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Diagnosis and assessment of DPLD
  1. J E COTES
  1. Respiration & Exercise Laboratory
  2. Department of Physiological Sciences
  3. Medical School
  4. Newcastle upon Tyne NE2 4HH
  5. UK
  6. email: JEC{at}

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In this excellent report1 the transfer factor (Tl) in untreated cryptogenic fibrosing alveolitis is reported as reflecting the extent of fibrosis; it is noted that Kco (Tl/Va) does not. Given more space, the authors might have added that Kco can mislead by being normal or increased when alveolar volume is restricted. This is because Kco is based on a proportional model that does not make valid allowance for alveolar volume. An alternative linear model is available and should be used instead.2