Dataset Information

Spirometric Interpretation and Clinical Relevance According to Different Reference Equations.

ABSTRACT:

Background

Global Lung Function Initiative (GLI)-2012 reference equation is currently suggested for interpretation of spirometry results and a new local reference equation has been developed in South Korea. However, lung function profiles according to the different reference equations and their clinical relevance have not been identified in chronic obstructive pulmonary disease (COPD) patients.

Methods

Our cross-sectional study evaluated Choi's, Korean National Health and National Examination Survey (KNHANES)-VI, and GLI-2012 reference equations. We estimated the percentages of predictive forced expiratory volume in one second (FEV₁) and airflow limitation severity according to reference equations and analyzed their associations with patient reported outcomes (PROs): COPD assessment test (CAT) score, St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) score, and six minute walk distance (6MWD).

Results

In the eligible 2,180 COPD patients, lower predicted values of FEV₁ and forced vital capacity (FVC) were found in GLI-2012 compared to Choi's and KNHANES-VI equations. GLI-2012 equation resulted in a lower proportion of patients being classified as FEV₁ < 80% or FVC < 80% compared to the other equations. However, the Z-scores of FEV₁ and FVC were similar between the KNHANES-VI and GLI-2012 equations. Three reference equations exhibited significant associations between FEV₁ (%) and patient-reported outcomes (CAT score, SGRQ-C score, and 6MWD).

Conclusion

GLI-2012 reference equation may not accurately reflect FEV₁ (%) in the Korean population, but the Z-score using GLI-2012 equation can be a viable option for assessing FEV₁ and airflow limitation in COPD patients. Similar to the other two equations, the GLI-2012 equation demonstrated significant associations with PROs.

SUBMITTER: Lee HW

PROVIDER: S-EPMC10825457 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

Spirometric Interpretation and Clinical Relevance According to Different Reference Equations.

Lee Hyun Woo HW Lee Jung-Kyu JK Hwang Yong-Il YI Seo Hyewon H Ahn June Hong JH Kim Sung-Ryeol SR Kim Hyun Jung HJ Jung Ki-Suck KS Yoo Kwang Ha KH Kim Deog Kyeom DK

Journal of Korean medical science 20240129 4

<h4>Background</h4>Global Lung Function Initiative (GLI)-2012 reference equation is currently suggested for interpretation of spirometry results and a new local reference equation has been developed in South Korea. However, lung function profiles according to the different reference equations and their clinical relevance have not been identified in chronic obstructive pulmonary disease (COPD) patients.<h4>Methods</h4>Our cross-sectional study evaluated Choi's, Korean National Health and National ...[more]

PMID: 38288534

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Project description:ImportanceRace and ethnicity are routinely used to inform pulmonary function test (PFT) interpretation. However, there is no biological justification for such use, and it may reinforce health disparities.ObjectiveTo compare the PFT interpretations produced with race-neutral and race-specific equations.Design, setting, and participantsIn this cross-sectional study, race-neutral reference equations recently developed by the Global Lung Function Initiative (GLI) were used to interpret PFTs performed at an academic medical center between January 2010 and December 2020. The interpretations produced with these race-neutral reference equations were compared with those produced using the race and ethnicity-specific reference equations produced by GLI in 2012. The analysis was conducted from April to October 2022.Main outcomes and measuresThe primary outcomes were differences in the percentage of obstructive, restrictive, mixed, and nonspecific lung function impairments identified using the 2 sets of reference equations. Secondary outcomes were differences in severity of these impairments.ResultsPFTs were interpreted from 2722 Black (686 men [25.4%]; mean [SD] age, 51.8 [13.9] years) and 5709 White (2654 men [46.5%]; mean [SD] age, 56.4 [14.3] years) individuals. Among Black individuals, replacing the race-specific reference equations with the race-neutral reference equations was associated with an increase in the prevalence of restriction from 26.8% (95% CI, 25.2%-28.5%) to 37.5% (95% CI, 35.7%-39.3%) and of a nonspecific pattern of impairment from 3.2% (95% CI, 2.5%- 3.8%) to 6.5% (95% CI, 5.6%-7.4%) and no significant change in the prevalence of obstruction (19.9% [95% CI, 18.4%-21.4%] vs 19.5% [95% CI, 18.0%-21.0%]). Among White individuals, replacing the race-specific reference equations with the race-neutral reference equations was associated with a decrease in the prevalence of restriction from 22.6% (95% CI, 21.5%-23.6%) to 18.0% (95% CI, 17.0%-19.0%), a decrease in the prevalence of a nonspecific pattern of impairment from 8.7% (95% CI, 7.9%-9.4%) to 4.0% (95% CI, 3.5%-4.5%), and no significant change in the percentage with obstruction from 23.9% (95% CI, 22.8%-25.1%) to 25.1% (95% CI, 23.9%- 26.2%). The race-neutral reference equations were associated with an increase in severity in 22.8% (95% CI, 21.2%-24.4%) of Black individuals and a decrease in severity in 19.3% (95% CI, 18.2%-20.3%) of White individuals vs the race-specific reference equations.Conclusions and relevanceIn this cross-sectional study, the use of race-neutral reference equations to interpret PFTs resulted in a significant increase in the number of Black individuals with respiratory impairments along with a significant increase in the severity of the identified impairments. More work is needed to quantify the effect these reference equations would have on diagnosis, referral, and treatment patterns.

