title: Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test.
abstract: BACKGROUND
  Alveolar volume measured according to the American Thoracic Society-European Respiratory Society (ATS-ERS) guidelines during the single breath diffusion test can be underestimated when there is maldistribution of ventilation. Therefore, the alveolar volume calculated by taking into account the ATS-ERS guidelines was compared to the alveolar volume measured from sequentiallly collected samples of the expired volume in two groups of individuals: COPD patients and healthy individuals. The aim of this study was to investigate the effects of the maldistribution of ventilation on the real estimate of alveolar volume and to evaluate some indicators suggestive of the presence of maldistribution of ventilation.
  
  
  METHODS
  Thirty healthy individuals and fifty patients with moderate-severe COPD were studied. The alveolar volume was measured either according to the ATS-ERS guidelines or considering the whole expired volume subdivided into five quintiles. An index reflecting the non-uniformity of the distribution of ventilation was then derived (DeltaVA/VE).
  
  
  RESULTS
  Significant differences were found when comparing the two measurements and the alveolar volume by quintiles appeared to have increased progressively towards residual volume in healthy individuals and much more in COPD patients. Therefore, DeltaVA/VE resulted in an abnormal increase in COPD.
  
  
  CONCLUSIONS
  The results of our study suggest that the alveolar volume during the single breath diffusion test should be measured through the collection of a sample of expired volume which could be more representative of the overall gas composition, especially in the presence of uneven distribution of ventilation. Further studies aimed at clarifying the final effects of this way of calculating the alveolar volume on the measure of DLCO are needed. DeltaVA/VE is an index that can help assess the severity of inhomogeneity in COPD patients.
authors: Institute of Clinical Physiology, National Research Council of Italy, Pisa, Italy. predile@ifc.cnr.it
authors: Renato
authors: R
authors: Prediletto
authors: Edo
authors: E
authors: Fornai
authors: Giosuè
authors: G
authors: Catapano
authors: Cristina
authors: C
authors: Carli
mesh_terms: D000368:Aged; D001944:Breath Tests / Q000379:methods; D016022:Case-Control Studies; D045853:Exhalation / Q000502:physiology*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008176:Lung Volume Measurements / Q000379:methods; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011650:Pulmonary Alveoli / Q000473:pathology / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology / Q000503:physiopathology*; D012123:Pulmonary Ventilation / Q000502:physiology; D015203:Reproducibility of Results; D012115:Residual Volume / Q000502:physiology*; D012129:Respiratory Function Tests / Q000379:methods; D012720:Severity of Illness Index; D014109:Total Lung Capacity / Q000502:physiology*