Spirometry Reference Values Research Articles

Déterminants de la fonction pulmonaire chez l’enfant sain en Tunisie

Introduction Pulmonary function parameters are known to vary with age, sex, height and ethnic extraction. No normal values have been reported for pulmonary function in Tunisian children. Moreover, little attention has been paid to the factors affecting the development of lung function in Tunisian healthy children. State of art Birth weight and height, physical activity level, anthropometric, socioeconomic and environmental factors could influence the development of lung function in healthy children. Perspectives The studies conducted by our group have allowed us 1) to set reference values for spirometry in healthy Tunisian children; 2) to indicate that, in Tunisian adolescents, the use of only one morphological parameter such as height, is not sufficient, but the pubertal status could be taken into account to standardize the lung function and 3) to show the main predictive factors for pulmonary development to be the anthropometric factors such as height, weight, maximal inspiratory and expiratory thoracic perimeter, sex and age, and the environmental conditions (type of heating) in our population of healthy Tunisian children. Conclusion These findings should improve medical surveillance of respiratory diseases, stipulation of preventive and therapeutic measures in Tunisian children.

Espirometría forzada en preescolares sanos bajo las recomendaciones de la ATS/ERS: estudio CANDELA

Introduction Reference values for spirometry in healthy preschool children have not yet been obtained in accordance with American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. The objective was to establish reference values for spirometry in healthy preschoolers under the ATS/ERS 2007 statement. Material and method Children of at least 2 and under 7 years of age were tested in 9 pediatric pulmonary function laboratories. The technicians were trained to apply a standardized protocol to perform spirometry. Results Valid spirometry results were obtained in 455 (81.54%) out of 558 children: 242 boys (53.2%) and 213 girls (46.8%). Ages were as follows: 31 at least 2 and under 3 years old; 96, at least 3 and under 4; 108, at least 4 and under 5; 122, at least 5 and under 6 years, and 98, at least 6 and under 7 years. Formulas were used to calculate the reference values for all the spirometry variables in preschoolers. Conclusions Spirometry is feasible in the majority of preschool children under the new guidelines. The availability of the reference values presented is an important step, both for the care of preschoolers and for further research on pulmonary function.

Reference values for spirometry of the European Coal and Steel Community: time for change

To the Editors: Recently, an American Thoracic Society (ATS)/European Respiratory Society (ERS) Task Force suggested the need for a new Europe-wide study to derive updated reference equations for lung function 1. Until the results of such a study become available (we have been waiting for new reference values in Europe for ∼25 yrs), the official reference values in Europe are still those implemented by the European Coal and Steel Community (ECSC) 2 and the ERS 3. The ATS/ERS Task Force has not commented on newer reference values for spirometry derived from the Swiss Study on Air Pollution and Lung Disease in Adults (SAPALDIA) 4, 5. It has previously been pointed out that the main differences between …

Chronic obstructive pulmonary disease in Hispanics.

Hispanics are individuals whose ancestry can be traced to Spain and/or areas previously under Spanish control (e.g., Mexico, Puerto Rico). They are a rapidly growing subset of the population of the United States and are quite diverse in their racial ancestry, country of origin, area of residence, socioeconomic status, tobacco use, and access to health care. Current evidence suggests that the prevalence and morbidity of chronic obstructive pulmonary disease (COPD) vary widely among Hispanic-American nations, with similar but limited findings among Hispanic subgroups in the United States. Potential reasons for such variation include differences in racial ancestry and genetic susceptibility, exposure to tobacco smoke and/or biomass smoke, access to health care, and disease management. Future studies of COPD in Hispanics should include large samples of subgroups that are well defined with regard to self-reported ethnicity, country of origin, area of residence, tobacco use, and socioeconomic status. Areas that need to be carefully examined include validation of COPD diagnoses for epidemiologic studies (e.g., by radiologic assessment), COPD in high-risk groups (e.g., Puerto Ricans), impact of biomass smoke (in rural areas) and air pollution (in urban areas) on COPD morbidity, effects of migration and acculturation on COPD prevalence and morbidity among Hispanic subgroups in the United States, development of reference values for spirometry, smoking cessation, and overcoming barriers to management. Public health measures, such as effective smoking prevention and cessation programs, reduction of air pollution and exposure to biomass smoke, and improved access to health care, would help reduce the burden of COPD among Hispanics in the United States and Latin America.

