Effect of preinspiratory maneuver on the single-breath DLCO.

We have observed in some patients with pulmonary disease and normal subjects that the difference between two successive measurements for single-breath DLCO amounted to 10%. By scrutinizing data from these subjects, we observed that they spontaneously changed their preinspiratory maneuver just before inhaling the test gas mixture. The purpose of the present work is to assess the influence of five different preinspiratory maneuvers on DLCO. Nine healthy males were investigated. They performed at random the five following maneuvers: (A) rapid exhalation from functional residual capacity (FRC) to residual volume (RV), (B) rapid exhalation from FRC to RV and long apnea at RV, (C) rapid exhalation from FRC to RV and short apnea at RV, (D) slow exhalation at a constant speed from FRC to RV, and (E) curvilinear exhalation from FRC to RV. The DLCO values after maneuver B were higher than those after the four other maneuvers; there was a significant relationship between DLCO and the duration of the preinspiratory maneuver. The data are best explained by an alteration in the distribution of the inspired gas mixture to areas with different diffusing capacities. In conclusion, the preinspiratory maneuvers must be standardized in order to improve the reproducibility of the single-breath DLCO measurements.

Acute effect of molsidomine on pulmonary circulation of patients with chronic obstructive pulmonary disease.

Chronic obstructive lung diseases (COLD) are very often complicated by pulmonary arterial hypertension and right heart failure. Several drugs including nitrates have been used to counteract this type of hypertension. Molsidomine (M) is a recent nitrates-like drug acting for a longer time than the classical nitrates. Our aim was to investigate whether M could significantly lower pulmonary arterial hypertension of patients suffering from COLD. Ten male patients were investigated before and after intake of 4.0 mg M given sublingually. Ventilatory and cardiocirculatory indices were measured at rest and during a 30 and a 50 watts exercise. During exercise, M significantly lowers pulmonary arterial pressure and pulmonary vascular resistance without detrimental effect on arterial blood gases. M seems to be a promising drug to counteract the pulmonary hypertension of patients with COLD.

Effect of molsidomine on the lung diffusing capacity of normal men.

Molsidomine (M) is a new antianginal drug which induces a peripheral venous pooling and decreases pulmonary artery and pulmonary venous pressures. The purpose of our study is to assess whether M influences the filling of the pulmonary capillary bed as estimated by the single-breath lung diffusing capacity (DLCO). DLCO was measured before and 10, 20, 30, 40, 50 and 60 minutes after sublingual administration of 2 mg molsidomine in six healthy men examined in sitting and supine positions. The blood flow distribution was estimated by means of radioactive xenon, in sitting position only, before and 30 minutes after M intake. M. induces a significant fall in DLCO from the 20th to the 60th minute which indicates an emptying of the pulmonary capillary bed. Concomitantly, blood flow is redistributed from the apices to the lung bases. We explain the decrease in DLCO by two mutually non-exclusive mechanisms: an outflow of the blood from the thorax to the periphery and a change in the lung-perfusion distribution. From a practical point of view, two conclusions may be reached. First, in coronary patients a decrease in DLCO and DLCO/VA may be due to the intake of vasodilating agents such as molsidomine and not to emphysema or lung fibrosis. Secondly, the measurement of DLCO is a useful tool to assess the action of a drug on the pulmonary circulation.

Hysteresis of the alveolar capillary membrane in normal subjects.

Weibel and associates (Respir. Physiol. 18: 285-308, 1973), using morphometric techniques, demonstrated in the rat that changes in lung volume related to inflation and deflation caused a hysteretic variation in alveolar capillary membrane which is locally pleated at low pulmonary volume, unfolds during inflation but does not immediately refold during deflation, possibly enhancing the CO diffusion throughout the membrane. The present study was conducted to verify the existence of this hysteresis in human lungs in vivo. Single-breath diffusing capacity for CO (DLCO) was measured in five healthy seated subjects before and 0, 0.5, 1, 3, and 7 min after an inflation-deflation maneuver (IDM) in 6 separate days. The value of mean DLCO was 36.4 +/- 3 (SD) before and 42.1 +/- 2.9, 41.6 +/- 3.3, 40.3 +/- 3.3, 39.2 +/- 3.2, and 38.1 +/- 2.7 ml X min-1 X Torr-1 after the IDM. Two mechanisms can explain our findings: an active filling of the capillary bed, or an unfolding of the alveolar capillary membrane. The first mechanism should be accompanied by changes in pulmonary circulation. Therefore, right-heart catheterization was performed in two normal subjects and in four patients examined for a chest pain syndrome. At the end of the IDM, the values for the pulmonary artery pressure and capillary wedge pressure had returned to control levels. This suggests that the capillary bed is not directly involved in the DLCO increase observed from 0.5 to 7 min after the IDM. The unfolding of the alveolar capillary membrane appears to better explain our findings.(ABSTRACT TRUNCATED AT 250 WORDS)