Spirometry reference equations for central European populations from school age to old age.
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ABSTRACT: Background
Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations.Objective
To develop spirometry reference equations for central European populations between 8 and 90 years of age.Materials
We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS).Results
The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years.Conclusion
We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings.
SUBMITTER: Rochat MK
PROVIDER: S-EPMC3540072 | biostudies-literature | 2013
REPOSITORIES: biostudies-literature
Publications
Spirometry reference equations for central European populations from school age to old age.
Rochat Mascha K MK Laubender Ruediger P RP Kuster Daniela D Braendli Otto O Moeller Alexander A Mansmann Ulrich U von Mutius Erika E Wildhaber Johannes J
PloS one 20130108 1
<h4>Background</h4>Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations.<h4>Objective</h4>To develop spirometry reference equations for central European populations between 8 and 90 years of age.<h4>Materials</h4>We u ...[more]
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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.
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Project description:The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5-95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3-95 yrs for Caucasians (n=57,395), African-Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV(1)) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV(1)/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3-95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.
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Project description:BackgroundReference equations from the Global Lung Function Initiative (GLI) are now available for both spirometry and diffusion. However, respiratory phenotypes defined by GLI-based measures of diffusion have not yet been evaluated in GLI-based normal-for-age spirometry or spirometric impairments.MethodsWe evaluated cross-sectional data from 2100 Caucasians, aged 40-85 years. GLI-based spirometric categories included normal-for-age and the impairments of restrictive-pattern and three-level severity of airflow-obstruction (mild, moderate, severe). GLI-based diffusion included diffusing capacity of the lung for carbon monoxide (DLCO) and measured components of alveolar volume (VA) and transfer coefficient (KCO): DLCO = [VA]x[KCO]. Using multivariable regression models, adjusted odds ratios (adjORs) for DLCO, VA, and KCO < lower limit of normal (LLN) were calculated for spirometric impairments, relative to normal-for-age spirometry.ResultsRelative to normal-for-age spirometry, the restrictive-pattern increased the adjORs (95% confidence intervals) for DLCO and VA < LLN-4.61 (3.62, 5.85) and 15.53 (11.8, 20.4), respectively, but not for KCO < LLN-1.02 (0.79, 1.33). Also relative to normal-for-age spirometry, airflow-obstruction from mild to severe increased the adjORs for DLCO < LLN-from 1.22 (0.80, 1.86) to 6.63 (4.91, 8.95), for VA < LLN-from 1.37 (0.85, 2.18) to 7.01 (5.20, 9.43), and for KCO < LLN-from 2.04 (1.33, 3.14) to 3.03 (2.29, 3.99). Notably, in normal-for-age spirometry, 34.5%, 19.7%, and 25.3% of participants had DLCO, VA, or KCO < LLN, respectively.ConclusionAbnormal diffusion is most prevalent in spirometric impairments but also occurs in normal-for-age spirometry. These results further inform the respiratory phenotypes of GLI-based spirometric categories and, in turn, the spirometric evaluation of respiratory disease.
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Project description:Background and objective:This study aimed to establish reference equations for spirometry in healthy Taiwanese children and assess the applicability of the Global Lung Function Initiative (GLI)-2012 equations to Taiwanese children. Methods:Spirometric data collected from 757 healthy Taiwanese children aged 5 to 18 years in a population-based cohort study. Prediction equations derived using linear regression and the generalized additive models for location, scale and shape (GAMLSS) method, respectively. Results:The GLI-2012 South East Asian equations did not provide a close fit with mean ± standard error z-scores of -0.679 ± 0.030 (FVC), -0.186 ± 0.044 (FEV1), -0.875 ± 0.049 (FEV1/FVC ratio) and -2.189 ± 0.063 (FEF25-75) for girls; and 0.238 ± 0.059, -0.061 ± 0.053, -0.513 ± 0.059 and -1.896 ± 0.077 for boys. The proposed GAMLSS models took age, height, and weight into account. GAMLSS models for boys and girls captured the characteristics of spirometric data in the study population closely in contrast to the linear regression models and the GLI-2012 equations. Conclusion:This study provides up-to-date reference values for spirometry using GAMLSS modeling in healthy Taiwanese children aged 5 to 18 years. Our study provides evidence that the GLI-2012 reference equations are not properly matched to spirometric data in a contemporary Taiwanese child population, indicating the urgent need for an update of GLI reference values by inclusion of more data of non-Caucasian decent.
| S-EPMC6835053 | biostudies-literature
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.
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