Detection of structural pulmonary changes with real-time high-fidelity analysis of expiratory CO.

There is an unmet need for breath-based markers for pulmonary vascular disease (PVD). We developed a fully-automatic algorithm to analyze expiratory COflow from resting ventilation and evaluated the clinical associations of our readouts. We enrolled patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pulmonary arterial hypertension (PAH) and healthy controls and evaluated fractionated volumes for dead space, mixed space (MSV) and alveolar space, their respective COvolumes and ventilatory equivalents for CO(EqCO) and the maximum slope of the first derivative of the cumulative expiratory COvolume over expired volume (MSV-slope) as primary readouts. Differences between groups were analyzed using non-parametric tests. Associations were analyzed by Spearman correlation. The discriminatory power was determined with receiver operating characteristic analysis. Eleven COPD (median (IQR) age 64 (63-69) years), 10 ILD (61 (54-77) years), 10 PAH (64 (61-73) years) and 21 healthy controls (56 (52-61) years) were investigated. Patients vs healthy controls showed increased MSV and mixed space CO(221 (164-270) ml vs 144 (131-167) ml, and 3.9 (3.2-4.9) ml vs 3.0 (2.7-3.4) ml,< 0.001 and= 0.002) and EqCO(38 (34-42) vs 30 (29-35),< 0.001), and decreased MSV-slopes (0.16 (0.12-0.21) vs 0.27 (0.23-0.32) l COl,< 0.001). Area under the curve (AUC) for MSV and MSV-slope for disease prediction was 0.81 (95% CI 0.69-0.93) and 0.84 (0.73-0.95), respectively. MSV and mixed space COwere only strongly increased in COPD and ILD but not PAH, resulting in a significant difference between PAH and COPD&ILD (AUC 0.74 (95% CI: 0.56-0.92). MSV and MSV-slope were significantly correlated with DLCO (=-0.69 and= 0.72, respectively; both< 0.001). Fully-automatic high-fidelity expiratory COflow analysis is technically feasible, easy and safe to perform, and may represent a novel approach to detect PVD with or without structural changes of the airways and lung parenchyma. Prospective studies with larger sample size are needed to validate these findings.