffusing capacity in cystic fibrosis. Med Sci Sports Exerc 2013; 44:2315-21. [PMID: 22776878 DOI: 10.1249/mss.0b013e318266ebc3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Epithelial Na channels (ENaCs) play a crucial role in ion and fluid regulation in the lung. In cystic fibrosis (CF), Na hyperabsorption results from ENaC overactivity, leading to airway dehydration. Previous work has demonstrated functional genetic variation of SCNN1A (the gene encoding the ENaC α-subunit), manifesting as an alanine (A) to threonine (T) substitution at amino acid 663, with the αT663 variant resulting in a more active channel. METHODS We assessed the influence of genetic variation of SCNN1A on the diffusing capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO), together with alveolar-capillary membrane conductance (DM), pulmonary capillary blood volume, and alveolar volume (VA) at rest and during peak exercise in 18 patients with CF (10 homozygous for αA663 (AA group) and 8 with at least one T663 allele (AT/TT group)). Because of the more active channel, we hypothesized that the AT/TT group would show a greater increase in DLCO, DLNO, and DM with exercise because of exercise-mediated ENaC inhibition and subsequent attenuation of Na hyperabsorption. RESULTS The AT/TT group had significantly lower pulmonary function, weight, and body mass index than the AA group. Both groups had similar peak workloads, relative peak oxygen consumptions, and cardiopulmonary responses to exercise. The AT/TT group demonstrated a greater increase in DLNO, DLNO/VA, and DM in response to exercise (% increases: DLNO = 18 ± 11 vs 41 ± 38; DLNO/VA = 14 ± 21 vs 40 ± 37; DM = 15 ± 11 vs 41 ± 38, AA vs AT/TT, respectively). There were no differences between groups in absolute diffusing capacity measures at peak exercise. CONCLUSION These results suggest that genetic variation of the α-subunit of ENaC differentially affects the diffusing capacity response to exercise in patients with CF.
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Affiliation(s)
- Sarah E Baker
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
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Abstract
As the first step in the oxygen-transport chain, the lung has a critical task: optimizing the exchange of respiratory gases to maintain delivery of oxygen and the elimination of carbon dioxide. In healthy subjects, gas exchange, as evaluated by the alveolar-to-arterial PO2 difference (A-aDO2), worsens with incremental exercise, and typically reaches an A-aDO2 of approximately 25 mmHg at peak exercise. While there is great individual variability, A-aDO2 is generally largest at peak exercise in subjects with the highest peak oxygen consumption. Inert gas data has shown that the increase in A-aDO2 is explained by decreased ventilation-perfusion matching, and the development of a diffusion limitation for oxygen. Gas exchange data does not indicate the presence of right-to-left intrapulmonary shunt developing with exercise, despite recent data suggesting that large-diameter arteriovenous shunt vessels may be recruited with exercise. At the same time, multisystem mechanisms regulate systemic acid-base balance in integrative processes that involve gas exchange between tissues and the environment and simultaneous net changes in the concentrations of strong and weak ions within, and transfer between, extracellular and intracellular fluids. The physicochemical approach to acid-base balance is used to understand the contributions from independent acid-base variables to measured acid-base disturbances within contracting skeletal muscle, erythrocytes and noncontracting tissues. In muscle, the magnitude of the disturbance is proportional to the concentrations of dissociated weak acids, the rate at which acid equivalents (strong acid) accumulate and the rate at which strong base cations are added to or removed from muscle.
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Affiliation(s)
- Michael K. Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael I. Lindinger
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - I. Mark Olfert
- Robert C. Byrd Health Sciences Center, Center for Cardiovascular and Respiratory Sciences, Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Susan R. Hopkins
- Departments of Medicine and Radiology, University of California, San Diego, San Diego, California
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Stickland MK, Butcher SJ, Marciniuk DD, Bhutani M. Assessing exercise limitation using cardiopulmonary exercise testing. Pulm Med 2012; 2012:824091. [PMID: 23213518 DOI: 10.1155/2012/824091] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/26/2012] [Indexed: 01/12/2023] Open
Abstract
The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption ([Formula: see text]) is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation ([Formula: see text] = cardiac output × arterial-venous O(2) content difference). In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O(2) content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO(2). Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O(2) pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.
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Lavin KM, Straub AM, Uhranowsky KA, Smoliga JM, Zavorsky GS. Alveolar-membrane diffusing capacity limits performance in Boston marathon qualifiers. PLoS One 2012; 7:e44513. [PMID: 22984520 PMCID: PMC3439386 DOI: 10.1371/journal.pone.0044513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/03/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose (1) to examine the relation between pulmonary diffusing capacity and marathon finishing time, and (2), to evaluate the accuracy of pulmonary diffusing capacity for nitric oxide (DLNO) in predicting marathon finishing time relative to that of pulmonary diffusing capacity for carbon monoxide (DLCO). Methods 28 runners [18 males, age = 37 (SD 9) years, body mass = 70 (13) kg, height = 173 (9) cm, percent body fat = 17 (7) %] completed a test battery consisting of measurement of DLNO and DLCO at rest, and a graded exercise test to determine running economy and aerobic capacity prior to the 2011 Steamtown Marathon (Scranton, PA). One to three weeks later, all runners completed the marathon (range: 2∶22:38 to 4∶48:55). Linear regressions determined the relation between finishing time and a variety of anthropometric characteristics, resting lung function variables, and exercise parameters. Results In runners meeting Boston Marathon qualification standards, 74% of the variance in marathon finishing time was accounted for by differences in DLNO relative to body surface area (BSA) (SEE = 11.8 min, p<0.01); however, the relation between DLNO or DLCO to finishing time was non-significant in the non-qualifiers (p = 0.14 to 0.46). Whereas both DLCO and DLNO were predictive of finishing time for all finishers, DLNO showed a stronger relation (r2 = 0.30, SEE = 33.4 min, p<0.01) compared to DLCO when considering BSA. Conclusion DLNO is a performance-limiting factor in only Boston qualifiers. This suggests that alveolar-capillary membrane conductance is a limitation to performance in faster marathoners. Additionally, DLNO/BSA predicts marathon finishing time and aerobic capacity more accurately than DLCO.
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Affiliation(s)
- Kaleen M. Lavin
- Human Physiology Laboratory, Marywood University, Scranton, Pennsylvania, United States of America
| | - Allison M. Straub
- Human Physiology Laboratory, Marywood University, Scranton, Pennsylvania, United States of America
| | - Kathleen A. Uhranowsky
- Human Physiology Laboratory, Marywood University, Scranton, Pennsylvania, United States of America
| | - James M. Smoliga
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
| | - Gerald S. Zavorsky
- Human Physiology Laboratory, Marywood University, Scranton, Pennsylvania, United States of America
- The Commonwealth Medical College, Scranton, Pennsylvania, United States of America
- * E-mail:
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Wémeau-Stervinou L, Perez T, Murphy C, Polge AS, Wallaert B. Lung capillary blood volume and membrane diffusion in idiopathic interstitial pneumonia. Respir Med 2012; 106:564-70. [DOI: 10.1016/j.rmed.2011.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/26/2011] [Accepted: 12/13/2011] [Indexed: 12/01/2022]
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