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Published ahead of print on February 20, 2004, doi:10.1164/rccm.200309-1287OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 9, May 2004, 1034-1040

A more recent version of this article appeared on May 1, 2004
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Submitted on September 30, 2003
Accepted on February 20, 2004

Nitric Oxide Diffusing Capacity and Alveolar Microvascular Recruitment in Sarcoidosis

Anagha R Phansalkar1, Chad M Hanson1, Ahmed R Shakir1, Robert L Johnson, Jr.1, and Connie C Hsia1*

1 Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States

* To whom correspondence should be addressed. E-mail: Connie.Hsia{at}utsouthwestern.edu.

We measured diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), lung volume and cardiac output by a rebreathing technique at two alveolar O2 tensions at rest and exercise. Membrane diffusing capacity for CO (DmCO) and pulmonary capillary blood volume (Vc) were estimated from DLCO by the Roughton-Forster (RF) method, and also from simultaneous DLNO and DLCO measured at one O2 tension (modified RF method). Estimates by these methods agreed closely in normal subjects (Tamhane, Chest 120:1850-6,2001). Using these methods we studied patients with stage II-III pulmonary sarcoidosis to determine a) whether the modified RF method accurately estimates DmCO and Vc in parenchymal disease, and b) whether sarcoidosis alters recruitment of diffusing capacity with respect to cardiac output. In patients, DmCO and Vc estimated by the two methods agreed closely. DmCO was disproportionately reduced relative to Vc at any given cardiac output, and slope of the relationship between DLCO and cardiac output was significantly below normal. We conclude that in sarcoidosis: a) the modified RF method provides comparable estimates of DmCO and Vc as the standard RF method; b) limitation to diffusive gas transport resides primarily in the membrane barrier although recruitment of microvascular reserves is also modestly impaired.
Key words: membrane diffusing capacity, nitric oxide, capillary blood volume, exercise, Roughton-Forster relationship




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