There is limited knowledge on diffusing capacity in scoliosis patients. It remains to be determined if impaired pulmonary diffusing capacity is mostly influenced by reduced alveolar–capillary membrane diffusing capacity (D_{M, CO}), reduced pulmonary capillary blood volume (V_C) or both. This study aims to report findings from dual test gas pulmonary diffusing capacity for carbon monoxide and nitric oxide (D_{L, CO, NO}) with quantification of pulmonary diffusing capacity for carbon monoxide corrected for haemoglobin with a five s breath‐hold (D_{L, COc, 5s}) and nitric oxide with a five s breath‐hold (D_{L, NO, 5s}), D_{M, CO} and V_C. The study included 57 patients with idiopathic scoliosis seen at our department from 1972 to 1983, all of whom underwent radiological assessment and measurement of D_{L, CO, NO} during examination 40 years after diagnosis. One‐way ANOVA was performed for between‐group differences and Pearson's correlation coefficient was used to assess correlations between D_{L, CO, NO} metrics and Cobb angle. No significant between‐group differences based on disease severity were detected. Thirty‐nine percent of the patients were presented with either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} represented as Z‐scores below −1.65. No significant correlations between Cobb angle and Z‐scores for D_{L, COc, 5s}, D_{L, NO, 5s}, D_{M, CO} and V_C according to height measurements were found. When using arm span instead, a weak negative correlation between D_{L, COc, 5s} and Cobb angle (r = −0.29; P = 0.04) was detected. In conclusion, approximately 39% of patients with idiopathic scoliosis had either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} 40 years after diagnosis with varying contributions from V_C or D_{M, CO}.

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