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

Abstract

We evaluated the intra-session and inter-session variability of the diffusing capacity of nitric oxide (DLNO), carbon monoxide (DLCO), alveolar-capillary membrane diffusing capacity for carbon monoxide (DMCO) and pulmonary capillary blood volume (Vc) in patients with cystic fibrosis (CF). Patients performed single-breath diffusing capacity measurements during all of 3 consecutive study visits. Precision of gas diffusing parameters was quantified by within-subject standard deviation (SD_ws) and coefficient of variation (CV). Intra-session and inter-session reproducibility was determined by SD_ws*2.77. 15 clinically stable patients were included. The intra-session precision of gas diffusing parameters improved over the study visits. The inter-session SD_ws for DLNO, DLCO, DMCO, and Vc was 4.8, 1.3, 2.4, and 4.3, respectively. Reproducibility was 13.3, 3.8, 6.7 and 12.0mLmin^-1mmHg^-1; CV was 4.4, 4.7, 4.4 and 5.8%, respectively. The intra-session variability of DLNO, DLCO, DMCO and Vc improves with breath-hold maneuver training in test-naïve patients with CF, indicating a learning effect. Inter-session reproducibility data are lower than those previously reported in healthy subjects.

Keywords: Diffusing capacity for nitric oxide; Lung disease; Reliability; Reproducibility; Single-breath.