There is evidence to suggest that NO could be a better transfer gas compared to CO, or at least, used alongside CO. These abstracts resulted in the first publications of DLNO.
The first two abstracts on DLNO originated from the United Kingdom in the 1980s. While carbon monoxide (CO) has been the transfer gas of choice for the measurement of diffusing capacity, the use of nitric oxide (NO) as a potential alternative originated much later by separate and independent research teams. These equations have been created for adults and children, with a wide range of racial backgrounds. Prediction equations for DLCO were developed to decipher normal from abnormal gas transfer through the lung. Since 1957, the single-breath DLCO test has become the clinical standard to assess gas transfer through the lung.
One such PFT, pulmonary diffusing capacity for carbon monoxide (DLCO), is a single-breath technique using a 10-s breath-hold maneuver that was clinically established in 1957. Many patients get misdiagnosed and are improperly treated without the guidance of PFTs. They are used in the evaluation of patients with respiratory symptoms and for guiding the management of diagnosed lung disease. Pulmonary function tests (PFTs) are essential tools for modern clinical respiratory function assessment. If these differences are not accounted for, then the risk of falsely diagnosing lung disease increase in blacks when using reference equations for whites. Future reference equations should account for racial differences. The results of this pilot data reveal small but important and statistically significant racial differences in DLNO and DLCO in adults. The lower diffusing capacity values in blacks are due, in part, to their 0.6 L lower VA (controlling for sex and height). After normalizing for sex, age 2, and height, blacks had a 12.4 and 3.9 mL/min/mmHg lower DLNO and DLCO, respectively, compared to whites. Our models demonstrated that sex, age 2, race, and height explained 71% of the variance in DLNO and DLCO, with race accounting for approximately 5–10% of the total variance. Multiple linear regression equations for DLNO, alveolar volume (VA), and pulmonary diffusing capacity for carbon monoxide (DLCO) using a 5–6 s breath-hold were developed. In the development of DLNO reference equations, a white reference sample (randomly drawn from a population) matched to the black sample for sex, age, and height was used.
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In 2016, a total of 59 healthy black subjects (27 males and 32 females) were recruited to perform a full battery of pulmonary function tests. MethodsĪfrican Americans (blacks) were chosen as the comparative racial group. The purpose of this study was to collect pilot data to demonstrate that race-specific reference equations are needed for DLNO. Few reference equations exist for healthy adults of various races for pulmonary diffusing capacity for nitric oxide (DLNO).