Post-Bronchodilator Spirometry Reference Values in Adults and Implications for Disease Management

International guidelines promote the use of post-bronchodilator spirometry values in the definition and severity classification of chronic obstructive pulmonary disease. However, post-bronchodilator reference values have not yet been developed. To derive reference values for post-bronchodilator forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, and to compare these reference values with locally derived and existing pre-bronchodilator reference values. Based on a random sample of a general adult population, 2,235 subjects (70% of invited subjects) performed spirometry with reversibility testing. A reference population of healthy never-smokers constituted 23% of the study population (n=515). Reference values for median and lower-limit-of-normal pre- and post-bronchodilator lung function and bronchodilator response were modeled using quantile regression analyses. The reference population had equal proportions of men and women in the age range 26-82 yr. Both FEV1 and FVC decreased with age and increased with height. FEV1/FVC decreased with age, although this trend was not statistically significant for men after bronchodilatation. Linear models gave the best overall fit. Lower-limit-of-normal post-bronchodilator FEV1/FVC exceeded 0.7 for both sexes. Post-bronchodilator prediction equations gave higher predicted FEV1 and FEV1/FVC than both locally derived and existing pre-bronchodilator equations. The bronchodilator response decreased with age. The present study is the first to develop reference values for post-bronchodilator lung function. Post-bronchodilator prediction equations can facilitate better management of patients with chronic obstructive pulmonary disease by avoiding falsely high FEV1% predicted with a subsequent underestimation of disease severity.

Spirometry values in adults in northern Finland

Objectives. If reference values do not accurately reflect the distribution of lung function in the population, the interpretation of spirometry results may be incorrect. Differences in lung function exist between populations, which supports the use of local reference values. In Finland, the national reference values for spirometry are currently in use. The aim of this study was to assess the correlation between measured spirometric values from healthy adults and the reference values used in Finland.Methods. In the present population-based study, spirometry results were assessed in healthy adults aged 21 to 70 years in northern Finland. After exclusions for any chronic pulmonary disease or symptom, 206 men and 215 women remained in the group. We calculated regression equations for spirometric reference values in adults and compared these with European recommendations, and with the reference values currently used in Finland.Results. These comparisons revealed large differences. The linear models do not take into account the physiological changes in both young and old adults and, thus, the reference values calculated according to the European recommendations differed from the real measured results at both ends of the 20- to 70-year age scale. Moreover, values from the logarithmic Finnish reference equations also diverged from our measurements; the differences were largest in subjects younger than 30, and in elderly men.Conclusion. Differences between populations and reference equations make international comparisons difficult, and divergence between reference values and real results may lead to incorrect clinical interpretation. (Int J Circumpolar Health 2004; 63(2):129–139)

Spirometry Reference Values for Women and Men Aged 65–85 Living in Southern Europe: The Effect of Health Outcomes

Background: Spirometry is more and more frequently used for the diagnosis of respiratory diseases in the elderly people. Unfortunately, reliable predictive values for the spirometric variables in the elderly are lacking. Objectives: Data obtained from 429 subjects participating in the multicenter Italian study SARA on respiratory health in the elderly were analyzed in order to derive reference values for spirometry in the age range of 65–85 years. The second aim of this study was to assess the influence of variables describing many dimensions of the health status on the prediction of spirometric variables in that age range. Methods: Subjects were recruited as consecutive outpatients referred during the study period to 24 geriatric or respiratory institutions distributed throughout Italy. Spirometries were performed using the same equipment by specifically trained and certified personnel supervised by a real-time quality control program. In addition to the standard anthropometric variables, covariates describing the affective, mental, and general health conditions were investigated through standardized questionnaires, to improve the modeling of spirometric outcomes. Results: Reliable predictive values for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁) were produced (coefficient of determination, for FVC: R² = 0.64; for FEV₁: R² = 0.54). The effect of general health conditions on spirometric outcomes accounted for the most part of the between-gender difference in the ageing-dependent decrease in lung function. Conclusions: We suggest that a multidimensional approach to health problems should be used for a better interpretation of spirometric results in the elderly.

Forced spirometry reference values for Norwegian adults: the Bronchial Obstruction in Nord-Trøndelag Study.

The purpose of this study was to develop new prediction equations for flow/volume spirometry parameters in asymptomatic, never-smoking adults in Norway, and to assess any differences of these parameters when applying the new and most commonly used equation sets. Flow/volume spirometry was measured according to the American Thoracic Society criteria in 2,792 subjects aged > or = 20 yrs, randomly selected from participants in the Nord-Trøndelag Health Study. Ever-smokers and subjects with respiratory symptoms and/or diseases reported in this questionnaire were excluded. A total of 546 females and 362 males met the inclusion criteria and were included in the analyses. Most lung function variables were nonlinear by age and had to be transformed. After a plateau in younger adults, the variables declined by age. The reference values for forced expiratory volume in one second and forced vital capacity from the present study, were higher than those given by prediction equations from the European Community for Coal and Steel, but in closer agreement with later studies from Europe, Australia and the USA. Healthcare providers should be encouraged to reconsider their choice of prediction equations of spirometry in order to improve management of obstructive lung diseases.

