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A total of 50 participants (35 with COPD and 15 healthy controls) underwent measurements of\n D<\/jats:italic>\n L,CO,NO<\/jats:sub>\n in the upright and supine postures. A subset (COPD:\n n<\/jats:italic>\n =\u00a012, controls:\n n<\/jats:italic>\n =\u00a012) also completed a 12\u2010week supervised high\u2010intensity interval training (HIIT) intervention. The reported\n D<\/jats:italic>\n L,CO,NO<\/jats:sub>\n metrics were diffusing capacity for nitric oxide and carbon monoxide (\n D<\/jats:italic>\n L,NO<\/jats:sub>\n and\n D<\/jats:italic>\n L,CO,5s<\/jats:sub>\n , respectively), alveolar\u2013capillary membrane diffusing capacity (\n D<\/jats:italic>\n M,CO<\/jats:sub>\n ), pulmonary capillary blood volume (\n V<\/jats:italic>\n C<\/jats:sub>\n ), and alveolar volume (\n V<\/jats:italic>\n A<\/jats:sub>\n ). The upright\u2010to\u2010supine change in neither\n D<\/jats:italic>\n L,NO<\/jats:sub>\n (\n P\u00a0<\/jats:italic>\n =\u00a00.271), nor\n D<\/jats:italic>\n M,CO<\/jats:sub>\n (\n P\u00a0<\/jats:italic>\n =\u00a00.068) nor\n V<\/jats:italic>\n A<\/jats:sub>\n (\n P\u00a0<\/jats:italic>\n =\u00a00.934) differed between groups. In contrast, the upright\u2010to\u2010supine change in\n D<\/jats:italic>\n L,CO5s<\/jats:sub>\n was reduced in moderate and severe COPD compared with controls (control vs. moderate: median [IQR] 0.6 [0.3, 0.9] mmol\/min\/kPa,\n P\u00a0<\/jats:italic>\n <\u00a00.001; control vs. severe: 0.9, [0.2, 1.5] mmol\/min\/kPa,\n P\u00a0<\/jats:italic>\n =\u00a00.006), whereas it did not differ between controls and mild COPD (0.3 [\u22120.1, 0.7] mmol\/min\/kPa,\n P\u00a0<\/jats:italic>\n =\u00a00.13). Similarly, the upright\u2010to\u2010supine\n V<\/jats:italic>\n C<\/jats:sub>\n change was reduced in moderate and severe COPD compared with healthy controls (control vs. moderate: 8.3 [3.9, 12.8] mL,\n P\u00a0<\/jats:italic>\n <\u00a00.001; control vs. severe: 10.7 [1.2, 20.2] mL,\n P\u00a0<\/jats:italic>\n =\u00a00.021), but not in mild COPD (5.3 [\u22120.2, 10.8] mL,\n P\u00a0<\/jats:italic>\n =\u00a00.063). The HIIT intervention had no effect on these metrics. The blunted\n V<\/jats:italic>\n C<\/jats:sub>\n response to an upright\u2010to\u2010supine postural change in moderate\u2010to\u2010severe COPD is consistent with reduced alveolar\u2013capillary reserve and may be useful when measurements during exercise are not possible.\n <\/jats:p>","DOI":"10.1113\/ep093384","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:49:08Z","timestamp":1779756548000},"page":"2759-2776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Alveolar\u2013capillary reserve in COPD assessed by the pulmonary diffusing capacity response to an upright\u2010to\u2010supine postural change"],"prefix":"10.1113","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6349-0308","authenticated-orcid":false,"given":"Iben Elmerdahl","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Centre for Physical Activity Research Copenhagen University 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