Skip to main content
Thorax logoLink to Thorax
. 1990 Nov;45(11):873–877. doi: 10.1136/thx.45.11.873

A simple method for correcting single breath total lung capacity for underestimation.

A Loiseau 1, P Loiseau 1, G Saumon 1
PMCID: PMC462786  PMID: 2256017

Abstract

The single breath method underestimates total lung capacity by comparison with the multiple breath method (TLCmb) because of inhomogeneity of ventilation distribution. This study proposes a simple correction for the single breath TLC (TLCsb), using inert gas phase III slope to account for the effects of uneven ventilation distribution. A model of a non-uniform lung ventilation was designed, composed of a serial dead space and two alveolar compartments arranged in parallel, whose relative ventilations were determined from the phase III plateau. Before correction TLCsb was 104-44% of TLCmb in 64 subjects (17 with diffuse interstitial disease, 42 with chronic obstructive pulmonary disease, and five healthy subjects). The limit of acceptability for the correction (TLCcorr) was determined from the 95% confidence interval of TLCsb/TLCmb in the healthy subjects. The correction resulted in a significant increase in TLCsb (p less than 0.004). TLCcorr remained under the limit of acceptability for only 12 patients with emphysema, and all 12 showed a large improvement in the TLC estimate. The presence of poorly ventilated zones during a single breath in these patients may explain this partial correction.

Full text

PDF
873

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anthonisen N. R., Robertson P. C., Ross W. R. Gravity-depende sequential emptying of lung regions. J Appl Physiol. 1970 May;28(5):589–595. doi: 10.1152/jappl.1970.28.5.589. [DOI] [PubMed] [Google Scholar]
  2. Buist A. S., Ross B. B. Predicted values for closing volumes using a modified single breath nitrogen test. Am Rev Respir Dis. 1973 May;107(5):744–752. doi: 10.1164/arrd.1973.107.5.744. [DOI] [PubMed] [Google Scholar]
  3. Burns C. B., Scheinhorn D. J. Evaluation of single-breath helium dilution total lung capacity in obstructive lung disease. Am Rev Respir Dis. 1984 Oct;130(4):580–583. doi: 10.1164/arrd.1984.130.4.580. [DOI] [PubMed] [Google Scholar]
  4. Cumming G., Horsfield K., Jones J. G., Muir D. C. The influence of gaseous diffusion on the alveolar plateau at different lung volumes. Respir Physiol. 1967 May;2(3):386–398. doi: 10.1016/0034-5687(67)90043-6. [DOI] [PubMed] [Google Scholar]
  5. Engel L. A., Utz G., Wood L. D., Macklem P. T. Ventilation distribution in anatomical lung units. J Appl Physiol. 1974 Aug;37(2):194–200. doi: 10.1152/jappl.1974.37.2.194. [DOI] [PubMed] [Google Scholar]
  6. FOWLER W. S. Lung function studies; uneven pulmonary ventilation in normal subjects and in patients with pulmonary disease. J Appl Physiol. 1949 Dec;2(6):283–299. doi: 10.1152/jappl.1949.2.6.283. [DOI] [PubMed] [Google Scholar]
  7. Hook C., Meyer M., Piiper J. Model simulation of single-breath washout of insoluble gases from dog lungs. J Appl Physiol (1985) 1985 Mar;58(3):802–811. doi: 10.1152/jappl.1985.58.3.802. [DOI] [PubMed] [Google Scholar]
  8. Lyons J. P., Clarke W. G., Hall A. M., Cotes J. E. Transfer factor (diffusing capacity) for the lung in simple pneumoconiosis of coal workers. Br Med J. 1967 Dec 30;4(5582):772–774. doi: 10.1136/bmj.4.5582.772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. MORTON J. W., OSTENSOE L. G. A CLINICAL REVIEW OF THE SINGLE BREATH METHOD OF MEASURING THE DIFFUSING CAPACITY OF THE LUNGS. Dis Chest. 1965 Jul;48:44–54. doi: 10.1378/chest.48.1.44. [DOI] [PubMed] [Google Scholar]
  10. Martin C. J., Das S., Young A. C. Measurements of the dead space volume. J Appl Physiol Respir Environ Exerc Physiol. 1979 Aug;47(2):319–324. doi: 10.1152/jappl.1979.47.2.319. [DOI] [PubMed] [Google Scholar]
  11. Medina J. R., Lillehei J. P., Loken M. K., Ebert R. V. Use of the scintillation anger camera and xenon Xe 133 in the study of chronic obstructive lung disease. JAMA. 1969 May 12;208(6):985–991. [PubMed] [Google Scholar]
  12. Milic-Emili J., Henderson J. A., Dolovich M. B., Trop D., Kaneko K. Regional distribution of inspired gas in the lung. J Appl Physiol. 1966 May;21(3):749–759. doi: 10.1152/jappl.1966.21.3.749. [DOI] [PubMed] [Google Scholar]
  13. Nixon W., Pack A. I. Effect of gaseous interaction between lung units on the expired concentration of nitrogen. J Appl Physiol Respir Environ Exerc Physiol. 1982 Aug;53(2):496–504. doi: 10.1152/jappl.1982.53.2.496. [DOI] [PubMed] [Google Scholar]
  14. OTIS A. B., MCKERROW C. B., BARTLETT R. A., MEAD J., MCILROY M. B., SELVER-STONE N. J., RADFORD E. P., Jr Mechanical factors in distribution of pulmonary ventilation. J Appl Physiol. 1956 Jan;8(4):427–443. doi: 10.1152/jappl.1956.8.4.427. [DOI] [PubMed] [Google Scholar]
  15. Paiva M., Engel L. A. Pulmonary interdependence of gas transport. J Appl Physiol Respir Environ Exerc Physiol. 1979 Aug;47(2):296–305. doi: 10.1152/jappl.1979.47.2.296. [DOI] [PubMed] [Google Scholar]
  16. Paiva M., Engel L. A. The anatomical basis for the sloping N2 plateau. Respir Physiol. 1981 Jun;44(3):325–337. doi: 10.1016/0034-5687(81)90027-x. [DOI] [PubMed] [Google Scholar]
  17. Piiper J., Sikand R. S. Determination of D-CO by the single breath method in inhomogeneous lungs: theory. Respir Physiol. 1966;1(1):75–87. doi: 10.1016/0034-5687(66)90030-2. [DOI] [PubMed] [Google Scholar]
  18. Sterk P. J., Quanjer P. H., van der Maas L. L., Wise M. E., van der Lende R. The validity of the single-breath nitrogen determination of residual volume. Bull Eur Physiopathol Respir. 1980;16(2):195–213. [PubMed] [Google Scholar]
  19. Teculescu D. B. Validity, variability and reproducibility of single-breath total lung capacity determinations in normal subjects. Bull Physiopathol Respir (Nancy) 1971 May-Jun;7(3):645–658. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES