The results can be affected by smoking, so if you are a smoker, dont smoke for 24 hours before your test. WebThe normal values for KCO are dependent on age and sex. Apex PDFWriter This elevated pressure tends to reduce the capillary blood volume a bit further. Due for review: January 2023. endstream endobj 32 0 obj <> endobj 33 0 obj <> endobj 34 0 obj <> endobj 35 0 obj <> endobj 36 0 obj <> endobj 37 0 obj <> endobj 38 0 obj <> endobj 39 0 obj <> endobj 40 0 obj <> endobj 41 0 obj <> endobj 42 0 obj <> endobj 43 0 obj <> endobj 44 0 obj <> endobj 45 0 obj <>stream GPnotebook no longer supports Internet Explorer. 28 0 obj Asthma, obesity, and less commonly polycythemia, congestive heart failure, pregnancy, atrial septal defect, and hemoptysis or pulmonary hemorrhage can increase Dlco above the normal range. weakness) then the TLCO is low but the KCO is normal or increased. Lung parenchyma is the portion of the lung involved in gas transfer - the alveoli, alveolar ducts and respiratory bronchioles. CO has a 200 to 250 times greater affinity for hemoglobin than does oxygen. Top tips for organising a brilliant charity quiz, Incredible support from trusts and foundations, Gwybodaeth yng Nghymraeg / Welsh language health information, The Asthma UK and British Lung Foundation Partnership, Why you'll love working with the British Lung Foundation, Thank you for supporting the British Lung Foundation helpline. What does air pollution do to people with a lung condition? Conversely, obesity, kyphoscoliosis, and neuromuscular disease will reduce Va, but Kco, due to relatively increased Vc for a given Va, will be increased, resulting in a normal range or slightly decreased Dlco. Patients with emphysema have low DLCO, Kco, DACO,and KAco. Z-iTr)Rrqgvf76__>dJ&x\H7YOpdDK|XYkEiQiKz[X)01aNLCPe.L&>\?0Gf~{LVk&k~7uQ>]%"R0.Lg'7iJ-EYu3Ivx};.e@IbSlu}&kDiqq~6CM=BFRFnre8P+n35f(PVUy4Rq89J%,WNl\Te3. Because carbon monoxide binds quite readily to hemoglobin, the fewer red blood cells in the blood, the less carbon monoxide will be taken up. Post was not sent - check your email addresses! Diaz PT, King MA, Pacht, ER et al. Examination of the carbon monoxide diffusing capacity (DLCO) in relation to its KCO and VA components. It is also often written as Authors: 0000019293 00000 n Kco is not the lung CO diffusing capacity. Carbon monoxide transfer coefficient (often abbreviated as KCO) is a parameter often performed as part of pulmonary function tests. Decreased volume of pulmonary capillary blood or hemoglobin volume, Decreased surface area integrated between capillaries and alveoli, Ventilation/perfusion mismatching or intrapulmonary shunting from atelectasis, The patient needs to hold his or her breath for 10 seconds, then exhale quickly and completely back to RV. This can be assessed by calculating the VA/TLC ratio from a DLCO test that was performed with acceptable quality (i.e. 24 0 obj The reason Kco increases with lower lung volumes in certain situations can best be understood by the diffusion law for gases. This information uses the best available medical evidence and was produced with the support of people living with lung conditions. 0000017721 00000 n WebNormal and Critical Findings Normal DLCO: >75% of predicted, up to 140% Mild: 60% to LLN (lower limit of normal) Moderate: 40% to 60% Severe: <40% What is a normal KCO? Despite this, Va typically approximates TLC within a few percentage points (Va/TLC>95%) in the normal lung. KCO is only a measurement of the rate at which CO disappears during breath-holding (i.e. DLCO however, is highest at TLC and lowest at FRC and this is because it is primarily a measurement of functional gas exchange surface area (and not the rate at which CO disappears). 0000126497 00000 n DLCO is primarily a measurement of the functional alveolar-capillary surface area, so the simple answer is that if there is an increase in pulmonary capillary blood volume in these disorders it is occurring in poorly ventilated areas and that overall there is low V/Q. These disorders may also cause a thickening of the alveolar-capillary membrane (i.e. (2012) American journal of respiratory and critical care medicine. I agree with you that a supranormal KCO (120%) is highly suggestive of a true volume effect. Examination of the carbon monoxide diffusing capacity (DlCO) in relation to its Kco and Va components. Required fields are marked *. 0000008422 00000 n I saw a respiratory consultant recently following a lung function test. Another striking example of where Dlco is helpful are cases of difficult-to-control young adult asthmatic women with normal spirometry and lung function who subsequently are diagnosed with PAH secondary to dieting pills or methamphetamines. For DLCO values that are close to the lower limit of the normal range (eg. Not seeing consultant for 3 months but radiography said I might get a letter with result before then. To see Percent Prediced, you must enter observed FVC, FEV1, and FEF25-75% values in the appropriate boxes. This site is intended for healthcare professionals. DLCO and KCO were evaluated in 2313 patients. Your original comment implied that DLCO and KCO were reduced by similar amounts. This is because there is no loss of the gas through uptake by pulmonary tissues (as with oxygen) or into the capillary bed. Chest 2007; 131: 237-244. 2023-03-04T17:06:19-08:00 Which pulmonary function tests best differentiate between COPD phenotypes? Normal DLCO: >75% of predicted, up to 140% Mild: 60% to LLN (lower limit of normal) Moderate: 40% to 60% Severe: <40% What When significant obstructive airways disease is present however, VA is often reduced because of ventilation inhomogeneity. Predicted KCO derived from these values would range from 3.28 to 7.13!] In the low V/Q area, Hb will have difficulties in getting oxygen due to a relatively limited ventilated area. Low Dlco less than or equal to 50% predicted can predict hypoxemia with exercise. If, on the other hand, the patient performs a Muller maneuver (attempts to inhale forcefully against the closed mouthpiece) this will cause negative pressure inside the lung and will increase the capillary blood volume. Because helium is not absorbed, the dilution of the helium in the exhaled air permits the calculation of the alveolar volume. The diagnosis should be suspected in a patient taking amiodarone with nonproductive cough, dyspnea, and weight loss accompanied by an abnormal chest radiographs demonstrating chronic interstitial lung changes. 0000032077 00000 n Eur Respir J. COo cannot be directly measured, since we only know the inhaled CO concentration (COi) and the exhaled CO concentration (COe). Carbon monoxide transfer coefficient (often abbreviated as KCO) is a parameter often performed as part of pulmonary function tests. (2011) Respiratory medicine. This is why DL/VA (KCO!!! Hughes JMB, Pride NB. The Va/TLC ratio does not depend on age, sex, height, or weight but decreases when there is intrapulmonary airflow obstruction and/or uneven distribution of ventilation. Why do we have to keep on ,time and time again asking some professionals about our own test results . A reduction in Va will reduce Dlco unless the rate of CO uptake or Kco increases. The ratio of these two values is expressed as a percentage. Poster presented at: American Thoracic Society 2010 International Conference; May 14-19, 2010; New Orleans, LA. (TLC) ratio (normal >85 percent). startxref 0000012865 00000 n Johnson DC. KCO has a more limited value when assessing reduced DLCO results for obstructive lung disease. I have no idea what any of the above percentages mean or 'parenchymal' means. (2000) Respiratory medicine. A fit young adult may have a KCO of approximately 1.75 mmol/min/kPa/litre, an elderly adult may be about 1.25. Reference Source: Gender: Optional Observed Values Below Enter to calculate Percent Predicted FEV1 (L): FEF25-75% (L/s): FEV1/FVC%: This could lead to a couple additional issues; one, that the depth of the pulmonary capillary around ventilated alveoli is increased and this may prevent the diffusion of oxygen to the blood furthest away from the alveolar membrane. Lung Function. 0000020808 00000 n A deliberately submaximal inspiration in a normal lung will show a very high KCO. Kiakouama L, Cottin V, Glerant JC, Bayle JY, Mornex JF, Cordier JF. In this scenario, no further valid inferences can be made regarding KCO, however, if KCO is low despite those caveats this could imply extensive impairment in pulmonary gas exchange efficiency,e.g. Microsoft is encouraging users to upgrade to its more modern. %PDF-1.7 % In the context of normal VA, a low KCO (provided there is no anemia or recent smoking) could suggest 3: In the context of a low VA, the next step is to look at the VA/TLC ratio. Clinical data and diagnostic investigations (high-resolution computed tomography (HRCT) scan of the It also indicates that the DLCO result only applies to that fraction of the lung included within the VA/TLC ratio. 1 0 obj 2. This by itself would be a simple reason for KCO to increase as lung volume decreases but the complete picture is a bit more complicated. Amer J Respir Crit Care Med 2012; 186(2): 132-139. Webelevated Kco levels, DACOand KACO levels are normal. 0000046665 00000 n 2023-03-04T17:06:19-08:00 eE?_2/e8a(j(D*\ NsPqBelaxd klC-7mBs8@ipryr[#OvAkfq]PzCT.B`0IMCruaCN{;-QDjZ.X=;j 3uP jW8Ip#nB&a"b^jMy0]2@,oB?nQ{>P-h;d1z &5U(m NZf-`K8@(B"t6p1~SsHi)E /Rr-A"}i~ If the patients VC is less than 2.0 L, it is recommended that the washout volume be reduced to 0.5 L. The averages of the 2 Dlco measurements must be within 10% of each other. Confusion arises in how PFT laboratories, by convention, report Dlco and the related measurements Va and Dlco/Va. K co will be greater than 120% predicted in case 1, 100120% in case 2, and 40120% in case 3, depending on pathology. (I am the senior scientist in he pulmonary lab). Carbon monoxide diffusing capacity (Dlco) probably is the least understood pulmonary function test (PFT) in clinical practice worldwide, even among experienced pulmonologists. Normal KCO The normal values for KCO are dependent on age and sex. <>stream endobj 0000126796 00000 n When you know the volume of the lung that youre measuring, then knowing the breath-holding time and the inspired and expired carbon monoxide concentrations allows you to calculate DLCO in ml/min/mmHg. As shown above, Dlco is the product of a volume (determined by the dilution of helium) and a decay rate of CO over a specific breath-hold time for a given atmospheric pressure, all of which are derived from measured values of exhaled CO and helium (or other inert gas). I wish I can discuss again with you when I have more questions. <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Type/Page>> H The American Thoracic Society/European Respiratory Society statement on PFT interpretation advocates the use of a Dlco percent predicted of 80% as the normal cutoff. xokOpcHL# Ja3E'}F>vVXq\qbR@r[DUL#!1>K!-^L(_qG@'t^WDb&R!4Ka7|EtpfUP3rDKN"D]vBYG2dQ@@xVk*T=3%P0oml J l, Chest wall disease, such as morbid obesity, pleural effusions, and kyphoscoliosis, can display a normal Dlco or a slightly decreased Dlco, but the Dlco/Va remains normal. left-to-right shunt and asthma), extra-vascular hemoglobin (e.g. Dyspnea is the most common reason for ordering a Dlco test, but there are many situations and presentations in which a higher than predicted or lower than predicted Dlco suggests the possible presence of lung or heart disease (. Rearranging this equation gives us a way to determine Va from carefully measured values of Vi, He, As Marie Krogh first modeled in 1915, CO leaves the alveolar space at an exponential rate related to the gradient of CO between the alveolar compartment and the pulmonary capillary compartment. Dlco correction by Va cannot reliably rule out the presence of underlying emphysema or parenchymal lung disease.4, Dlco usually is decreased in COPD when emphysema is present; it typically is normal in chronic bronchitis alone or in asthma, where it even could be increased during acute attacks.5. The fact that the KCO is similarly reduced to DLCO indicates that the cause is intrinsic but thats already known from the etiology of the disorders. Va is calculated by a change in the concentration of an inhaled inert gas (such as helium or methane) after that gas has had an opportunity to mix throughout the lungs. D:20044910114917 The gas transfer test tells your doctor how well your lungs can exchange oxygen from the lungs into the blood. Therefore, Dlco is defined as follows: Pb is atmospheric pressurewater vapor pressure at 37C, and Kco is kco/Pb. On a similar note, if a reduction in lung volume is due to an inability to expand the thorax (e.g. The inspired CO under these circumstances may not completely reach all the functioning alveolar-capillary units. xref TLco refers to the transfer capacity of the lung, for the uptake of carbon monoxide (CO). The normal values for KCO are dependent on age and sex. 3. Comparing the DLCO and DLCO/VA, the sensitivity of DLCO was greater than that of DLCO/VA for all cut-off values=5070%, and the area under the ROC 12 0 obj Would be great to hear your thoughts on this! It is very frustrating not to get the results for so long. Hi Richard I have been ejoying your posts for a while now and have forwarded on the link to my colleagues here at Monash. Normal levels are generally between 35.5 and 44.9 percent for adult women and 38.3 to 48.6 percent for adult men. application/pdf Hemoglobin. A reduced Dlco also can accompany drug-induced lung diseases. Retrospective study of pulmonary function tests in patients presenting with isolated reductions in single-breath diffusion capacity: Implications for the diagnosis of combined obstructive and restrictive lung diease. Given the fact that these disorders affect the pulmonary circulation I wouldnt be surprised to see a wide degree of Q heterogeneity