PT - JOURNAL ARTICLE AU - Thomas Radtke AU - Quintin de Groot AU - Sarah R. Haile AU - Marion Maggi AU - Connie C. W. Hsia AU - Holger Dressel TI - Lung diffusing capacity for nitric oxide measured by two commercial devices: a randomised crossover comparison in healthy adults AID - 10.1183/23120541.00193-2021 DP - 2021 Jan 01 TA - ERJ Open Research PG - 00193-2021 4099 - http://openres.ersjournals.com/content/early/2021/06/17/23120541.00193-2021.short 4100 - http://openres.ersjournals.com/content/early/2021/06/17/23120541.00193-2021.full AB - In Europe, two commercial devices are available to measure combined single-breath lung diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) in one maneuver. Reference values were derived by pooling datasets from both devices, but agreement between devices has not been established.We conducted a randomised crossover trial in 35 healthy adults (age 40.0±15.5 years, 51% female) to compare DLNO (primary endpoint) between MasterScreen™ (Vyaire Medical, USA) and HypAir (Medisoft, Belgium) devices during a single visit under controlled conditions. Linear mixed models were used adjusting for device and period as fixed effects and random intercept for each participant.Difference in DLNO between HypAir and MasterScreen was 24.0 mL·min−1·mmHg−1 (95% CI 21.7 to 26.3). There was no difference in DLCO (−0.03 mL·min−1·mmHg−1, 95% CI −0.57 to 0.12) between devices while alveolar volume (VA) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45 to 0.52). Disparity in the estimation of VA and the rate of NO uptake (KNO=DLNO/VA) could explain the discrepancy in DLNO between devices. Disparity in the estimation of VA and the rate of CO uptake (KCO=DLCO/VA) per unit of VA offset each other resulting in negligible discrepancy in DLCO between devices. Differences in methods of expiratory gas sampling and sensor specifications between devices likely explain these observations.These findings have important implications for derivation of DLNO reference values and comparison of results across studies. Until this issue is resolved reference values, established on the respective devices, should be used for test interpretation.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. de Groot has nothing to disclose.Conflict of interest: Dr. Haile has nothing to disclose.Conflict of interest: Dr. Maggi has nothing to disclose.Conflict of interest: Dr. Hsia has nothing to disclose.Conflict of interest: Dr. Dressel has nothing to disclose.