Distribution of ventilation and diffusing capacity in the normal and diseased lung

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Abstract
Conventional tests of diffusing capacity (DL) consider the lung to be a uniform structure with regard to both ventilation and diffusion. These assumptions are incorrect even in normal subjects. We present a method for determining the distribution of both specific ventilation (SV) and DL from the washin and washout of C18O and simultaneous washout of argon. Both end-tidal and mixed-expired data are fit to a two-compartment lung model; parameters that define SV and DL are assigned to each compartment. From data generated by a model, the parameters recovered were found to be relatively insensitive to realistic levels of noise. Measurements in one subject were highly repeatable. We examined 15 normal subjects and 16 subjects with varying degrees of obstructive lung disease. In both groups the better ventilated spaces generally showed a higher DL. The sum of the total two-compartmental DL's correlated with, but was found to exceed, the value obtained using the steady-state method and generally exceeded the single-breath result. We conclude that this method has potential advantages over conventional methods and is worthy of further study.