but Im not certain I see a cause for a high degree of V heterogeneity. Examination of the carbon monoxide diffusing capacity (DL(CO)) in relation to its KCO and VA components. extra-parenchymal restriction such as pleural, chest wall or neuromuscular disease), an increase in pulmonary blood flow from areas of diffuse (pneumonectomy) or localized (local destructive lesions/atelectasis) loss of gas exchange units to areas with preserved parenchyma; this frequently leads to more modest increases in KCO (although a high KCO can also be seen with normal VA when there is "increased pulmonary blood flow" or redistribution (e.g. The uptake of CO can be calculated from the Va and inspired and expired CO concentrations. This There is also another minor point that may be skewing the percent predicted DLCO and KCO somewhat. Interstitial involvement in restrictive lung disease is often complicated and there can be multiple reasons for a decrease in DLCO. A gas transfer test is used to help diagnose and monitor lung conditions including COPD and pulmonary fibrosis. However as noted, blood flow of lost alveolar units is diverted to the remaining units, resulting in a slight increase in Kco; as a result, Dlco falls relatively less than Va and not always proportionately. 20 0 obj To one degree or another a reduced VA/TLC ratio is an artifact of the DLCO measurement requirements. Kco is. Because anemia can lower Dlco, all calculations of Dlco are adjusted for hemoglobin concentration to standardize measurements and interpretation. Learn how your comment data is processed. A Dlco within the normal range (75% to 140% predicted) cannot completely rule out lung disease when the patient is persistently and genuinely dyspneic. Two, this would also lead to an increase in the velocity of blood flow and oxygen may not have sufficient time to diffuse completely because of the decrease in pulmonary capillary residence time. Making me feel abit breathless at times but I'm guess it's because less oxygen than normal is circulating in my blood. Acute respiratory distress syndrome (ARDS), Submit a review of our health information, Stories about living with a lung condition, Positions for obstructive lung conditions, Positions for restrictive lung conditions. Dyspnea is the most common reason for ordering a Dlco test, but there are many situations and presentations in which a higher than predicted or lower than predicted Dlco suggests the possible presence of lung or heart disease (Table 1). 0000009603 00000 n WebKco. At end-exhalation (FRC), again the alveoli and pulmonary capillaries are at atmospheric pressure but the capillaries are mechanically relaxed and able to hold a greater amount of blood. You are currently on the A test of the diffusing capacity of the lungs for carbon monoxide (DLCO, also known as transfer factor for carbon monoxide or TLCO), is one of the most clinically valuable tests of lung function. After elimination of estimated dead-space exhaled breath, a volume of exhaled breath is sampled to measure test gas concentrations (, Va is calculated by a change in the concentration of an inhaled inert gas (such as helium or methane) after that gas has had an opportunity to mix throughout the lungs. This demonstrates that Dlco could be lowered by 2 different mechanisms in the same patient. Increases in DLCO are less common and appear to be mostly due to an increase in blood volume and/or cardiac output. 31 41 The patient needs to hold his or her breath for 10 seconds, then exhale quickly and completely back to RV. If DLCO is not normal, and DLCO adjusted for lung volume (DACO) is above the LLN as % predicted, then add phrase due to low lung volume. These findings are welcome as they provide significant insight into the long-term lung function impairment associated with COVID-19. If so however, then for what are more or less mechanical reasons these factors could also contribute to a decrease in DLCO. To view profiles and participate in discussions please. Since a low Q regardless of V can explain both hypoxia and a low DLCO Im not sure there needs to be a separate mechanism. please choose your country or region. Hi, Richard. Because, in both disease entities, pulmonary congestion is present and then DLCO and KCO should be increased. 