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. 2020 Oct 28;29(158):190171.
doi: 10.1183/16000617.0171-2019. Print 2020 Dec 31.

The effects of lung volume reduction treatment on diffusing capacity and gas exchange

Marlies van Dijk  1 , Karin Klooster  2 , Nick H T Ten Hacken  2 , Frank Sciurba  3 , Huib A M Kerstjens  2 , Dirk-Jan Slebos  2
Affiliations

The effects of lung volume reduction treatment on diffusing capacity and gas exchange

Marlies van Dijk et al. Eur Respir Rev. .

Abstract

Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide (D LCO) and arterial gas parameters are discussed, the use of D LCO in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (V')/perfusion (Q') mismatch are considered.A systematic review of the literature was performed for studies reporting on D LCO and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). D LCO after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted D LCO was +5.7% (range -4.6% to +29%), with no real change in blood gas parameters. Improvement in V' inhomogeneity and V'/Q' mismatch are plausible explanations for the improvement in D LCO after LVR treatment.

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Conflict of interest statement

Provenance: Submitted article peer reviewed Conflict of interest: M. van Dijk has nothing to disclose. Conflict of interest: K. Klooster reports other funding from PulmonX Inc., outside the submitted work. Conflict of interest: N.H.T. Ten Hacken has nothing to disclose. Conflict of interest: F. Sciurba has nothing to disclose. Conflict of interest: H.A.M. Kerstjens reports research grants from GSK, Novartis and Boehringer, and fees for consultancies on advisory boards from GSK, Novartis and Boehringer, all paid to his institution, outside the submitted work. Conflict of interest: D-J. Slebos reports grants, personal fees, non-financial support and other funding from PulmonX Inc, during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
a) Factors influencing the measurement of diffusing capacity of the lung for carbon monoxide (DLCO) in patients with chronic obstructive pulmonary disease (COPD). b) Factors influencing DLCO after lung volume reduction (LVR) treatment. VC: vital capacity; V′/Q′: ventilation/perfusion ratio; CO: cardiac output; PH: pulmonary hypertension; HbCO: carboxyhaemoglobin.
FIGURE 2
FIGURE 2
a) Change in % predicted diffusing capacity of the lung for carbon monoxide (DLCO) from before to after lung volume reduction (LVR) surgery, as reported in 25 studies. b) Change in % predicted DLCO from before to after endoscopic LVR with endobronchial valves (EBV), as reported in 15 studies. Weighted mean change is represented by the red line.
See this image and copyright information in PMC

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