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Cestelli L, Stavem K, Johannessen A, Gulsvik A, Nielsen R. Outcome-based Definition of the Lower Limit of Normal in Spirometry: A Study of 26,000 Young Adult Men. Ann Am Thorac Soc 2024; 21:1261-1271. [PMID: 38656819 DOI: 10.1513/annalsats.202312-1027oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
Rationale: The definition of the lower limit of normal (LLN) of spirometric variables is not well established. Objectives: To investigate the relationship between spirometric abnormalities defined with different thresholds of the LLN and clinical outcomes and to explore the possibility of using different LLN thresholds according to the pretest probability of disease. Methods: We studied the associations between prebronchodilator spirometric abnormalities (forced expiratory volume in the first second [FEV1] < LLN, forced vital capacity [FVC] < LLN, airflow obstruction, spirometric restriction) defined with different thresholds of the LLN (10th, 5th, 2.5th, 1st percentile) and multiple outcomes (prevalence of spirometric abnormalities, respiratory symptoms, all-cause and respiratory mortality) in 26,091 30- to 46-year-old men who participated in a general population survey in Norway in 1988-1990 and were followed for 26 years. Analyses were performed with both local and Global Lung Function Initiative (GLI)-2012 reference equations, stratified by pretest risk (presence or absence of respiratory symptoms), and adjusted for age, body mass index, smoking, and education. Results: In the total population, the prevalence of airflow obstruction was 11.6% with GLI-LLN10, 11.0% with Local-LLN5, 6.1% with GLI-LLN5, 7.6% with Local-LLN2.5, and 3.5% with GLI-LLN2.5. The prevalence of spirometric restriction was 5.9% with GLI-LLN10, 5.2% with Local-LLN5, and 2.8% with GLI-LLN5. Increasingly lower thresholds of the LLN were associated with increasingly higher odds of respiratory symptoms and hazard of mortality for all spirometric abnormalities with both reference equations. Spirometric abnormalities defined with Local-LLN2.5 in asymptomatic subjects were associated with lower hazard of all-cause mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.15-1.95 for FEV1 < LLN) than those defined with Local-LLN5 in the general population (HR, 1.67; 95% CI, 1.50-1.87 for FEV1 < LLN) and symptomatic subjects (HR, 1.67; 95% CI, 1.46-1.91 for FEV1 < LLN). Overall, the prevalence of spirometric abnormalities and associations with outcomes obtained with Local-LLN5 were comparable to those obtained with GLI-LLN10 and those obtained with Local-LLN2.5 to GLI-LLN5. Conclusions: There is a relationship between statistically based thresholds of the LLN of spirometric variables and clinical outcomes. Different thresholds of the LLN may be used in different risk subgroups of subjects, but the choice of the threshold needs to be evaluated together with the choice of reference equations.
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Affiliation(s)
| | - Knut Stavem
- Pulmonary Department and
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; and
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Rune Nielsen
- Department of Clinical Science and
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Christopher DJ, Oommen AM, George K, Premkumar PS, Shankar D, Agrawal A, Thangakunam B. Rural South Indian spirometry values show wide variation compared to existing prediction equations. Lung India 2023; 40:193-199. [PMID: 37148014 PMCID: PMC10298811 DOI: 10.4103/lungindia.lungindia_336_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/04/2022] [Accepted: 01/23/2023] [Indexed: 05/07/2023] Open
Abstract
Background and Objective India, a highly heterogeneous country, has no common reference standards for predicting spirometry values, with very few recent studies from south India. This study aimed to create reference equations for rural south Indian adults, based on a population-based survey in Vellore, south India and compare it with other equations from India. Methods The data from 583 non-smoking, asymptomatic participants (30 years and older) from a spirometry-based survey for airflow obstruction (rural Vellore, 2018), were used to develop equations for FEV1, FEV1/FVC, and FVC. The dataset was divided for development (70%) and validation (30%), by gender. Differences between observed and predicted values were assessed using the new equations and comparisons made with other equations from India. Results Predictions with Vellore rural equations were closest to the previous south Indian equations from urban Bangalore. However, the Bangalore equations led to overestimation of FVC values in males, and of both FEV1 and FVC values in females. Using the rural Vellore equations also led to a higher percent of males being classified as having airflow obstruction, compared to the Bangalore equations which underestimated airflow obstruction in this rural population. Comparison with previously derived Indian equations from other parts of the country showed pronounced variations. Conclusions Our study reiterates the need for representative rural and urban studies of adults from various parts of India, to obtain region specific reference equations, given the wide variations in spirometry values in "normal" individuals, due to social heterogeneities of the Indian population and resulting complexities in defining normal.
