Spirometric reference equations for Cameroonians aged 4 to 89\xa0years derived using lambda, mu, sigma (LMS) method

Eric Walter Pefura-Yone,Amadou Djenabou,Adamou Dodo Balkissou,Francine Amougou,Halidou Hadjara,Massongo Massongo,Virginie Poka-Mayap,Antoinette Ghislaine Tsala,Nguetsa Arsene Ofimboudem,Catherine Fanny Mayoh-Nguemfo

doi:10.1186/s12890-021-01705-1

Abstract

BackgroundSpirometric reference values are well known in several ethnic groups but the normative spirometric values of blacks living in Africa have been less studied. The purpose of this study is to establish normative spirometric equations from a representative population of Cameroonian children and adults and compare these equations with those developed by the Global Lung Initiative (GLI) and in Nigerians.MethodsSpirometric data from healthy Cameroonians aged 4–89 years randomly collected between 2014 and 2018 were used to derive reference equations using generalized additive model for location (mu), shape (lambda) and scale (sigma).ResultsA total of 625 children and adolescents (290 males and 335 females) and 1152 adults (552 males and 600 females) were included in the study. The prediction equation for spirometric index was written as: M = Exp[a0 + a1*ln (Height) + a2*ln (Age) + Mspline, Mspline was age related spline contribution]. Applying the GLI standards for African Americans resulted in overall values greater than those found in our study for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC). These values were very close in children and adolescents while the values obtained with the GLI equations for African Americans were significantly higher in adults. FEV1/FVC ratio in our study was similar for adult males but lower in adult females (88% vs 85%, difference = + 3.5%) when applying Nigerian standards.ConclusionsFEV1 and FVC of the Cameroonian infant and adolescent population are very close to those of black Americans. However, FEV1 and FVC of Cameroonian adults are significantly lower than those of black American adults. These equations should allow a more suitable interpretation of spirometry in the Cameroonian population.

Highlights

Lung function tests (LFTs) are of great value in the diagnosis, therapeutic management and prognosis of a broad range of respiratory diseases [1]
Spirometric reference values are well known in several ethnic groups but the normative spirometric values of blacks living in Africa have been less studied [8]
Exp[− 8.30 + 1.81*ln(Height) + 0.09*ln(Age) + Mspline] Exp[− 1.77 + 0.19*ln(Age) + Sspline] − 0.54 + 0.32*ln(Age) + Lspline applying the equations derived from our study for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC). These values are very close in children and adolescents, while the values obtained with the Global Lung Initiative (GLI) equations for African Americans [8] were significantly higher in adults, with an average difference reaching + 9.2% for FVC in adult women

Summary

Introduction

Lung function tests (LFTs) are of great value in the diagnosis, therapeutic management and prognosis of a broad range of respiratory diseases [1]. Values obtained during lung function tests are usually related to predicted or theoretical values These predicted values are derived from the reference equations established from the values of the normal or “healthy” population. LFTs laboratories in sub-Saharan Africa commonly use normative values derived from the African American population without prior validation of these norms in the resident population of Africa. The application of these non-validated standards can be a source of misinterpretation of the spirometric values with a negative impact on patients’ care [3]. The purpose of this study is to establish normative spirometric equations from a representative population of Cameroonian children and adults and compare these equations with those developed by the Global Lung Initiative (GLI) and in Nigerians

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Discussion

Conclusion