Interrogating pulmonary diffusing capacity in long COVID: insights from DLCO and DLNO testing.

Interrogating pulmonary diffusing capacity in long COVID: insights from DLCO and DLNO testing.

Publication date: Oct 14, 2025

The lingering respiratory effects of COVID-19, particularly in patients with Long COVID, remain poorly understood, prompting a comprehensive evaluation of lung function in this population. Simultaneous measurements of diffusion capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO), chest computed tomography (CT), lung ultrasound and questionnaires were collected in 74 subjects. Participants were categorized into two groups: those that have no lingering symptoms (NS, n = 37) and those still struggling with symptoms after initial infection, the disease known as Long COVID (LC, n = 37). DLCO and DLNO were significantly lower in the LC group compared to the NS group (LC vs. NS, DLCO: 25. 94 +/- 7. 65 vs. 21. 71 +/- 6. 35 mL/min/mmHg, p = 0. 009; DLNO: 148. 5 +/- 35. 6 vs. 126. 6 +/- 32. 2 mL/min/mmHg, p = 0. 006). Pulmonary capillary blood volume (Vc) was also significantly lower in the LC group (43. 38 +/- 13. 87, 70. 79 +/- 17. 77, p = 0. 003; LC vs. NS, respectively). Alveolar volume (VA) is significantly lower in the LC group (LC vs. NS, 5. 06 +/- 1. 17 vs. 5. 95 +/- 1. 16, p = 0. 004). There was no significant difference between groups for surface area of the lungs available for gas exchange by resistance to gas transfer across the alveolar-capillary membrane (DM) between groups (LC vs. NS, 208. 63 +/- 97. 3, 223. 0 +/- 93. 47 mL/min/mmHg, p = 0. 54). These findings indicate that Vc is the driving factor of decreased DLCO. CT findings and lung ultrasound showed no differences between the two groups for lung fluid (p = 0. 525; p = 0. 298). These findings suggest that a lack of volume available for perfusion could be problematic for these patients and as such requires further investigation for clinical management of these patients.

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Concepts Keywords
Ct alveolar volume
Driving COVID
Nitric long COVID
Poorly membrane conductance
Pulmonary

Semantics

Type Source Name
disease MESH long COVID
disease MESH COVID-19
drug DRUGBANK Carbon monoxide
drug DRUGBANK Nitric Oxide
disease MESH infection
pathway REACTOME Reproduction
disease MESH Cardiovascular Diseases
disease MESH brain fog
disease MESH included
disease MESH dyspnea
disease MESH fatigue
disease MESH cognitive impairment
disease MESH orthostatic intolerance
disease MESH chest pain
disease MESH seizure disorders
disease MESH pulmonary edema
drug DRUGBANK Water
disease MESH inflammation
disease MESH asthma
pathway KEGG Asthma
drug DRUGBANK Helium
drug DRUGBANK Oxygen
drug DRUGBANK Nitrogen
drug DRUGBANK Medical air
drug DRUGBANK Sulodexide
disease MESH ATS
disease MESH ERS
disease MESH wheezing
disease MESH dysautonomia
disease MESH light sensitivity
disease MESH hypercoagulability
disease MESH CRC
disease MESH pulmonary diseases
disease MESH Dis
disease MESH edema
disease MESH heart diseases
drug DRUGBANK Coenzyme M
disease MESH Thromboinflammation
disease MESH pneumonia
drug DRUGBANK Tolbutamide
disease MESH respiratory diseases
drug DRUGBANK Isosorbide Mononitrate
disease MESH heart failure
disease MESH syndrome
drug DRUGBANK Aminohippuric acid

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