Diffusion capacity

Diffusion capacity
Diagnostics
MeSH	D011653

In biology, diffusion capacity is a measurement of the lung's ability to transfer gases. Oxygen uptake may be limited by diffusion in circumstances of low ambient oxygen or high pulmonary blood flow. Carbon dioxide is not limited by diffusion under most circumstances.

The "diffusing capacity" or "diffusion capacity" is part of a comprehensive test series of lung function called pulmonary function testing. In Europe, this is often called the "transfer factor". Critics of the term "diffusion capacity" argue that it may be misleading, and point out two problems with the term. The first is that the test measures not just diffusion across the alveolar-capillary membrane, but also takes into account factors affecting the chemical combination of a given gas with hemoglobin. The second criticism is that the test is typically measured under submaximal conditions and doesn't truly reflect a functional capacity. For these reasons the term "transfer factor" better reflects the physiological process being measured.

Calculation

The rate of flow is directly proportional to the oxygen gradient (per Fick's law of diffusion), and the diffusion capacity (DLO_O2) can be calculated as the ratio of oxygen flux (J^*) across the alveolar-capillary membrane over the oxygen partial pressure gradient between the alveoli ("A") and the alveolar capillaries ("a")

$D_L = \frac {J^*_{O2}}{P_{AO2} - P_{aO2}}$

(The asterisk should be read as a dot over the letter, which is used to denote rate in respiratory physiology.)

J^*_O2 is the uptake of oxygen (ml/min). P_AO2 is the alveolar partial pressure of oxygen. P_aO2 is the partial pressure of oxygen in the alveolar capillary. Thus, the higher the diffusing capacity DL, the more gas will be transferred across the alveolar-capillary membrane for a given gradient in partial pressure (or concentration) of the gas.

Because it is difficult to measure the capillary partial pressure of oxygen, carbon monoxide (CO) is used as the test gas to measure the diffusing capacity (Dlco). Because CO is so tightly bound to hemoglobin in the red blood cells, the partial pressure of CO in the capillaries is assumed to be zero. Thus,

$D_LCO = \frac {J^*_{CO}}{P_{ACO}}$

Test Performance

In practice, the test is performed by having the test subject blow out all of the air that they can to reach residual volume. The person then takes a full vital capacity inhalation of a test gas mixture that contains a small amount of carbon monoxide (usually 0.3%) and some helium or other non-absorbed tracer gas. The test gas is held in the lung for about 10 seconds and then is exhaled from the lung. The first part of the expired gas is discarded and the next portion which represents gas from the alveoli is collected. By analyzing the concentrations of carbon monoxide and helium in the inspired gas and in the exhaled gas, it is possible to calculate how much carbon monoxide was taken up during the breath hold, and what the partial pressure of carbon monoxide was during the breath hold. This method is known as the single-breath diffusing capacity test.

Other methods that are not so widely used at present can measure the diffusing capacity. These include the steady state diffusing capacity that is performed during regular tidal breathing, or the rebreathing method that requires rebreathing from a reservoir of gas mixtures. A more sophisticated "three-equation method" which involves fast responding analysers for the carbon monoxide and a tracer gas such as helium has been developed. It monitors all parameters continuously and solves some of the technical problems of the traditional method but is more expensive to implement.

Interpretation

Values between 75% and 125% of average diffusion capacity in the healthy population are considered normal.^[1]

The diffusing capacity (DLCO) is a test of the integrity of the alveolar-capillary surface area for gas transfer. It may be reduced in disorders that damage the alveolar walls (septa) such as emphysema, which leads to a loss of effective surface area. The DLCO is also reduced in disorders that thicken or damage the alveolar walls such as pulmonary fibrosis. The DLCO is also reduced in interstitial lung diseases such as hypersensitivity pneumonitis (e.g. bird fancier's lung, farmer's lung) or dust-inhalation diseases such as asbestosis. Because the transfer of CO depends upon how much blood is present in the lung capillaries, the DLCO can be reduced due to anemia and raised in polycythemia. Some laboratories adjust or correct the DLCO for a serum hemoglobin to take into account the effect of anemia. Disorders of the pulmonary blood vessels such as chronic thromboembolic disease or pulmonary hypertension also reduce the diffusing capacity, as can any condition/disease which results in reduction in pulmonary capillary blood volume. The DLCO is not, however, a sensitive test for acute pulmonary embolism. Cigarette smokers tend to have lower DLCO, which is partly due to damage to the lungs (mild emphysema) and partly due to the retention of carbon monoxide from the cigarettes, which causes back pressure (decreasing the CO gradient). For these reasons, the DLCO is a sensitive test for disorders of the lung, but does not point toward a specific diagnosis. By calculating the dilution of the tracer gas, the test can also be used to estimate the total lung capacity. In the presence of poor gas mixing from obstructive lung disease it is used to measure the single breath total lung capacity.

References

1. ^ LUNGFUNKTION - Practice compendium for semester 6. Department of Medical Sciences, Clinical Physiology, Academic Hospital, Uppsala, Sweden. Retrieved 2010.

External links

• MeSH Pulmonary+diffusing+capacity
• Physiology at MCG 4/4ch3/s4ch3_32