Lung Diffusing Capacities ( D L ) for Nitric Oxide (NO) and Carbon Monoxide (CO): The Evolving Story

Nitric oxide and carbon monoxide diffusing capacities (DLNO and DLCO ) obey Fick's First Law of Diffusion and the basic principles of chemical kinetic theory. NO gas transfer is dominated by membrane diffusion (DM ), whereas CO transfer is limited by diffusion plus chemical reaction within the red cell. Marie Krogh, who pioneered the single-breath measurement of DLCO in 1915, believed that the combination of CO with red cell hemoglobin (Hb) was instantaneous. Roughton and colleagues subsequently showed, in vitro, that the reaction rate was finite, and prolonged in the presence of high P O 2 . Roughton and Forster (R-F) proposed that the resistance to transfer (1/DL ) was the sum of the membrane resistance (1/DM ) and (1/thetaVc), the red cell resistance (theta being the CO or NO conductance for blood uptake and Vc the capillary volume). From this R-F equation, DM for CO and Vc can be solved with simultaneous NO and CO inhalation. At near maximum exercise, DMCO and Vc for normal subjects were 88% and 79%, respectively, of morphometric values. The validity of these calculations depends on the values chosen for theta for CO and NO, and on the diffusivity of NO versus CO. Recent mathematical modeling suggests that theta for NO is "effectively" infinite because NO reacts only with Hb in the outer 0.1 muM of the red cell. An "infinite thetaNO " recalculation reduced DMCO to 53% and increased Vc to 95% of morphometric values. (c) 2020 American Physiological Society. Compr Physiol 10:73-97, 2020.