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American Journal of Respiratory and Critical Care Medicine Vol 165. pp. 1587-1591, (2002)
© 2002 American Thoracic Society

Original Article

Partitioning of Alveolar and Conducting Airway Nitric Oxide in Scleroderma Lung Disease

Reda E. Girgis, Manish K. Gugnani, Judith Abrams and Maureen D. Mayes

Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine; Division of Rheumatology, Department of Internal Medicine; and Department of Biostatistics, Wayne State University School of Medicine, Detroit, Michigan

Correspondence and requests for reprints should be addressed to Reda E. Girgis, M.B., B.Ch., Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe St., Blalock 910, Baltimore, MD 21287. E-mail: rgirgis{at}jhmi.edu

We partitioned exhaled nitric oxide (NO) into alveolar concentration (CA) and conducting airway flux (JNOair,max) in scleroderma (SSc) lung disease and hypothesized that CA would be elevated. Twenty patients with SSc, 15 with interstitial lung disease (SSc–ILD) alone, and 5 with pulmonary hypertension (SSc–PH) were compared with 20 control subjects. CA and JNOair,max were derived from the slope and y intercept, respectively, of the NO output versus expiratory flow rate (V·exh) relationship obtained by measuring exhaled NO (FENO) at multiple V·exh values of 50–200 ml/second. There were no significant differences in FENO at any V·exh between the SSc group and control subjects. JNOair,max was reduced (0.6 ± 0.1 versus 1.2 ± 0.2 nl of NO per second; p = 0.01), whereas CA was increased (4.7 ± 0.5 versus 1.8 ± 0.2 ppb; p < 0.001) in the SSc group compared with control subjects. No differences were noted between SSc–ILD and SSc–PH. There was a negative correlation between CA and DLCO among the patients with SSc (R = -0.66, p = 0.002). We conclude that CA is increased whereas JNOair,max is decreased in SSc–ILD and SSc–PH. A reduced diffusing capacity of NO from the alveolar space into the blood could explain the observed increase in CA.

Key Words: interstitial lung disease • nitric oxide • pulmonary hypertension • scleroderma




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