0
Clinical Investigations: PULMONARY FUNCTION |

Measurement Variability in Single-Breath Diffusing Capacity of the Lung*

Naresh M. Punjabi; David Shade; Anshul M. Patel; Robert A. Wise
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

Correspondence to: Naresh M. Punjabi, MD, PhD, FCCP, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail: npunjabi@jhmi.edu



Chest. 2003;123(4):1082-1089. doi:10.1378/chest.123.4.1082
Text Size: A A A
Published online

Study objectives: The single-breath diffusing capacity of the lung (Dlco) is a commonly performed pulmonary function test. The current American Thoracic Society (ATS) recommendations for reproducibility of Dlco measurements suggest that two measurements for the Dlco agree within 10% or 3 mL/min/mm Hg of the average value. The European Respiratory Society (ERS) recommends that two measurements should agree within 10%. The objectives of the present study were to examine whether the current reproducibility criteria were met in a general pulmonary function laboratory and to determine whether alternative criteria might be appropriate.

Design: Cross-sectional study.

Setting: University-based pulmonary function laboratory.

Patients or Participants: Patients referred for spirometry, helium lung volumes, and Dlco measurement.

Interventions: None.

Measurements and results: In a sample of 6,193 patients referred for clinical testing, 98.3% had two Dlco values that fulfilled the current ATS criteria for reproducibility. The coefficient of variation (CV) and the percentage difference between two repeat measurements were inversely associated with the baseline Dlco and the FEV1. As the baseline Dlco (percentage of predicted) or FEV1 (percentage of predicted) decreased, there was an increase in the CV and the percentage difference. In contrast, the absolute difference between repeat measurements was relatively stable irrespective of the baseline Dlco or FEV1 values. Other patient factors, such as gender and race, were not associated with measurement variability. Using an absolute difference of 2 to 2.5 mL/min/mm Hg between two Dlco measurements as alternative criteria for reproducibility, 91.5% and 95.8% of the patient sample fulfilled these criteria, respectively.

Conclusions: Reproducibility of the Dlco measurement is generally much better than current standards allow. Future standards should consider an absolute difference rather than a percentage difference criterion for Dlco reproducibility.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543