Spirometry Reference Values for American Indian Adults: Results From the Strong Heart Study

To derive spirometry normative values from a large population of American Indian adults and compare them to reference values for white adults. Pulmonary function was assessed using spirometry in participants of the Strong Heart Study, a multicenter, community-based, prospective study of cardiovascular risk factors and disease in American Indians, utilizing American Thoracic Society guidelines and a vigorous quality assurance program. Central Arizona, southwestern Oklahoma, central South Dakota, and northeastern North Dakota. Acceptable spirometry results were obtained from 1,619 women and 1,005 men aged 45 to 74 years. Internal reference values and normal ranges for FEV(1), FVC, and the FEV(1)/FVC ratio were derived from a healthy subgroup of 253 women and 190 men, identified by excluding participants with factors associated with a lower FEV(1). Ten percent of the entire cohort (269 of 2,624 subjects) had airways obstruction, as defined by an FEV(1)/FVC below the lower limit of the normal (LLN) using the internal reference equations. After allowing for measurement "noise," 31 participants were below the LLN using reference equations for white adults from the large National Health and Nutrition Examination Study (NHANES) III study but were normal using the internal reference equations (1.3% false-positive), while 27 participants were classified as normal using NHANES III equations but had airways obstruction using the internal reference equations (1.2% false-negative). Similarly low misclassification rates were seen for a low FVC (prevalence, 17.6%). For clinical purposes, NHANES III spirometry reference equations for white adults may be used when testing American Indian women and men aged 45 to 74 years.

Spirometric reference values in Estonian schoolchildren.

This study was conducted to describe the relationship between anthropometric parameters and lung function in Estonian children, to determine the reference values for spirometry, and to compare these results with other data sets. The results are based on 1170 healthy non-smoking children (643 girls and 527 boys), aged 6-18 years. The spiroanalyser Pneumoscreen II (Jaeger) was used to register dynamic lung parameters. Natural logarithmic values of lung volumes, standing or sitting height and age were used in the final regression model. Prediction equations for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow, forced expiratory flows when 50 and 75% of FVC has been exhaled, and mean forced expiratory flow over the middle 50% of the FVC for both sexes are presented. In comparison with recent data from European children the reference values were close for FVC, the differences were bigger for FEV1 and forced expiratory flows, especially in taller children.

Assessment of respiratory function: influence of spirometry reference values and normality criteria selection

The purpose of this study was to determine the impact upon classification of patients of the choice of reference equation and the criterion defining the lower limit of the normal range in clinical practice. One thousand consecutive spirometries were checked to calculate the predicted values [forced vital capacity (FVC) and forced expiratory volume in sec (FEV 1)] in accordance with the equations by Morris, Cherniack, Crapo, Knudson and the Economic Community for Coal and Steel (ECCS). We quantified the difference between the predicted values obtained for each individual and each equation, determined the percentage of individuals whose classification might have changed from normal to abnormal when using a different equation and defined the lower limit of the normal range in accordance with the determination of 1. the 90% confidence interval or 2. 80% of predicted, comparing their differences. The greatest differences found were between the values given by Morris and Crapo's equations for male FEV 1, between Morris and Cherniak for female FEV 1 and male FVC and between Morris and Knudson for female FVC. Using 80% of predicted value for female FEV 1, up to 35% of tests changed their classification from ‘normal’ to ‘abnormal’ upon changing the equation used. A high percentage of tests showed a lower limit of normal defined by the confidence interval under 80% and 70% of predicted value. This study emphasizes the importance of choosing the appropriate reference equation. We do not consider it acceptable to use a fixed percentage of the predicted value as the lower limit of normal because of the great number of patients found to be inappropriately classified.

Paediatric reference values for spirometry.

Clinical PhysiologyVolume 18, Issue 6 p. 489-497 Paediatric reference values for spirometry Jana Kivastik, Jana Kivastik Department of Physiology, University of Tartu, Tartu, EstoniaSearch for more papers by this author Jana Kivastik, Jana Kivastik Department of Physiology, University of Tartu, Tartu, EstoniaSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1046/j.1365-2281.1998.00135.xCitations: 6 Kivastik 2 Näituse Str., Department of Physiology, University of Tartu, EE2400 Tartu, Estonia Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume18, Issue6November 1998Pages 489-497 RelatedInformation

Prediction Equations of Pulmonary Function Parameters Derived from the Forced Expiratory Spirogram for Healthy Adults over 50 years old in rural area