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Affiliation(s)
| | - Anu M. Oommen
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kuryan George
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Deepa Shankar
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anurag Agrawal
- Department of Trivedi School of Biosciences, Ashoka University, Sonepat, Haryana, India
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Al-Qerem W, Hammad AM, Gassar ES, Al-Qirim RA, Ling J. Spirometry reference equations for an adult Middle Eastern population. Expert Rev Respir Med 2019; 13:489-497. [DOI: 10.1080/17476348.2019.1601560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Alaa M. Hammad
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Ezeddin S. Gassar
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Rania A. Al-Qirim
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Chlif M, Keochkerian D, Temfemo A, Choquet D, Ahmaidi S. Relationship Between Electromyogram Spectrum Parameters and the Tension-Time Index During Incremental Exercise in Trained Subjects. J Sports Sci Med 2018; 17:509-514. [PMID: 30116125 PMCID: PMC6090392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/12/2016] [Indexed: 06/08/2023]
Abstract
The inspiratory muscle tension-time index TT0.1 (given by P0.1/PImax x TI/TTOT) could be used to reliably assess inspiratory muscle activity during exercise. So far, the correlation between the TT0.1 and diaphragmatic activity has not been measured and the TT0.1 has not been compared with other measurements of the inspiratory muscle load such as the transdiaphragmatic pressure index or TTdi. In this study we hypothesize that the TT0.1 measuring the mouth is a noninvasive reflection of the electromyographic activity of the diaphragm. We simultaneously measured TT0.1 and surface EMG (SEMG) of 8 trained subjects at rest and during incremental exercise. The curvature of TT0.1 and the root mean square (RMS) follow the same trend during the incremental exercise with a significant correlation between TT0.1 and surface EMG parameters (RMS; r = 0.81 p < 0.001 and MPF; r = 0.80 p < 0.001 respectively). We conclude that TT0.1 measured as s an adequate noninvasive method reflects the diaphragmatic activity during incremental exercise in healthy subjects.
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Affiliation(s)
- Mehdi Chlif
- Tunisian Research Laboratory Sport Performance Optimization, National Center of Medicine and Science in Sports, Tunis, Tunisia
| | - David Keochkerian
- EA 3300 "APERE: Adaptations-Rehabilitation", Picardie Jules Verne University, Sport Science Department, Amiens, F-80025 Cedex, France
| | - Abdou Temfemo
- EA 3300 "APERE: Adaptations-Rehabilitation", Picardie Jules Verne University, Sport Science Department, Amiens, F-80025 Cedex, France
| | - Dominique Choquet
- EA 3300 "APERE: Adaptations-Rehabilitation", Picardie Jules Verne University, Sport Science Department, Amiens, F-80025 Cedex, France
| | - Said Ahmaidi
- EA 3300 "APERE: Adaptations-Rehabilitation", Picardie Jules Verne University, Sport Science Department, Amiens, F-80025 Cedex, France
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Zhang J, Hu X, Tian X, Xu KF. Global lung function initiative 2012 reference values for spirometry in Asian Americans. BMC Pulm Med 2018; 18:95. [PMID: 29855299 PMCID: PMC5984415 DOI: 10.1186/s12890-018-0658-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background Spirometry reference values specifically designed for Asian Americans are currently unavailable. The performance of Global Lung Function Initiative 2012 (GLI-2012) equations on assessing spirometry in Asian Americans has not been evaluated. This study aimed to assess the fitness of relevant GLI-2012 equations for spirometry in Asian Americans. Methods Asian subjects who never smoked and had qualified spirometry data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Z-scores of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were separately constructed with GLI-2012 equations for North East (NE) Asians, South East (SE) Asians, and individuals of mixed ethnic origin (Mixed). In addition, Proportions of subjects with observed spirometry data below the lower limit of normal (LLN) were also evaluated on each GLI-2012 equation of interest. Results This study included 567 subjects (250 men and 317 women) aged 6–79 years. Spirometry z-scores (z-FEV1, z-FVC, and z-FEV1/FVC) based on GLI-2012 Mixed equations had mean values close to zero (− 0.278 to − 0.057) and standard deviations close to one (1.001 to 1.128); additionally, 6.0% (95% confidence interval (CI) 3.1–8.9%) and 6.4% (95% CI 3.7–9.1%) of subjects were with observed data below LLN for FEV1/FVC in men and women, respectively. In contrast, for NE Asian equations, all mean values of z-FEV1 and z-FVC were smaller than − 0.5; for SE Asian equations, mean values of z-FEV1/FVC were significantly smaller than zero in men (− 0.333) and women (− 0.440). Conclusions GLI-2012 equations for individuals of mixed ethnic origin adequately fitted spirometry data in this sample of Asian Americans. Future studies with larger sample sizes are needed to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12890-018-0658-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jingzhou Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xiao Hu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.,Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Xinlun Tian
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Kai-Feng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Simpson S, Hall G. How ‘healthy’ do children really need to be? Going beyond the limits. Respirology 2018; 23:354-355. [DOI: 10.1111/resp.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Shannon Simpson
- Children's Lung Health, Telethon Kids Institute and Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
| | - Graham Hall
- Children's Lung Health, Telethon Kids Institute and Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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Langhammer A, Johannessen A, Holmen TL, Melbye H, Stanojevic S, Lund MB, Melsom MN, Bakke P, Quanjer PH. Global Lung Function Initiative 2012 reference equations for spirometry in the Norwegian population. Eur Respir J 2016; 48:1602-1611. [DOI: 10.1183/13993003.00443-2016] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022]
Abstract
We studied the fit of the Global Lung Function Initiative (GLI) all-age reference values to Norwegians, compared them with currently used references (European Community for Steel and Coal (ECSC) and Zapletal) and estimated the prevalence of obstructive lung disease.Spirometry data collected in 30 239 subjects (51.7% females) aged 12–90 years in three population-based studies were converted to z-scores.We studied healthy non-smokers comprising 2438 adults (57.4% females) aged 20–90 years and 8725 (47.7% female) adolescents aged 12–19 years. The GLI-2012 prediction equations fitted the Norwegian data satisfactorily. Median±sd z-scores were respectively 0.02±1.03, 0.01±1.04 and −0.04±0.91 for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC in males, and −0.01±1.02, 0.07±0.97 and −0.21±0.82 in females. The ECSC and Zapletal references significantly underestimated FEV1 and FVC. Stricter criteria of obstruction (FEV1/FVC <GLI-2012 lower limit of normal (LLN)) carried a substantially higher risk of obstructive characteristics than FEV1/FVC <0.7 and >GLI-2012 LLN. Corresponding comparison regarding myocardial infarction showed a four-fold higher risk for women.The GLI-2012 reference values fit the Norwegian data satisfactorily and are recommended for use in Norway. Correspondingly, the FEV1/FVC GLI-2012 LLN identifies higher risk of obstructive characteristics than FEV1/FVC <0.7.
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Chlif M, Keochkerian D, Temfemo A, Choquet D, Ahmaidi S. Inspiratory muscle performance in endurance-trained elderly males during incremental exercise. Respir Physiol Neurobiol 2016; 228:61-8. [PMID: 26994757 DOI: 10.1016/j.resp.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 03/13/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to compare the inspiratory muscle performance during an incremental exercise of twelve fit old endurance-trained athletes (OT) with that of fit young athletes (YT) and healthy age-matched controls (OC). The tension-time index (TT0.1) was determined according to the equation TT0.1=P0.1/PImax×ti/ttot, where P0.1 is the mouth occlusion pressure, PImax the maximal inspiratory pressure and ti/ttot the duty cycle. For a given VCO2, OT group displayed P0.1, P0.1/PImax ratio, TT0.1 and effective impedance of the respiratory muscle values which were lower than OC group and higher than YT group. At maximal exercise, P0.1/PImax ratio and TT0.1 was still lower in the OT group than OC group and higher than YT group. This study showed lower inspiratory muscle performance attested by a higher (TT0.1) during exercise in the OT group than YT group, but appeared to be less marked in elderly men having performed lifelong endurance training compared with sedentary elderly subjects.
