Aplicación clínica de los valores de referencia de espirometría realizados en niños chilenos

Cecilia Alvarez G,Pablo Brockmann V,Eugenia Campos M,Ignacio Sánchez D,Solange Caussade L,Pablo Bertrand N

doi:10.4067/s0034-98872004001000007

Cecilia Alvarez G, Pablo Brockmann V + Show 4 more

Open Access

https://doi.org/10.4067/s0034-98872004001000007

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Abstract

The interpretation of lung function tests must be based on reference normal values obtained in the same population. In Chile an expert panel recommended the use of values obtained by, Gutierrez el al locally, that are higher than those obtained by Knudson, for forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). To analyze the clinical application of both reference values in a selected population. Retrospective review of 499 spirometries done in our laboratory to 285 males and 214 females, aged 4.5 to 18 years. The reports using either Gutierrez (G) or Knudson (K) reference values were compared. The 5th percentile was considered the inferior limit for normality. The height range of patients was 110-178 cm (median 130, 3rd quartile 143). Referral diagnoses were probable asthma in 349 (70%), asthma in 119 (24%), to rule out restrictive disease in 12 (2%) and others 19 (4%). FEV1/FVC ratio was > or =84% in 290 patients. Using K values, lung function was interpreteed as within normal limtits in 321 patients (64.3%), as mild obstructive disease (MOD) in 171 (34.3%), as combined limitation (CL) in 2, mild restrictive disease (MRD), moderate restrictive disease (MR) and severe restrictive disease (SRD) in 1 patient each. Using G values, lung function was interpreted as within normal limits in 133 patients (26.7%), MOD in 343 (68.7%), MRD in 6, CL. in 4 and MR in 2. In 193 spirometries (39%) there was lack of concordance between the interpretations using K or G values. There is a wide rante of variability when G or K values are used to interpret lung function in children in Chile. Redefinition of local standards would be necessary.

Highlights

The interpretation of lung function tests must be based on reference normal values obtained in the same population
Los diagnósticos de referencia para la realización de las espirometrías fueron: sospecha diagnóstica de asma: 349 (70%), asma en tratamiento 119 (24%), sospecha de limitación restrictiva 12 (2,4%) y otros 19 (3,8%)
Creemos que los valores de referencia para el índice VEF1/CVF deben ser reevaluados y reconsiderados para la interpretación de los informes espirométricos, considerando principalmente que este parámetro es el que define, por excelencia, la clasificación de una limitación obstructiva, y que este trabajo demostró que el utilizar los valores de pc[5] recomendados por Gutiérrez y cols, para VEF1/CVF generó las mayores discrepancias en los informes espirométricos y la posibilidad de un sobrediagnóstico de limitación obstructiva en un grupo de pacientes con curva flujo/volumen normal y sin respuesta a broncodilatador

Summary

Introduction

The interpretation of lung function tests must be based on reference normal values obtained in the same population. Posteriormente, del grupo de informes no concordantes se analizaron 174 informes catalogados como normales por Knudson y cols, que eran considerados limitación obstructiva leve (LOL) al analizarlos por Gutiérrez y cols, se consideró la forma de la curva flujo/volumen (F/V), diagnóstico de referencia y cambio significativo postbroncodilatador (VEF1 ≥12% y FEF 25-75% ≥30%)[2].

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