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 Jul 01
TA  - ERJ Open Research
PG  - 00193-2021
VI  - 7
IP  - 3
4099  - http://openres.ersjournals.com/content/7/3/00193-2021.short
4100  - http://openres.ersjournals.com/content/7/3/00193-2021.full
SO  - erjor2021 Jul 01; 7
AB  - In Europe, two commercial devices are available to measure combined single-breath diffusing capacity of the lung for nitric oxide (DLNO) and carbon monoxide (DLCO) in one manoeuvre. 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 end-point) between MasterScreen™ (Vyaire Medical, Mettawa, IL, USA) and HypAir (Medisoft, Dinant, 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 21.7–26.3). There was no difference in DLCO (−0.03 mL·min−1·mmHg−1, 95% CI −0.57–0.12) between devices while alveolar volume (VA) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45–0.52). 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.Large discrepancies between commercial devices to measure single-breath diffusing capacity of the lung for nitric oxide in healthy subjects caution against pooling or direct comparison of measurements obtained using different protocols and devices https://bit.ly/3vKyF7U