We established the differential diagnosis of an isolated reduction in the single breath diffusing capacity for carbon monoxide (DLCO-sb) by retrospective examination of the results of 4171 pulmonary function tests and by a review of the literature. From our laboratory records, we identified 27 patients with a reduction in DLCO as an isolated abnormality not due to a decreased hemoglobin level. Our records contributed the following to the differential diagnosis: idiopathic interstitial fibrosis (n = 10), sarcoidosis (n = 5), scleroderma (n = 4), recent smoking (n=2), pulmonary embolism (n = 2), dermatomyositis (n = 1), asbestosis (n = 1), lymphomatoid granulomatosis (n = 1), and primary pulmonary hypertension (n=1). A review of the literature added other collagen vascular diseases (rheumatoid interstitial lung disease, Sjogren's syndrome, systemic lupus erythematosus), drug toxicity, inflammatory bowel disease, and chronic renal failure to the differential diagnosis. We conclude that an isolated reduction in DLCO-sb in a patient who has not smoked recently is a clinically important finding that is indicative of pulmonary disease. (Respir Care 1988;33:333-340.)
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