0000126565 00000 n Thank you so much for your help in this issue! Respir Med 2006; 100: 101-109. Could that be related to reduced lung function? When the heart squeezes, it's called a contraction. Little use without discussion with your consultant. Finally I always try to explain to the trainee physicians that VA is simply the volume of lung that that has been exposed to the test gas and may not reflect the true alveolar volume. monitor lung nodules). I feel that hypoxemia is caused by the presence of low V/Q area rather than high V/Q. A normal KCO can be taken as an indication that the interstitial disease is not as severe as it would considered to be if the KCO was reduced, but it is still abnormal. endobj s2r2(V|+j4F0,y"Aa>o#ovovw2%6+_."ifD6ck;arWlfhxHn[(Au~h;h#H\}vX H61Ri18305dFb|"E1L In drug-induced lung diseases. endobj Find out how we produce our information. Am Rev Respir Dis 1981; 123:185. It is also often written as It is important to remember that the VA is measured from an expiratory sample that is optimized for measuring DLCO, not VA. If your predicted KCO is derived from separate population studies I would wonder what effect re-calculating percent predicted DLCO and KCO using reference equations from a single study would have on your data and your expectations. endobj [Note: The value calculated from DLCO/VA is related to Kroghs constant, K, and for this reason DL/VA is also known as KCO. Lower than normal hemoglobin levels indicate anemia. They helped me a lot! 0000003645 00000 n 9 This typically amounts to less than 5% of all white blood cells. <> Ruth. 0000002120 00000 n The normal values for KCO are dependent on age and sex. If you have health concerns or need clinical advice, call our helplineon03000 030 555between 9am and 5pm on a weekday or email them. Realistically, the diagnosis of a reduced DLCO cannot proceed in isolation and a complete assessment requires spirometry and lung volume measurements as well. Thank you for your informative PFT Blog! When Dlco is below the predicted reference range (75% to 140% of predicted) it becomes a clue to the presence of a physiologic problem that ultimately may impair exercise, and even affect long-term survival from common lung diseases and disorders. Respir Med 1997; 91: 263-273. Dlco is the product of Va and Kco, the rate of diffusion across a membrane that is dependent upon the partial pressure of the gas on each side of the alveolar membrane. 0000002233 00000 n 2023 I'm hoping someone here could enlighten me. Unable to process the form. useGPnotebook. VA (alveolar volume). Standardization of the single-breath determination of carbon monoxide uptake in the lung. Sorry, your blog cannot share posts by email. Single breath methods are used to determine the rate constant of the alveolar uptake of carbon monoxide (CO) for 10 s at barometric pressure, that is, transfer coefficient of the lung for CO (Kco) and alveolar volume (V A) (Krogh, 1915; Hughes and Pride, 2012).Kco more sensitively reflects the uptake efficiency of alveolar-capillary When you remove the volume of the lung from the equation however (which is what happens when you divide DLCO by VA), all you can measure is how quickly carbon monoxide decreases during breath-holding (KCO). It also indicates that 79% to 60% of predicted is a mild reduction, 59% to 40% is a moderate reduction, and that Dlco values less than 40% of predicted are severely reduced.1. We're currently reviewing this information. 16 0 obj 0.88. [43 0 R] trailer Because anemia can lower Dlco, all calculations of Dlco are adjusted for hemoglobin concentration to standardize measurements and interpretation.1 In the PFT laboratory, a very small amount of CO (0.3% of the total test and room air gases) is inhaled by the patient during the test, and the level is not dangerousCO poisoning with tissue hypoxemia does not occur with the Dlco measurement. Remember, blood in the airways also can bind CO, hence Dlco can rise with hemoptysis and pulmonary hemorrhage. What effect does air pollution have on your health? (2019) Breathe (Sheffield, England). 29 0 obj 0000014758 00000 n Hughes JMB, Pride NB. A reduced KCO cannot indicate the site or scale of the diffusion defect. 0000016132 00000 n The corrected value is referred to as the DLCO/VA and a normal value is considered to be 80% or more of the predicted value. Low lung efficiency is when severe emphysema, a high KCOindicates a predominance of VC over VA due to, incomplete alveolar expansion but preserved gas exchange i.e. endobj A licensed medical inhalation to a lung volume below TLC), then DLCO may be underestimated. For example, if the patient has a disease that causes a decrease in lung surface area, or has had a lung removed, then there is a decrease in transfer factor but there is a normal KCO. The diagnostic value of KCO is pretty much limited to restrictive lung defects and can only be used to differentiate between intrinsic and extrinsic causes for a reduced DLCO. The calculated VA therefore depends on where the tracer gas is measured during exhalation. Using and Interpreting Carbon Monoxide Diffusing Capacity (Dlco) Correctly. We are busy looking for a solution. A fit young adult may have a KCO of approximately 1.75 mmol/min/kPa/litre, an elderly adult may be about 1.25. In this specific situation, if the lung itself is normal, then KCO should be elevated. The use of the term DL/VA is probably a major contributor to the confusion surrounding this subject and for this reason it really should be banned and KCO substituted instead.]