Background: The studies on prediction equations of pulmonary function parameters for adults in Korea have been performed in a reference population mainly consisted of young and middle ages. So they included a relatively few elderly who conducted pulmonary function test frequently in clinic. We established prediction equations of pulmonary function parameters for adults over 50 years old in rural area and compared this results with those of other studies. Therefore we attempted to consider normative values of pulmonary function tests for elderly in Korea. Method: Five hundred thirty-three women and men over 50 years old in rural area were participated. A healthy subgroup of 110 women and 32 men were identified by excluding those who had conditions that negatively influenced pulmonary function. We derived prediction equations for FVC, and by multiple linear regression method from their age, heights and weights in each sex. Results: Prediction equations for FVC and in each sex were derived as follows Male; FVC (L)=0.02488Height(cm)-0.0269Age(years)+0.493 =0.01874Weight(kg)-0.0282Age(years)+2.906 Female; FVC(L)=0.02160Height(cm)-0.0192Age(years)-0.0125 =0.01720Height(cm)-0.0194Age(years)+0.3890 Prediction equations for were not derived because didn't have statistically significant terms. Comparing Predicted values that were calculated by substitution into the equations of various studies of mean values of age, heights and weights from this study, FVC and values in men of this study were lower than those of other studies. In women, FVC and values of this study were as similar as or lower than those of the study conducted for elderly blacks in U.S.A respectively. Conclusion: We have got prediction equations of pulmonary function parameters which were driven from forced expiratory spirogram in adults over 50 years old in rural area. Predicted values of this study were lower than those of other studies which were conducted in Korea. So we consider that the study for spirometry reference values for elderly Korean using the method compatible with ATS recommendation need to be conducted more frequently forward.

Spirometry Reference Values for Healthy Elderly Blacks

Pulmonary function was assessed by spirometry in 497 black and 2,980 white ambulatory elderly male and female participants of the Cardiovascular Health Study. The quality assurance program prompted technicians to exceed American Thoracic Society recommendations for spirometry. A "healthy" subgroup of 235 black and 1,227 white participants age 65 years and older was identified by excluding current and former smoker, and those with self-reported asthma or emphysema, congestive heart failure, and poor-quality results of spirometry tests, since those factors were associated with a lower FEV1. Reference equations and normal ranges for elderly blacks for measurements of FEV1, FVC, and the FEV1/FVC ratio were then determined from the healthy group. These elderly blacks had an FVC about 6% lower than elderly whites, even after correcting for standing height, sitting height (trunk length), and age. The popular use of spirometry reference values from studies of middle-aged white subjects by applying a 12% race correction factor for black patients appears to overestimate predicted values.

Spirometry and Maximal Respiratory Pressure References From Healthy Minnesota 65- to 85-Year-Old Women and Men

To obtain spirometry and maximal respiratory pressure (MRP) reference values for elderly persons. Survey. General community. Four hundred seventy-one healthy ambulatory white women and men age 65+ years. A stringent spirometry quality assurance program exceeded American Thoracic Society recommendations. A "healthy" subgroup of 176 women and 112 men between the ages of 65- and 85 years were identified by excluding those with conditions that negatively influenced FEV1 in a multiple regression analysis. Reference equations and normal ranges for FEV1, FVC, FEF25-75%, peak flow, and maximal inspiratory and expiratory pressures (MRPs) were determined from the healthy group with good quality maneuvers. Less than 10% of the subjects were unable to perform three acceptable spirometry maneuvers and ten MRP maneuvers. When the age and height corrected FEV1s from this group were compared with other spirometry reference studies, mean values from the women were nearly identical to those from Morris, while these men had substantially lower FEV1 values (by 0.3- to 0.5L) than elderly men in Crapo's study. Mean peak flow was over 20% higher when compared with previous studies, suggesting greater initial expiratory effort by our subjects. The maximal inspiratory pressure (MIP) values were about 20% higher than those reported by the Cardiovascular Health Study, perhaps because five MIP maneuvers were always performed. Spirometry and MRP reference values used for elderly patients should come from population studies using similar techniques and with large numbers of subjects over age 65 years.

Spirometry Reference Values for Women and Men 65 to 85 Years of Age: Cardiovascular Health Study

Pulmonary function was assessed by spirometry in 5,201 ambulatory elderly participants of the Cardiovascular Health Study, sampled from four communities. A stringent quality assurance program exceeded American Thoracic Society (ATS) recommendations for spirometry. Less than 6% of the participants were unable to perform three acceptable spirometry maneuvers. A "healthy" subgroup of 777 women and men 65 to 85 yr of age was identified by excluding smokers and those with lung disease and other factors determined to independently, significantly, and negatively influence the FEV1. Results from black participants were examined separately. Reference equations and normal ranges for FEV1, FVC, and the FEV1/FVC ratio were determined from the healthy group. The results demonstrate differences in predicted values as great as 20% (0.5 to 1 L) for elderly patients when compared with the spirometry reference equations that are most commonly used in the United States.