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Background  Due to large-scale destruction, changes in membrane diffusion (Dm) may occur in cystic fibrosis (CF), in correspondence to alterations observed by computed tomography (CT). Dm can be easily quantified via the diffusing capacity for nitric oxide (DL NO ), as opposed to the conventional diffusing capacity for carbon monoxide (DL CO ). We thus studied the relationship between DL NO  as well as DL CO  and a CF-specific CT score in patients with stable CF.    Methods  Simultaneous single-breath determinations of DL NO  and DL CO  were performed in 21 CF patients (mean ± SD age 35 ± 9 y, FEV 1  66 ± 28%pred). Patients also underwent spirometry and bodyplethysmography. CT scans were evaluated via the Brody score and rank correlations (r S ) with z-scores of functional measures were computed.    Results  CT scores correlated best with DL NO  (r S  = -0.83; p < 0.001). Scores were also related to the volume-specific NO transfer coefficient (KNO; r S  = -0.63; p < 0.01) and to DL CO  (r S  = -0.79; p < 0.001) but not KCO. Z-scores for DL NO  were significantly lower than for DL CO  (p < 0.001). Correlations with spirometric (e.g., FEV 1 , IVC) or bodyplethysmographic (e.g., SR aw , RV/TLC) indices were weaker than for DL NO  or DL CO  but most of them were also significant (p < 0.05 each).    Conclusion  In this cross sectional study in patients with CF, DL NO  and DL CO  reflected CT-morphological alterations of the lung better than other measures. Thus the combined diffusing capacity for NO and CO may play a future role for the non-invasive, functional assessment of structural alterations of the lung in CF.

bmc pulmonary medicine

Lung diffusing capacity for nitric oxide and carbon monoxide in relation to morphological changes as assessed by computed tomography in patients with cystic fibrosis