Effect of preinspiratory maneuver on the single-breath DLCO

We have observed in some patients with pulmonary disease and normal subjects that the difference between two successive measurements for single-breath DLCO amounted to 10%. By scrutinizing data from these subjects, we observed that they spontaneously changed their preinspiratory maneuver just before inhaling the test gas mixture. The purpose of the present work is to assess the influence of five different preinspiratory maneuvers on DLCO. Nine healthy males were investigated. They performed at random the five following maneuvers: (A) rapid exhalation from functional residual capacity (FRC) to residual volume (RV), (B) rapid exhalation from FRC to RV and long apnea at RV, (C) rapid exhalation from FRC to RV and short apnea at RV, (D) slow exhalation at a constant speed from FRC to RV, and (E) curvilinear exhalation from FRC to RV. The DLCO values after maneuver B were higher than those after the four other maneuvers; there was a significant relationship between DLCO and the duration of the preinspiratory maneuver. The data are best explained by an alteration in the distribution of the inspired gas mixture to areas with different diffusing capacities. In conclusion, the preinspiratory maneuvers must be standardized in order to improve the reproducibility of the single-breath DLCO measurements.