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Respiratio 2018; 8 (1-2): 1-6




Diffusion capacity for CO in elite athletes


Biljana Lazović¹, Mirjana Zlatković-Švenda², Jelena Grbović, Vladimir Zugić4

¹ University clinical center "Zemun", Belgrade, Pulmonary Ward, Serbia

² Univerzitet u Beogradu, Medicinski fakultet, Institut za reumatologija, Srbija

³ Clinic for lung disease, Clinical Center Serbia

4 Univerzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za pulmologiju, Srbija


Original research

Naučni članak

doi: 10.26601/rsp.aprs.18.1


Summary: Introduction: The lung diffusion carbon monoxide capacity (DLCO) is used to measure the oxygen and carbon monoxide exchange between the air and the blood at the alveolo-capillary membrane site. Therefore, DLCO level is determined with structural and functional characteristics of the lung performance. Elite athletes tend to have higher DLCO values.


Aim: To evaluate the anthropometric and training factors influence on carbon monoxide lung diffusion capacity (DLCO) and on transfer coefficient (KCO) in elite athletes, by using the logistic regression model.


Methods: From November 2012 to September 2015, 70 randomly selected male Caucasian elite athletes were analyzed. They came to be regularly screened for the respiratory diseases at the Belgrade Clinical Centre Lung disease Unit. Medical history and training data were assessed by questionnaire; DLCO and KCO were measured by the single breath method standardized technique; anthropometric values were measured as standing body height (cm) and body weight (kg).


Results: The logistic regression model has shown that the combination of training frequency per week and the weekly amount of training expressed in hours was correlated with higher DLCO. This model was found to be excellent according to classification table, providing 80,0% of agreement for DLCO, at a cut off value of p=0.50. A set of goodness of fit tests was performed in order to further test the model, and all were nonsignificant, showing that it has correctly predicted the real data: Hosmer and Lemeshow test (p=0.866); Cox and Snell R2 (p=0.420) and Nagelkerke R2 (p=0.561). Predictors for KCO were not identified, with 71,0% of agreement.


Conclusion: Training factors are shown to have positive influence on DLCO. Anthropometric features were not found to be significant predictors of DLCO. Further studies are encouraged.


Key words: elite athlete, DLCO, KCO, logistic regression


Full Article (PDF)


1. JohnsonDC. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume. Respir Med 2000; 94: 28–37.


2. Thompson BR, Johns DP, Bailey M, Raven J, Walters EH, Abramson MJ. Prediction equations for single breath diffusing capacity (TLCO) in a middle aged caucasian population.Thorax. 2008;63(10):889-93.



3. Miller A, Thornton JC, Warshaw R, Anderson H, Teirstein AS, Selikoff IJ. Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state. Predicted values, lower limits of normal, and frequencies of abnormality by smoking history". Am Rev Respir Dis. 1983; 127 (3): 270–7.



4. Knudson RJ, Kaltenborn WT, Knudson DE, Burrows B. The single-breath carbon monoxide diffusing capacity. Reference equations derived from a healthy nonsmoking population and effects of hematocrit". Am Rev Respir Dis. 1987; 135 (4): 805–11.



5. Cotes JE, Chinn DJ, Quanjer PH, Roca J, Yernault JC. Standardization of the measurement of transfer factor (Diffusing capacity)". Eur Respir J Suppl 1993; 16: 41–52.



6. Chin NK, Ng TP, Hui KP, Tan WC. Population based standards for pulmonary function in non-smoking adults in Singapore". Respirology 1997; 2 (2): 143–9.



7. Piirilä P, Seikkula T, Välimäki P. Differences between Finnish and European reference values for pulmonary diffusing capacity". Int J Circumpolar Health 2007;66 (5): 449–57.



8. Ip MS, Lam WK, Lai AY, Ko FW, Lau AC, Ling SO et al. Hong Kong Thoracic Society. Reference values of diffusing capacity of non-smoking Chinese in Hong Kong". Respirology 2007; 12 (4): 599–606.



9. La Gerche A, Roberts T, Claessen G. The response of the pulmonary circulation and right ventricle to exercise: exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes (2013 Grover Conference series). Pulm Circ 2014; 4(3): 407-16.
PMid:25621154 PMCid:PMC4278600



10. Naeije R, Chesler N. Pulmonary Circulation at Exercise. Compr Physiol 2012; 2: 71141.



11. Heinonen I, Savolainen AM, Han C, Kemppainen J, Oikonen V, Luotolahti M et al. Pulmonary blood flow and its distribution in highly trained endurance athletes and healthy control subjects. J Appl Physiol (1985). 2013; 114(3): 329-34.



12. Hsia CC, Herazo LF, Ramanathan M, Johnson RL Jr, Wagner PD. Cardiopulmonary adaptations to pneumonectomy in dogs: II. Ventilation-perfusion relationships and microvascular recruitment. J Appl Physiol 1993; 74: 1299-1309.



13. Mostyn EM, Helle S, Gee JB, Bentivoglio LG, Bates DV. Pulmonary diffusing capacity of athletes. J Appl Physiol 1963; 18: 687-95.



14. Lazovic B, Mazic S, Suzic-Lazic J, Djelic M, Djordjevic-Saranovic S, Durmic T et al. Respiratory adaptations in different types of sports. Eur Rev Med Pharmacol Sci 2015; 19 (12): 2269-74.



15. Mazic S, Lazovic B, Djelic M, Suzic-Lazic J, Djordjevic-Saranovic S, Acimovic T et al. Respiratory parameters in elite athletes - does sport have an influence? Rev Port Pneumol 2015; 21(4):192-7.



16. Connie CW, Hsia CCW. Recruitment of Lung Diffusing Capacity- Update of Concept and Application. Chest 2002; 122 (5):1774-83.



17. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al. Standardisation of spirometry. Eur Respir J 2005; 26:319 –38.



18. Degens H, Rittweger J, Parviainen T, Timonen KL, Suominen H, Heinonen A et al. Diffusion capacity of the lung in young and old endurance athletes. .Int J Sports Med. 2013; 34(12): 1051-7.



19. West JB. Thoughts on the pulmonary blood-gas barrier.Am J Physiol Lung Cell Mol Physiol. 2003; 285(3):L501-13.



20. Armour J, Donnelly PM, Bye PT. The large lungs of elite swimmers: an increased alveolar number?Eur Respir J 1993; 6(2): 237-47.



21. Dempsey JA, Hanson PG, Henderson KS. Exercise-induced arterial hypoxaemia in healthy human subjects at sea level.J Physiol. 1984; 355:161-75.
PMid:6436475 PMCid:PMC1193484



Biljana Lazovic

University clinical center "Zemun",

Belgrade, Pulmonary Ward, Serbia

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