Gas Transfer

  • Ali AltalagEmail author
  • Jeremy Road
  • Pearce Wilcox
  • Kewan Aboulhosn
Part of the In Clinical Practice book series (ICP)


Testing for gas transfer abnormalities is often the final invaluable step in our diagnostic decision tree. Here we discuss techniques for measuring DLCO and how to utilize these measurements for accurate classification of pulmonary function abnormalities. We also review the various correction techniques to obtain accurate DLCO values.


Carobon monoxide (CO) Hemogobin (Hgb) Diffusing Capacity for Carbon Monoxide (DLCOAlveolar Volume (VADLCO/VA ratio 


  1. 1.
    MacIntyre N, Crapo RO, Viegi G, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26:720–35.CrossRefGoogle Scholar
  2. 2.
    West JB. Respiratory physiology: the essentials. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.Google Scholar
  3. 3.
    Rodenstein DO, Stănescu DC. Reassessment of lung volume measurement by helium dilution and by body plethysmography in chronic air-flow obstruction 1–3. Am Rev Respir Dis. 1982;126:1040–4.PubMedGoogle Scholar
  4. 4.
    Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978;118:1–120.PubMedGoogle Scholar
  5. 5.
    Graham BL, Brusasco V, Burgos F, Cooper BG, Jensen R, Kendrick A, Macintyre NR, Thompson BR, Wanger J. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017;49:1600016. Scholar
  6. 6.
    Renzetti AD Jr. Standardization of spirometry. Am Rev Respir Dis. 1979;119:831–8.Google Scholar
  7. 7.
    Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.CrossRefGoogle Scholar
  8. 8.
    Johnson DC. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume. Respir Med. 2000;94:28–37.CrossRefGoogle Scholar
  9. 9.
    Welle I, Eide GE, Bakke P, Gulsvik A. Applicability of the single-breath carbon monoxide diffusing capacity in a Norwegian Community Study. Am J Respir Crit Care Med. 1998;158:1745–50.CrossRefGoogle Scholar
  10. 10.
    Punjabi NM, Shade D, Patel AM, Wise RA. Measurement variability in single-breath diffusing capacity of the lung. Chest. 2003;123:1082–9.CrossRefGoogle Scholar
  11. 11.
    Cotes JE, Chinn DJ, Quanjer PH, Roca J, Yernault JC. Standardization of the measurement of transfer factor (diffusing capacity). Eur Respir J. 1993;6(Suppl 16):41–52.CrossRefGoogle Scholar
  12. 12.
    American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144:1202–18.CrossRefGoogle Scholar
  13. 13.
    Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.CrossRefGoogle Scholar
  14. 14.
    Solberg HE, Gräsbeck R. Reference values. Adv Clin Chem. 1989;27:1–79.CrossRefGoogle Scholar
  15. 15.
    Stam H, Versprille A, Bogaard JM. The components of the carbon monoxide diffusing capacity in man dependent on alveolar volume. Bull Eur Physiopathol Respir. 1983;19:17–22.PubMedGoogle Scholar
  16. 16.
    Viegi G, Baldi S, Begliomini E, Ferdeghini EM, Pistelli F. Single breath diffusing capacity for carbon monoxide: effects of adjustment for inspired volume dead space, carbon dioxide, hemoglobin and carboxyhemoglobin. Respiration. 1998;65:56–62.CrossRefGoogle Scholar
  17. 17.
    Mohsenifar Z, Brown HV, Schnitzer B, Prause JA, Koerner SK. The effect of abnormal levels of hematocrit on the single breath diffusing capacity. Lung. 1982;160:325–30.CrossRefGoogle Scholar
  18. 18.
    Clark EH, Woods RL, Hughes JM. Effect of blood transfusion on the carbon monoxide transfer factor of the lung in man. Clin Sci Mol Med. 1978;54:627–31.PubMedGoogle Scholar
  19. 19.
    Cotes JE, Dabbs JM, Elwood PC, Hall AM, McDonald A, Saunders MJ. Iron-deficiency anaemia: its effect on transfer factor for the lung (diffusiong capacity) and ventilation and cardiac frequency during sub-maximal exercise. Clin Sci. 1972;42:325–35.CrossRefGoogle Scholar
  20. 20.
    Marrades RM, Diaz O, Roca J, Campistol JM, Torregrosa JV, Barberà JA, Cobos A, Félez MA, Rodriguez-Roisin R. Adjustment of DLCO for hemoglobin concentration. Am J Respir Crit Care Med. 1997;155:236–41.CrossRefGoogle Scholar
  21. 21.
    Steve H. Pulmonary function testing. In: ACCP Pulmonary Board Review Course; 2005. p. 297–320.Google Scholar
  22. 22.
    Hancox B, Whyte K. Bob pocket guide to lung function tests. 1st ed. Sydney: McGraw-Hill; 2001.Google Scholar
  23. 23.
    Coburn RF, Forster RE, Kane PB. Considerations of the physiological variables that determine the blood carboxyhemoglobin concentration in man. J Clin Invest. 1965;44:1899–910.CrossRefGoogle Scholar
  24. 24.
    Viegi G, Paoletti P, Carrozzi L, Baldacci S, Modena P, Pedreschi M, Di Pede F, Mammini U, Giuntini C. CO diffusing capacity in a general population sample: relationships with cigarette smoking and airflow obstruction. Respiration. 1993;60:155–61.CrossRefGoogle Scholar
  25. 25.
