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During exercise pulmonary diffusing capacity for carbon monoxide and oxygen increases because the pulmonary capillary bed expands (1). It seems reasonable that there should be an upper limit to this expansion at which the diffusing capacity reaches maximum. The apparent oxygen diffusing capacity (DLO2) has been noted to approach a plateau or upper limit as the work load increases (2, 3), but a similar plateau for COdiffusing capacity has never been clearly demonstrated (1, 4) perhaps because it has not been measured at heavy enough work loads. Thus our purpose was to determine how high CO diffusing capacity can go as exercise work load increases and to see whether it reaches a plateau before the maximal tolerated work load is achieved. To accomplish this we measured apparent CO diffusing capacity (DLco) and pulmonary blood flow simultaneously in five normal adults, five normal children, and in three adult patients with mitral stenosis. Measurements were made at rest and at increasing treadmill work loads up to and beyond that causing maximal oxygen consumption. At rest and at maximal oxygen consumption the true membrane diffusing capacity for CO (DMco) and the pulmonary capillary blood volume (Vc) were estimated by the RoughtonForster method (5).

Maximal Diffusing Capacity of the Lung for Carbon Monoxide*