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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Value of lung diffusing capacity for nitric oxide in systemic sclerosis.

Giovanni Barisione1, Alessandro Garlaschi2, Mariaelena Occhipinti3

  • 1Unità Operativa Fisiopatologia Respiratoria, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy.

Physiological Reports
|July 3, 2019
PubMed
Summary

Lung diffusing capacity for nitric oxide (DLNO) is more sensitive than DLCO in detecting early lung disease in systemic sclerosis (SSc). DLNO can identify diffusion impairment even in SSc patients without lung restriction or fibrosis.

Keywords:
Interstitial lung diseaselung diffusing capacity for carbon monoxidelung diffusing capacity for nitric oxidesystemic sclerosis

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Area of Science:

  • Pulmonary Medicine
  • Rheumatology
  • Cardiopulmonary Physiology

Background:

  • Systemic sclerosis (SSc) lung disease evaluation often uses carbon monoxide diffusing capacity (DLCO).
  • DLCO reflects both alveolar membrane diffusion (DMCO) and pulmonary capillary blood volume (VC), limiting its specificity.
  • Nitric oxide diffusing capacity (DLNO) is hypothesized to be more sensitive to DMCO changes than DLCO.

Purpose of the Study:

  • To compare DLCO and DLNO in systemic sclerosis (SSc) patients.
  • To assess the sensitivity of DLNO in detecting early lung diffusion abnormalities in SSc.
  • To evaluate the utility of DLNO in differentiating interstitial lung disease from vasculopathy in SSc.

Main Methods:

  • Simultaneous measurement of standard DLCO and DLNO in 96 SSc subjects.
  • Analysis of DLCO and DLNO in relation to lung volumes, pulmonary fibrosis extent (CT scan), and pulmonary artery pressure.
  • Comparison of DLNO sensitivity versus DLCO in subjects with normal lung volumes and those with varying degrees of pulmonary fibrosis.

Main Results:

  • DLNO was reduced in 22% of SSc patients with normal lung volumes and DLCO.
  • DLCO was normal in 30% of patients who had decreased DLNO.
  • DLNO was consistently reduced in patients with ≥5% pulmonary fibrosis, and also decreased in some with <5% fibrosis, unlike DLCO.

Conclusions:

  • DLNO is more sensitive than standard DLCO for detecting DMCO loss in SSc, even in non-restricted patients without significant fibrosis.
  • DLNO may offer superior clinical value in early SSc lung disease detection compared to DLCO.
  • DLCO partitioning does not reliably distinguish between vascular and interstitial causes of diffusion limitation in individual SSc patients.