    Roughton FJW, Forster RE. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol. 1957;11:290–302.CrossRefGoogle Scholar
  26. 26.
    Comroe JJ. Pulmonary diffusing capacity for carbon monoxide (DLCO). Am Rev Respir Dis. 1975;111:225–40.PubMedGoogle Scholar
  27. 27.
    Huang YC, Helms MJ, MacIntyre NR. Normal values for single exhalation diffusing capacity and pulmonary capillary blood flow in sitting, supine positions, and during mild exercise. Chest. 1994;105:501–8.CrossRefGoogle Scholar
  28. 28.
    Stam H, Kreuzer FJ, Versprille A. Effect of lung volume and positional changes on pulmonary diffusing capacity and its components. J Appl Physiol. 1991;71:1477–88.CrossRefGoogle Scholar
  29. 29.
    Stokes DL, MacIntyre NR, Nadel JA. Nonlinear increases in diffusing capacity during exercise by seated and supine subjects. J Appl Physiol. 1981;51:858–63.CrossRefGoogle Scholar
  30. 30.
    Johnson RL, Spicer WS, Bishop JM, Forster RE. Pulmonary capillary blood volume, flow and diffusing capacity during exercise. J Appl Physiol. 1960;15:893–902.CrossRefGoogle Scholar
  31. 31.
    Smith TC, Rankin J. Pulmonary diffusing capacity and the capillary bed during Valsalva and Müller maneuvers. J Appl Physiol. 1969;27:826–33.CrossRefGoogle Scholar
  32. 32.
    Cotes JE, Snidal DP, Shepard RH. Effect of negative intraalveolar pressure on pulmonary diffusing capacity. J Appl Physiol. 1960;15:372–6.CrossRefGoogle Scholar
  33. 33.
    Cotton DJ, Mink JT, Graham BL. Effect of high negative inspiratory pressure on single breath CO diffusing capacity. Respir Physiol. 1983;54:19–29.CrossRefGoogle Scholar
  34. 34.
    Greening AP, Hughes JM. Serial estimations of carbon monoxide diffusing capacity in intrapulmonary haemorrhage. Clin Sci (Lond). 1981;60:507–12.CrossRefGoogle Scholar
  35. 35.
    Iversen ET, Sørensen T, Heckscher T, Jensen JI. Effect of terbutaline on exercise capacity and pulmonary function in patients with chronic obstructive pulmonary disease. Lung. 1999;177:263–71.CrossRefGoogle Scholar
  36. 36.
    Chinn DJ, Askew J, Rowley L, Cotes JE. Measurement technique influences the response of transfer factor (TICO) to salbutamol in patients with airflow limitation. Eur Respir J. 1988;1:15–21.PubMedGoogle Scholar
  37. 37.
    Cotton DJ, Prabhu MB, Mink JT, Graham BL. Effects of ventilation inhomogeneity on DLcoSB-3EQ in normal subjects. J Appl Physiol. 1992;73:2623–30.CrossRefGoogle Scholar
  38. 38.
    Cotton DJ, Prabhu MB, Mink JT, Graham BL. Effect of ventilation inhomogeneity on “intrabreath” measurements of diffusing capacity in normal subjects. J Appl Physiol. 1993;75:927–32.CrossRefGoogle Scholar
  39. 39.
    Gelb AF, Gold WM, Wright RR, Bruch HR, Nadel JA. Physiologic diagnosis of subclinical emphysema. Am Rev Respir Dis. 1973;107:50–63.CrossRefGoogle Scholar
  40. 40.
    Morrison NJ, Abboud RT, Ramadan F, Miller RR, Gibson NN, Evans KG, Nelems B, Müller NL. Comparison of single breath carbon monoxide diffusing capacity and pressure-volume curves in detecting emphysema. Am Rev Respir Dis. 1989;139:1179–87.CrossRefGoogle Scholar
  41. 41.
    Epler GR, Saber FA, Gaensler EA. Determination of severe impairment (disability) in interstitial lung disease. Am Rev Respir Dis. 1980;121:647–59.PubMedGoogle Scholar
  42. 42.
    Nordenfelt I, Svensson G. The transfer factor (diffusing capacity) as a predictor of hypoxaemia during exercise in restrictive and chronic obstructive pulmonary disease. Clin Physiol. 1987;7:423–30.CrossRefGoogle Scholar
  43. 43.
    Hyatt RE, Scanlon PD, Nakamura M. Interpretation of pulmonary function tests, a practical guide. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.Google Scholar
  44. 44.
    Mohsenifar Z, Tashkin DP. Effect of carboxyhemoglobin on the single breath diffusing capacity: derivation of an empirical correction factor. Respiration. 1979;37:185–91.CrossRefGoogle Scholar
  45. 45.
    Frey TM, Crapo RO, Jensen RL, Elliott CG. Diurnal variation of the diffusing capacity of the lung: is it real? Am Rev Respir Dis. 1987;136:1381–4.CrossRefGoogle Scholar
  46. 46.
    Sansores RH, Abboud RT, Kennell C, Haynes N. The effect of menstruation on the pulmonary carbon monoxide diffusing capacity. Am J Respir Crit Care Med. 1995;152:381–4.CrossRefGoogle Scholar
  47. 47.
    Peavy HH, Summer WR, Gurtner G. The effects of acute ethanol ingestion on pulmonary diffusing capacity. Chest. 1980;77:488–92.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Ali Altalag
    • 1
    Email author
  • Jeremy Road
    • 2
  • Pearce Wilcox
    • 2
  • Kewan Aboulhosn
    • 3
  1. 1.Prince Sultan Military Medical CityRiyadhSaudi Arabia
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.University of British ColumbiaVictoriaCanada

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