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The effect of posture-induced changes in peripheral nitric oxide uptake on exhaled nitric oxide

¹Respiratory Division, University Hospital UZ Brussel, Brussels; ²Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium; ³LAPHAP, Faculté des Sciences du Sport, Poitiers; ⁴Department of Physiology, Bordeaux University Hospital, Bordeaux, France; and ⁵Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium

Submitted 23 December 2008 ; accepted in final form 18 March 2009

Airway and alveolar NO contributions to exhaled NO are being extracted from exhaled NO measurements performed at different flow rates. To test the robustness of this method and the validity of the underlying model, we deliberately induced a change in NO uptake in the peripheral lung compartment by changing body posture between supine and prone. In 10 normal subjects, we measured exhaled NO at target flows ranging from 50 to 350 ml/s in supine and prone postures. Using two common methods, bronchial NO production [Jaw(NO)] and alveolar NO concentration (FANO) were extracted from exhaled NO concentration vs. flow or flow^–1 curves. There was no significant Jaw(NO) difference between prone and supine but a significant FANO decrease from prone to supine ranging from 23 to 33% depending on the method used. Total lung capacity was 7% smaller supine than prone (P = 0.03). Besides this purely volumetric effect, which would tend to increase FANO from prone to supine, the observed degree of FANO decrease from prone to supine suggests a greater opposing effect that could be explained by the increased lung capillary blood volume (V_c) supine vs. prone (P = 0.002) observed in another set of 11 normal subjects. Taken together with the relative changes of NO and CO transfer factors, this V_c change can be attributed mainly to pulmonary capillary recruitment from prone to supine. Realistic models for exhaled NO simulation should include the possibility that a portion of the pulmonary capillary bed is unavailable for NO uptake, with a maximum capacity of the pulmonary capillary bed in the supine posture.

exhaled nitric oxide; body posture; alveolar nitric oxide; capillary recruitment