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Affiliation(s)
- Mehdi Chlif
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France; Tunisian Research Laboratory Sport Performance Optimization, National Center of Medicine and Science in Sports (CNMSS), Bp263, Ave Med Ali Akid, 1004 El, Menzah, Tunis, Tunisia.
| | - David Keochkerian
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
| | - Abdou Temfemo
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
| | - Dominique Choquet
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France; Department of Cardiac Rehabilitation, Corbie's hospital, F-80800 Corbie, France
| | - Said Ahmaidi
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
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Brisman J, Kim JL, Olin AC, Torén K, Bake B. Spirometric reference equations for Swedish adults. Clin Physiol Funct Imaging 2016; 37:640-645. [DOI: 10.1111/cpf.12349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Jonas Brisman
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
- Occupational and Environmental Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Jeong-Lim Kim
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
- Occupational and Environmental Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
- Occupational and Environmental Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
- Occupational and Environmental Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Björn Bake
- Occupational and Environmental Medicine; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Respiratory Medicine and Allergology; Sahlgrenska University Hospital; Gothenburg Sweden
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Backman H, Lindberg A, Odén A, Ekerljung L, Hedman L, Kainu A, Sovijärvi A, Lundbäck B, Rönmark E. Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies. Eur Clin Respir J 2015; 2:26375. [PMID: 26557250 PMCID: PMC4629723 DOI: 10.3402/ecrj.v2.26375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abnormal lung function is commonly identified by comparing observed spirometric values to corresponding reference values. It is recommended that such reference values for spirometry are evaluated and updated frequently. The aim of this study was to estimate new reference values for Swedish adults by fitting a multivariable regression model to a healthy non-smoking general population sample from northern Sweden. Further aims were to evaluate the external validity of the obtained reference values on a contemporary sample from south-western Sweden, and to compare them to the Global Lung Function Initiative (GLI) reference values. METHOD Sex-specific multivariable linear regression models were fitted to the spirometric data of n=501 healthy non-smoking adults aged 22-91 years, with age and height as predictors. The models were extended to allow the scatter around the outcome variable to depend on age, and age-dependent spline functions were incorporated into the models to provide a smooth fit over the entire age range. Mean values and lower limits of normal, defined as the lower 5th percentiles, were derived. RESULT This modelling approach resulted in unbiased estimates of the spirometric outcomes, and the obtained estimates were appropriate not only for the northern Sweden sample but also for the south-western Sweden sample. On average, the GLI reference values for forced expiratory volume in one second (FEV1) and, in particular, forced expiratory vital capacity (FVC) were lower than both the observed values and the new reference values, but higher for the FEV1/FVC ratio. CONCLUSION The evaluation based on the sample of healthy non-smokers from northern Sweden show that the Obstructive Lung Disease in Northern Sweden reference values are valid. Furthermore, the evaluation based on the south-western Sweden sample indicates a high external validity. The comparison with GLI brought further evidence to the consensus that, when available, appropriate local population-specific reference values may be preferred.
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Affiliation(s)
- Helena Backman
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Odén
- Division of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Linnéa Hedman
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annette Kainu
- HUCH Heart and Lung Center, Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Anssi Sovijärvi
- HUS Medical Imaging Centre, Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Bo Lundbäck
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Bridevaux PO, Dupuis-Lozeron E, Schindler C, Keidel D, Gerbase MW, Probst-Hensch NM, Bettschart R, Burdet L, Pons M, Rothe T, Turk A, Stolz D, Tschopp JM, Kuenzli N, Rochat T. Spirometer Replacement and Serial Lung Function Measurements in Population Studies: Results From the SAPALDIA Study. Am J Epidemiol 2015; 181:752-61. [PMID: 25816817 DOI: 10.1093/aje/kwu352] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 11/12/2022] Open
Abstract
The Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), a population cohort study, used heated-wire spirometers in 1991 and 2002 and then ultrasonic spirometers in 2010 revealing measurement bias in healthy never smokers. To provide a practical method to control for measurement bias given the replacement of spirometer in long-term population studies, we built spirometer-specific reference equations from healthy never smokers participating in 1991, 2002, and 2010 to derive individualized corrections terms. We compared yearly lung function decline without corrections terms with fixed terms that were obtained from a quasi-experimental study and individualized terms. Compared with baseline reference equations, spirometer-specific reference equations predicted lower lung function. The mean measurement bias increased with age and height. The decline in forced expiratory volume in 1 second during the reference period of 1991-2002 was 31.5 (standard deviation (SD), 28.7) mL/year while, after spirometer replacement, uncorrected, corrected by fixed term, and individualized term, the declines were 47.0 (SD, 30.1), 40.4 (SD, 30.1), and 30.4 (SD, 29.9) mL/year, respectively. In healthy never smokers, ultrasonic spirometers record lower lung function values than heated-wire spirometers. This measurement bias is sizeable enough to be relevant for researchers and clinicians. Future reference equations should account for not only anthropometric variables but also spirometer type. We provide a novel method to address spirometer replacement in cohort studies.
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Kainu A, Timonen KL, Toikka J, Qaiser B, Pitkäniemi J, Kotaniemi JT, Lindqvist A, Vanninen E, Länsimies E, Sovijärvi ARA. Reference values of spirometry for Finnish adults. Clin Physiol Funct Imaging 2015; 36:346-58. [PMID: 25817817 DOI: 10.1111/cpf.12237] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/27/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diagnostic assessment of lung function necessitates up-to-date reference values. The aim of this study was to estimate reference values for spirometry for the Finnish population between 18 and 80 years and to compare them with the existing Finnish, European and the recently published global GLI2012 reference values. METHODS Spirometry was performed for 1380 adults in the population-based FinEsS studies and for 662 healthy non-smoking volunteer adults. Detailed predefined questionnaire screening of diseases and symptoms, and quality control of spirometry yielded a sample of 1000 native Finns (387 men) healthy non-smokers aged 18-83 years. Sex-specific reference values, which are estimated using the GAMLSS method and adjusted for age and height, are provided. RESULTS The predicted values for lung volumes are larger than those obtained by GLI2012 prediction for the Caucasian subgroup for forced vital capacity (FVC) by an average 6·2% and 5·1% and forced expiratory volume in 1 s (FEV1) by an average 4·2% and 3·0% in men and women, respectively. GLI2012 slightly overestimated the ratio FEV1/FVC with an age-dependent trend. Most reference equations from other European countries, with the exception of the Swiss SAPALDIA study, showed an underestimation of FVC and FEV1 to varying degrees, and a slight overestimation of FEV1/FVC. CONCLUSION This study offers up-to-date reference values of spirometry for native Finns with a wide age range. The GLI2012 predictions seem not to be suitable for clinical use for native Finns due to underestimation of lung volumes.
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Affiliation(s)
- A Kainu
- Department of Pulmonary Medicine, HUCH Heart and Lung Center, Peijas Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K L Timonen
- Department of Clinical Physiology, Central Hospital of Central Finland, Jyväskylä, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - J Toikka
- Department of Clinical Physiology, Turku University Hospital, Turku, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - B Qaiser
- Department of Public Health, Hjelt -institute, University of Helsinki, Helsinki, Finland
| | - J Pitkäniemi
- Department of Public Health, Hjelt -institute, University of Helsinki, Helsinki, Finland
| | - J T Kotaniemi
- Department of Respiratory Diseases, Tampere University Hospital, Tampere, Finland
| | - A Lindqvist
- Research Unit of Pulmonary Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Vanninen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - E Länsimies
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - A R A Sovijärvi
- Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Backman H, Lindberg A, Sovijärvi A, Larsson K, Lundbäck B, Rönmark E. Evaluation of the global lung function initiative 2012 reference values for spirometry in a Swedish population sample. BMC Pulm Med 2015; 15:26. [PMID: 25887050 PMCID: PMC4417328 DOI: 10.1186/s12890-015-0022-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 03/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Global Lung Function Initiative 2012 (GLI) reference values are currently endorsed by several respiratory societies but evaluations of applicability for adults resident in European countries are lacking. The aim of this study was to evaluate if the GLI reference values are appropriate for an adult Caucasian Swedish population. METHODS During 2008-2013, clinical examinations including spirometry were performed on general population samples in northern Sweden, in which 501 healthy Caucasian non-smokers were identified. Predicted GLI reference values and Z-scores were calculated for each healthy non-smoking subject and the distributions and mean values for FEV1, FVC and the FEV1/FVC ratio were examined. The prevalence of airway obstruction among these healthy non-smokers was calculated based on the Lower Limit of normal (LLN) criterion (lower fifth percentile) for the FEV1/FVC ratio. Thus, by definition, a prevalence of 5% was expected. RESULTS The Z-scores for FEV1, FVC and FEV1/FVC were reasonably, although not perfectly, normally distributed, but not centred on zero. Both predicted FEV1 and, in particular, FVC were lower compared to the observed values in the sample. The deviations were greater among women compared to men. The prevalence of airway obstruction based on the LLN criterion for the FEV1/FVC ratio was 9.4% among women and 2.7% among men. CONCLUSIONS The use of the GLI reference values may produce biased prevalence estimates of airway obstruction in Sweden, especially among women. These results demonstrate the importance of validating the GLI reference values in different countries.
