Diffusing capacity dependent on lung volume and age in normal subjects
Abstract
In this study we determined reference values of total diffusing capacity of carbon monoxide (DLCO) and DLCO per liter alveolar volume (DLCO/VA) at total lung capacity (TLC) and at lung volumes below TLC in sitting position. In 55 healthy nonsmoking volunteers (20–85 yr old), we determined reference values at TLC level in which age was the only parameter. In a subgroup (n = 16) these references did not change by correction for normal variability in hemoglobin concentration. In all volunteers DLCO decreased and DLCO/VA increased with decreasing VA. The increase in DLCO/VA was linear and less in older subjects. We derived equations to calculate reference values of DLCO/VA for lung volumes at and below TLC with two methods: 1) “random coefficients linear” model, which calculates the reference values directly, and 2) a conversion method, which calculates DLCO/VA for lower VA levels from reference values at TLC. An advantage of the conversion method is the suitability of DLCO/VA reference values at TLC of other populations. A disadvantage is the greater standard deviation of these reference values compared with those obtained by the random coefficients linear method. DLCO can be found by multiplying DLCO/VA with VA.
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As a person ages, there is a decrease in resting arterial oxygen tension, which gives rise to diminished gas exchange in the lungs.
“As a person ages, there is a decrease in resting arterial oxygen tension, which gives rise to diminished gas exchange in the lungs (7, 12, 22).”
From Aging and Lung Disease (2020) · cites this paper as [22]
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“Stam et al (1994) studied effect of age on diffusion capacity in 55 healthy subjects (age ≥70 yrs, n”
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“Age-associated changes in pulmonary circulation increase systolic pressure of pulmonary arteries and a reduction in lung-diffusing capacity of carbon dioxide (CO2) (22, 23).”
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“There is much confusion over how to adjust predicted values of DLCO and KCO for lung volume, with investigators using widely varying methods (8,9,10).”
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“It is now well established (see Stam et al., 1994, for example) that DLCO/VA increases in a linear fashion as the lung volume of the measurement is reduced from TLC, and that DLCO continues to decrease from TLC throughout the whole volume range.”
BackgroundIn defence of the carbon monoxide transfer coefficientKCO(TL/VA)
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“[5] suggested that when TLC is reduced by disease, TL,CO values should be compared with reference values based on the observed VA, but they cautioned that this assumes that "the effect of decreasing lung volume by disease has the same effect on TL/VA as the voluntary reduction in lung volume in healthy volunteers".”
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“Also the diffusion capacity across the alveolar-capillary interface (DLCO) declines significantly (18).”
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“However, it has been shown by others that the correction for hemoglobin concentration in a large sample did not change the spread of DLCO or the average DLCO [38].”
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“In the case of incomplete alveolar expansion in an otherwise normal lung, TL/VA or KCO increases linearly so that at FRC ( 50% of VA at full inflation, i.e. TLC) KCO is > 150% of KCO at TLC (Stam et al., 1994; Hughes & Pride, 2001.”
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“This results in a larger VA in the prone posture, which will affect the lung function in a positive manner because, generally, there is a positive relationship between DLCO and VA (43).”
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“Finally, DLCO decreases with age, as shown by Stam et al in healthy subjects over 70 years.(32) Thus, important analogies exist between the ageing lung and the diabetic lung.”
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“For example, pulmonary diffusing capacity, hypoxic ventilatory response, and peak O 2 , all of which should contribute to maintaining oxygenation and exercise performance in the hypoxic environment of high altitude (18,19,21), are all known to decline with age (22,23).”
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- Authors
- Stam, H., Hrachovina, V., Stijnen, T., & Versprille, A.
- Affiliations
- Erasmus University Rotterdam (NL)
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 1994-06-01
- Volume
- 76
- Issue
- 6
- Pages
- 2356-2363
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- OpenAlex
- W2128761283
- Cited by
- 105
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 2 · 2021: 4 · 2020: 3 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 3
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Applied Physiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- diffusing capacity for carbon monoxide, DLCO/VA, lung volume, total lung capacity, age-related decline, reference values, hemoglobin correction, alveolar volume, conversion method, lung function
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aging, Carbon Monoxide, Female, Hemoglobins, Humans, Lung, Lung Volume Measurements, Male, Middle Aged, Pulmonary Alveoli, Pulmonary Diffusing Capacity, Reference Values, Total Lung Capacity
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