Deciphering the nitric oxide to carbon monoxide lung transfer ratio: physiological implications.

Using simultaneous nitric oxide and carbon monoxide lung transfer measurements (T(LNO) and T(LCO)), the membrane transfer capacity (D(m)) and capillary lung volume (V(c)) as well as the dimensionless ratio T(LNO)/T(LCO) can be calculated. The significance of this ratio is yet unclear. Theoretically, the T(LNO)/T(LCO) ratio should be inversely related to the product of both lung alveolar capillary membrane (mu) and blood sheet thicknesses (K). NO and CO transfers were measured in healthy subjects in various conditions likely to be associated with changes in K and/or mu. Experimentally, deflation of the lung from 7.4 to 4.8 l decreased the T(LNO)/T(LCO) ratio from 4.9 to 4.2 (n=25) which was consistent mainly with a thickening of the blood sheet. Compared with continuous negative pressure breathing, continuous positive pressure breathing increased this ratio suggesting a thinning of the capillary sheet. It was also observed with 12 healthy subjects that slight haemodilution that may thicken the blood sheet decreased the T(LNO)/T(LCO) ratio from 4.85 to 4.52. In conclusion, the T(LNO)/T(LCO) ratio is related to the thickness of the alveolar blood barrier. This ratio provides novel information for the analysis of the diffusion properties.

Membrane conductance in trained and untrained subjects using either steady state or single breath measurements of NO transfer.

The aim of this work was to define the relationship between membrane conductance for NO (Dm) and physical activity by using either the steady state NO transfer (T(LNO)SS) or the single breath method (T(LNO)SB), making the hypothesis that NO transfer is only limited by the membrane. Alterations in T(LNO)SS with lung volume during tidal ventilation were measured in six subjects at rest and during steady exercise at 30, 60, and 80% of maximal aerobic power (MAP). A fast responding chemoluminescent NO analyser was used. Two calculation methods were used by sampling NO: (1) at mid-tidal volume, (2) in the middle of the alveolar plateau. T(LNO)SB at rest and maximal oxygen consumption (V(.-)O(2)max) were also measured in 18 other subjects. At rest T(LNO)SS with method 2 was 192% of the value given by method 1. T(LNO)SS with method 1 increased by 50% with 80% MAP as it did not change with method 2. Method 2 seemed inaccurate. T(LNO)SB at rest, which is closely related to Dm, was correlated to age and V(.-)O(2)max, T(LNO)SB=182-1.2 age+24.3 V(.-)O(2) max(l min(-1)) (p<0.01, r(2)=0.72). The T(LNO)SS and T(LNO)SB versus lung volume relationships suggest an influence of the breathing pattern on Dm. Dm can be estimated either by these two NO transfer methods, however the use of the T(LNO)SS method is highly sensitive to the alveolar sampling level. Dm increase during exercise is a function of MAP. Dm at rest decreases with age as it increases with MAP.