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Affiliation(s)
- Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, the OLIN unit, Umeå University, Umeå, Sweden.
| | - Anssi Sovijärvi
- Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Centre, Helsinki University Central Hospital, Helsinki, Finland.
| | - Kjell Larsson
- Division of Physiology, the National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bo Lundbäck
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
- OLIN-Studierna, Robertsviksgatan 9, 97189, Lulea, Sweden.
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15
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Brisman J, Kim JL, Olin AC, Torén K, Bake B. A physiologically based model for spirometric reference equations in adults. Clin Physiol Funct Imaging 2014; 36:77-84. [DOI: 10.1111/cpf.12198] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jonas Brisman
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Jeong-Lim Kim
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
- Occupational Medicine, Respiratory Diseases and Toxicology; University of Perugia; Perugia Italy
| | - Björn Bake
- Respiratory Medicine and Allergology; Sahlgrenska University Hospital; Gothenburg Sweden
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16
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Vernillo G, Rinaldo N, Giorgi A, Esposito F, Trabucchi P, Millet GP, Schena F. Changes in lung function during an extreme mountain ultramarathon. Scand J Med Sci Sports 2014; 25:e374-80. [PMID: 25262823 DOI: 10.1111/sms.12325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Abstract
This study aimed to assess the effects of an extreme mountain ultramarathon (MUM, 330 km, 24,000 D+) on lung function. Twenty-nine experienced male ultramarathon runners performed longitudinally [before (pre), during (mid), and immediately after (post) a MUM] a battery of pulmonary function tests. The tests included measurements of forced vital capacity, forced expiratory volume in 1 s, peak flow, inspiratory capacity, and maximum voluntary ventilation in 12 s (MVV12). A significant reduction in the running speed was observed (-43.0% between pre-mid and mid-post; P < 0.001). Expiratory function declined significantly at mid (P < 0.05) and at post (P < 0.05). A similar trend was observed for inspiratory function (P < 0.05). MVV12 declined at mid (P < 0.05) and further decreased at post (P < 0.05). Furthermore, there are significant negative correlations between performance time and MVV12 pre-race (R = -0.54, P = 0.02) as well as changes in MVV12 between pre- and post-race (R = -0.53, P = 0.009). It is concluded that during an extreme MUM, a continuous decline in pulmonary function was observed, likely attributable to the high levels of ventilation required during this MUM in a harsh mountainous environment.
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Affiliation(s)
- G Vernillo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,CeRiSM, Research Center "Sport, Mountain and Health", University of Verona, Rovereto, Italy
| | - N Rinaldo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - A Giorgi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - F Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - P Trabucchi
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - G P Millet
- ISSUL, Institute of Sport Sciences, Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - F Schena
- CeRiSM, Research Center "Sport, Mountain and Health", University of Verona, Rovereto, Italy.,Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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17
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Rochat MK, Laubender RP, Kuster D, Braendli O, Moeller A, Mansmann U, von Mutius E, Wildhaber J. Spirometry reference equations for central European populations from school age to old age. PLoS One 2013; 8:e52619. [PMID: 23320075 PMCID: PMC3540072 DOI: 10.1371/journal.pone.0052619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
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.