Project description:Background:Use of different spirometry reference equations can lead to misinterpretation of spirometry results. Currently, no study has been carried out to determine if there is any discordance between the interpretation of spirometry data using the Global Lungs Initiative (GLI) 2012, the Third National Health and Nutrition Examination Survey (NHANES III), the Knudson, and the Siriraj reference equations in Thai people. Therefore, this study aimed to determine differences and agreements regarding spirometry results using the GLI2012, NHANES III, Knudson, and Siriraj reference equations in a Thai population. Methods:A retrospective study was carried out using 2,492 spirometry results from Thai people (age ranged 8-80 years old) who were referred by their physicians for spirometry testing at the Lung Health Center, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January 2005 and December 2015. The spirometry results were interpreted using four reference equations. Respiratory function patterns were classified as normal, spirometric restriction, obstruction, or mixed defect. The severity of abnormal patterns were classified as mild, moderate, moderately severe, severe or very severe. A Nominal Analysis of Variance (NANOVA) test was used to analyze differences in diagnosis and classification for the degree of severity. The Kappa statistic was used to determine agreements of spirometry results between four reference equations. Results:The differentiation in both spirometry diagnosis and the severity classification were significant across the four reference equations (P<0.001). However, the levels of agreement among the four reference equations were moderate to good (Kappa values ranged from 0.56 to 0.77 for the diagnosis and 0.67 to 0.82 for the severity). Conclusions:The results of this study suggest that the use of the GLI2012, NHANES III, Knudson, and Siriraj reference equations alters the interpretation of spirometry data in this population of Thai adults.

Project description:BackgroundThe 2012 Global Lung Function Initiative (GLI2012) provide multi-ethnic spirometric reference equations (SRE) for the 3-95 year-old age range, but Sub-Saharan African populations are not represented. This study aimed to evaluate the fit of the African-American GLI2012 SRE to a population of healthy urban and peri-urban Zimbabwean school-going children (7-13 years).MethodsSpirometry and anthropometry were performed on black-Zimbabwean children recruited from three primary schools in urban and peri-urban Harare, with informed consent and assent. Individuals with a history or current symptoms of respiratory disease or with a body mass index-z score (BMI) < - 2 were excluded. Spirometry z-scores were generated from African-American GLI2012 SRE, which adjust for age, sex, ethnicity and height, after considering all GLI2012 modules. Anthropometry z-scores were generated using the British (1990) reference equations which adjust for age and sex. The African-American GLI2012 z-score distribution for the four spirometry measurements (FVC, FEV1, FEV1/FVC and MMEF) were evaluated across age, height, BMI and school (as a proxy for socioeconomic status) to assess for bias. Comparisons between the African-American GLI2012 SRE and Polgar equations (currently adopted in Zimbabwe) on the percent-predicted derived values were also performed.ResultsThe validation dataset contained acceptable spirometry data from 712 children (344 girls, mean age: 10.5 years (SD 1.81)). The spirometry z-scores were reasonably normally distributed, with all means lower than zero but within the range of ±0.5, indicating a good fit to the African-American GLI2012 SRE. The African-American GLI2012 SRE produced z-scores closest to a normal distribution. Z-scores of girls deviated more than boys. Weak correlations (Pearson's correlation coefficient < 0.2) were observed between spirometry and anthropometry z-scores, and scatterplots demonstrated no systematic bias associated with age, height, BMI or socioeconomic status. The African-American GLI2012 SRE provided a better fit for Zimbabwean paediatric spirometry data than Polgar equations.ConclusionThe use of African-American GLI2012 SRE in this population could help in the interpretation of pulmonary function tests.

Dataset Information

Spirometric Interpretation and Clinical Relevance According to Different Reference Equations.

Background

Methods

Results

Conclusion

Publications

Spirometric Interpretation and Clinical Relevance According to Different Reference Equations.

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