Abstract
Pulmonary fibrosis leads to a decrease of oxygen diffusion, in particular during exercise. Bronchial obstruction also could decrease the partial pressure of oxygen (PaO2). In this study we investigated the validity of blood gas content, especially PaO2 and PaO2 affected by hyperventilation (PaO2corr) and alveolo-arterial oxygen gradient (PA-aO2) in comparison with the CO diffusion capacity (DLCO) in different lung diseases. A total of 250 subjects were studied (52.3 ± 12.5 year; F/M 40/210), among which there were 162 subjects with different lung disorders and 88 healthy controls. Pearson’s correlation coefficients (r) of DLCO with PaO2, PaO2corr, and PA-aO2 were analyzed in each group. The results show that the diagnostic power of PA-aO2 against PaO2corr was equivalent, especially during exercise (r = −0.89 and −0.92, respectively). DLCO showed only weak correlations with PaO2corr and PA-aO2 (r = 0.17 and −0.19, respectively). In conclusion, DLCO shows a better match with blood gas content during exercise than at rest during which it is routinely tested. Thus, the exercise test is advisable. The PA-aO2 takes into account the level of ventilation, which makes it correlate better with DLCO rather than with blood gas content. The most significant problems in clinical evaluation of blood gas parameters during exercise are the insufficiently defined limits of normal-to-pathological range.
In every breath we breathe two graces share – The indraught and the outflow of the air; that is a toil, but this refreshment brings; So marvellous are our life’s comminglings. (Johann Wolfgang von Goethe 1819)
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References
American Thoracic Society (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277
Cotes JE, Chinn DJ, Quanjer PH, Roca J, Yernault JC (1993) Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:41–52
Diekmann M, Smidt U (1984) Berechnung eines Standard-PaO2 in Analogie zum Standard Bikarbonat. Atemwegs-Lungenkrkh 6:248–250
Grouven U, Bender R, Ziegler A, Lange S (2007) The kappa coefficient. Dtsch Med Wochenschr 132(Suppl 1):e65–e68
Hughes JM, Pride NB (2001) In defence of the carbon monoxide transfer coefficient Kco (TL/VA). Eur Respir J 17:168–174
Hughes JM, Pride NB (2012) Examination of the carbon monoxide diffusing capacity (DLCO) in relation to its KCO and VA components. Am J Respir Crit Care Med 186:132–139
Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller MR, Navajas D, Pedersen OF, Pellegrino R, Wanger J (2005) Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 26:720–735
Meyer FJ, Borst MM, Buschmann HC, Ewert R, Friedmann-Bette B, Ochmann U, Petermann W, Preisser AM, Rohde D, Ruhle KH, Sorichter S, Stahler G, Westhoff M, Worth H (2013) Exercise testing in respiratory medicine. Pneumologie 67:16–34
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) Standardisation of spirometry. Eur Respir J 26:319–338
Mottram C, Blonshine S, Brown RA, Ruppel GL, Wanger J (1999) AARC clinical practice guideline: single-breath carbon monoxide diffusing capacity, 1999 update. Respir Care 44:539–546
Pearson K (1909) Determination of the coefficient of correlation. Science 757:23–25
Preisser AM, Ochmann U (2011) Cardiopulmonary exercise testing in occupational medical fitness examination and assessment. Pneumologie 65:662–670
Riley RL, Cournand A (1949) Ideal alveolar air and the analysis of ventilation-perfusion relationships in the lungs. J Appl Physiol 1:825–847
Schwarz S, Kaukel E, Kroidl RF (1999) Wertigkeit der alveolokapillären Sauerstoffdifferenz (AaDO2) und des Sauerstoffpartialdruckverhaltens in der Spiroergometrie bei der Beurteilung von Gasaustauschstörungen. Atemw Lungenkrkh 4:220–226
Thompson WD, Walter SD (1988) A reappraisal of the kappa coefficient. J Clin Epidemiol 41:949–958
von Goethe JW (1819) West-oestlicher Divan, Talismane (The West-Eastern Divan, Talismane). Cotta’sche Buchhandlung, Stuttgart. Translation by E. Dowden: Toronto 1914. https://openlibrary.org/books/OL23359206M/ West-eastern_divan
Woitowitz HJ, Schacke G, Woitowitz RH (1969) Arterial blood gases in working men and women before and after graded work load. Int Arch Arbeitsmed 25:124–139
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We would like to thank the Clinical Occupational Medicine Team of the institute for the implementation and backing the patient examinations.
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The authors declare no conflicts of interest in relation to this article.
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Preisser, A.M., Seeber, M., Harth, V. (2014). Diffusion Limitations of the Lung – Comparison of Different Measurement Methods. In: Pokorski, M. (eds) Environmental Biomedicine. Advances in Experimental Medicine and Biology(), vol 849. Springer, Cham. https://doi.org/10.1007/5584_2014_90
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