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18
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Lung function reference values in different German populations. Respir Med 2011; 105:352-62. [DOI: 10.1016/j.rmed.2010.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/11/2010] [Accepted: 10/12/2010] [Indexed: 11/19/2022]
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19
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Lubiński W, Gólczewski T. Physiologically interpretable prediction equations for spirometric indexes. J Appl Physiol (1985) 2010; 108:1440-6. [DOI: 10.1152/japplphysiol.01211.2009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The need for ethnic-specific reference values of lung function variables (LFs) is acknowledged. Their estimation requires expensive and laborious examinations, and therefore additional use of results in physiology and epidemiology would be profitable. To this end, we proposed a form of prediction equations with physiologically interpretable coefficients: a baseline, the onset age (A0) and rate (S) of LF decline, and a height coefficient. The form was tested with data from healthy, nonsmoking Poles aged 18–85 yr (1,120 men, 1,625 women) who performed spirometry maneuvers according to American Thoracic Society criteria. The values of all the coefficients (also A0) for several LFs were determined with regression of LF on patient's age and deviation of patient's height from the mean height in the year group of this patient. S values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow, and maximal expiratory flow at 75% of FVC (MEF75) were very similar in both sexes (1.03 ± 0.07%/yr). FEV1/FVC declines four to five times slower. S for MEF25 appeared age dependent. A0 was smallest (28–32 yr) for MEF25 and FEV1. About 50% of each age subgroup (18–40, 41–60, 61–85 yr) exhibited LFs below the mean, and 4–6% were below the 5th percentile lower limits of normal, and thus the form of equations proposed in the paper appeared appropriate for spirometry. Additionally, if this form is accepted, epidemiological and physiological comparison of different LFs and populations will be possible by means of direct comparison of the equation coefficients.
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Affiliation(s)
- Wojciech Lubiński
- Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw; and
| | - Tomasz Gólczewski
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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20
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Vollmer WM, Gíslason T, Burney P, Enright PL, Gulsvik A, Kocabas A, Buist AS. Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study. Eur Respir J 2009; 34:588-97. [PMID: 19460786 DOI: 10.1183/09031936.00164608] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Published guidelines recommend spirometry to accurately diagnose chronic obstructive pulmonary disease (COPD). However, even spirometry-based COPD prevalence estimates can vary widely. We compared properties of several spirometry-based COPD definitions using data from the international Burden of Obstructive Lung Disease (BOLD)study. 14 sites recruited population-based samples of adults aged > or =40 yrs. Procedures included standardised questionnaires and post-bronchodilator spirometry. 10,001 individuals provided usable data. Use of the lower limit of normal (LLN) forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio reduced the age-related increases in COPD prevalence that are seen among healthy never-smokers when using the fixed ratio criterion (FEV(1)/FVC <0.7) recommended by the Global Initiative for Chronic Obstructive Lung Disease. The added requirement of an FEV(1) either <80% predicted or below the LLN further reduced age-related increases and also led to the least site-to-site variability in prevalence estimates after adjusting for potential confounders. Use of the FEV(1)/FEV(6) ratio in place of the FEV(1)/FVC yielded similar prevalence estimates. Use of the FEV(1)/FVC<LLN criterion instead of the FEV(1)/FVC <0.7 should minimise known age biases and better reflect clinically significant irreversible airflow limitation. Our study also supports the use of the FEV(1)/FEV(6) as a practical substitute for the FEV(1)/FVC.
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Affiliation(s)
- W M Vollmer
- Kaiser Permanente, Center for Health Research, Portland, OR 97227-1110, USA.
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FEV1/FVC and FEV1 for the assessment of chronic airflow obstruction in prevalence studies: do prediction equations need revision? Respir Med 2008; 102:1568-74. [PMID: 18657959 DOI: 10.1016/j.rmed.2008.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 05/19/2008] [Accepted: 06/07/2008] [Indexed: 11/22/2022]
Abstract
Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire. Previously diagnosed cases and risk factors were identified. Prevalence of airflow obstruction was calculated using: (i) ATS-GOLD definition (FEV(1)/FVC<0.70); and (ii) ERS definition (FEV(1)/FVC<lower limit of normal) with European Community for Coal and Steel (ECCS) reference equations and with predicted values derived from the presumably normal fraction of the studied population. A total of 5008 subjects (4764 adequate datasets) were studied. Prevalence of airflow obstruction was 8.71% with ATS-GOLD definition and 6.40% with ERS definition and ECCS predicted values. The ERS definition with predicted values derived from the studied population provided a 7.96% prevalence. Severity distribution of airflow obstruction was also influenced by the equation used to calculate predicted values of FEV(1). Prevalence and severity of chronic airflow obstruction are influenced not only by the definition used but also by equations used to calculate predicted FEV(1)/FVC and FEV(1) values. These equations likely need to be periodically revised.
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