Abstract
ATS/ERS recommend the use of national reference values for the interpretation of spirometry. Reference values were published (2014) in general adult Chilean population, which are different from those of Knudson currently in use. However, most pulmonary function laboratories continue to use these latter equations. Multi-ethnic Global Lung Function Initiative (GLI) equations were published (2012) in order to standardize the interpretation of pulmonary function tests worldwide. Our objective was to evaluate the agreement in the spirometric reports between the most used equations in Chile with those from GLI. Methods: We compared the agreement in the interpretation of the spirometric pattern (normal, obstructive and restrictive) and the degree of alteration between GLI with Gutierrez 2014, with Knudson and with NHANES III according to recommendations of the Chilean Society of Respiratory Diseases, through the Kappa concordance coefficient (K). The sample correspond to 315 adults over 40 years of age (55% women, 59.3 ± 9.2 years-old), smokers or ex-smokers, healthy or with COPD, who underwent spirometry with a bronchodilator as part of a respiratory check-up. Differences were plotted using the Bland-Altman method. Results: agreement for pattern between GLI with Gutierrez 2014, with Knudson and with NHANES III was good (K = 0.73, 0.71 and 0.77 respectively) and also was good for the pattern and degree of alteration (K = 0.68, 0.67 and 0.76 respectively). Conclusions: We found a good agreement between the equations most used in Chile and those from the GLI, for a sample that includes subjects with and without lung disease, smokers and ex-smokers.
Highlights
ATS/ERS recommend the use of national reference values for the interpretation of spirometry
Se estudiaron 315 sujetos mayores de 40 años (55% mujeres, edad: 59,3 ± 9,2 años), fumadores o ex fumadores, sanos o con EPOC, sometidos a una espirometría con broncodilatador como parte de un reconocimiento respiratorio
Se utiliza tanto por especialistas en enfermedades respiratorias, enfermedades ocupacionales y por médicos de otras especialidades, para el diagnóstico y seguimiento de varias patologías, estudio preventivo y en investigación
Summary
Ecuaciones de referencia para informe de espirometrías. ¿Será tiempo de adoptar las ecuaciones de la Global Initiative for Lung Function?. Se comparó la concordancia en interpretación del patrón espirométrico (normal, obstructivo y restrictivo) y el grado de alteración (leve, moderada o avanzada) utilizando la espirometría basal, de acuerdo a las recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias, a través del coeficiente de concordancia Kappa (K), según los valores obtenidos de ecuaciones de referencia de valores normales de GLI 20125, con Knudson 19834, con Gutiérrez 20147 y con NHANES III 19998, en una base de datos de resultados espirométricos de una población de fumadores o ex fumadores con o sin EPOC que se sometieron a un reconocimiento médico del sistema respiratorio, que incluía una espirometría con broncodilatador (equipo Jaeger Master Screen, Alemania) realizada por tecnólogas del laboratorio de función pulmonar de Clínica Las Condes, de acuerdo a estándares de la American Thoracic Society. La concordancia medida por Kappa, fue buena para patrón entre GLI con Gutiérrez (K= 0,73; IC95% 0,64 – 0,83), con Knudson (K= 0,71; IC95% 0,60 – 0,81) y con NHANES III
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