. 8 0 obj Dlco is a calculated, derived value that indirectly assesses the ability of the lungs to transfer oxygen to blood through the use of a test gas (namely, CO) that has a greater affinity for blood hemoglobin. which is the rate at which CO disappears and nothing more) is lowest at TLC and highest near FRC. At the time the article was last revised Patrick J Rock had no recorded disclosures. Finally DLCO tests have to meet the ATS/ERS quality standards for the KCO to be of any use and what we consider to be normal or abnormal about DLCO, VA and KCO depends a lot on the reference equations we select. 0000126688 00000 n I also have a dull ache across chest area, as if I had done a big run(had for about two months). I work as a cardiologist in Hokkido Univ Hospital, JAPAN. You also state that at FRC (during expiration) ..an increase in pulmonary capillary blood volume.. Im getting a little confused. global version of this site. At least 1 Kco measurement <40% of predicted values; 2. In particular, consider also the ratio between alveolar volume and pulmonary capillary volume at TLC and FRC. Your replies always impress me so much as your knowledge seems to know no bounds to the extent that I am curious. Hansen JE. Inhaled CO is used because of its very high affinity for hemoglobin. 0000039691 00000 n But the fact is that for regular DLCO testing any missing fraction isnt measured so it really isnt possible to say what contribution it would have made to the overall DLCO. Haemoglobin is the protein in red blood cells that carries oxygen. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume, Respir Med 2000; 94: 28-37. The bottom line is that a reduced Dlco is not normal, requires explanation, and may indicate the presence of clinically significant lung disease or pulmonary vascular disease. As stone says the figures relate to the gas exchanging capacities of your lungs,the ct scan once interpreted by a radiological consultant will give all the info your consultant needs to give you an accurate diagnosis of your condition and hopefully the best treatment plan for the future. It is also often written as DLCO/VA (diffusing capacity per liter of lung volume) and is an index of the efficiency of alveolar transfer of carbon monoxide. %PDF-1.4 % VAT number 648 8121 18. WebPreoperative diffusion capacity per liter alveolar volume (Kco) in cardiac transplant recipients with an intrinsic normal lung is within the normal range. Dlco is a specific but insensitive predictor of abnormal gas exchange during exercise. It may also be used to assess your lungs before surgery, or to see how a persons lungs react when having chemotherapy. pbM%:"b]./j\iqg93o7?mHAd _42F*?6o>U8yl>omGxT%}Lj0 As one might postulate, a proportional decrease in Dlco would be expected if there were a reduction in lung volume and hence alveolar surface area, as seen in patients after pneumonectomy. It was very helpful! Not really, but it brings up an interesting point and that is that the VA/TLC ratio indicates how much of the lung actually received the DLCO test gas mixture (at least for the purposes of the DLCO calculation). Kaminsky DA, Whitman T, Callas PW. Respiratory tract symptoms and abnormalities on chest radiographs and/or chest computed tomography (CT) scans are essential to properly interpret any PFT, including Dlco. Furthermore, Kco is not a surrogate measurement for Dlco. These are completely harmless at the very low levels used. <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Type/Page>> Breathing techniques for moving or lifting, Non-tuberculous mycobacterial infection (NTM), Connective tissue and autoimmune diseases, Pulmonary haemorrhage (bleeding into the lung), Your living with a lung condition stories, Northern Ireland manifesto: Fighting for Northern Ireland's Right to Breathe, Northern Ireland manifesto: live better with it, Stoptober: the 28-day stop smoking challenge, Take action on toxic air in Greater Manchester, How air pollution makes society more unequal, Invisible threat: air pollution in your area.

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