Comparison between reference values for FVC, FEV1, and FEV1/FVC ratio in White adults in Brazil and those suggested by the Global Lung Function Initiative 2012

OBJECTIVE: To evaluate the spirometry values predicted by the 2012 Global Lung Function Initiative (GLI) equations, which are recommended for international use, in comparison with those obtained for a sample of White adults used for the establishment of reference equations for spirometry in Brazil. METHODS: The sample comprised 270 and 373 healthy males and females, respectively. The mean differences between the values found in this sample and the predicted values calculated from the GLI equations for FVC, FEV1, and VEF1/FVC, as well as their lower limits, were compared by paired t-test. The predicted values by each pair of equations were compared in various combinations of age and height. RESULTS: For the males in our study sample, the values obtained for all of the variables studied were significantly higher than those predicted by the GLI equations (p < 0.01 for all). These differences become more evident in subjects who were shorter in stature and older. For the females in our study sample, only the lower limit of the FEV1/FVC ratio was significantly higher than that predicted by the GLI equation. CONCLUSIONS: The predicted values suggested by the GLI equations for White adults were significantly lower than those used as reference values for males in Brazil. For both genders, the lower limit of the FEV1/FVC ratio is significantly lower than that predicted by the GLI equations.

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Spirometry reference values for Black adults in Brazil

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562018000000082 ◽

2018 ◽

Vol 44 (6) ◽

pp. 449-455 ◽

Cited By ~ 1

Author(s):

Tarciane Aline Prata ◽

Eliane Mancuzo ◽

Carlos Alberto de Castro Pereira ◽

Silvana Spíndola de Miranda ◽

Larissa Voss Sadigursky ◽

...

Keyword(s):

Reference Values ◽

Linear Equations ◽

European Respiratory Society ◽

Black Adults ◽

Technical Requirements ◽

Reference Equations ◽

Predicted Values ◽

Never Smokers ◽

Lower Limits ◽

White Adults

ABSTRACT Objective: To derive reference equations for spirometry in healthy Black adult never smokers in Brazil, comparing them with those published in 2007 for White adults in the country. Methods: The examinations followed the standards recommended by the Brazilian Thoracic Association, and the spirometers employed met the technical requirements set forth in the guidelines of the American Thoracic Society/European Respiratory Society. The lower limits were defined as the 5th percentile of the residuals. Results: Reference equations and limits were derived from a sample of 120 men and 124 women, inhabitants of eight Brazilian cities, all of whom were evaluated with a flow spirometer. The predicted values for FVC, FEV1, FEV1/FVC ratio, and PEF were better described by linear equations, whereas the flows were better described by logarithmic equations. The FEV1 and FVC reference values derived for Black adults were significantly lower than were those previously derived for White adults, regardless of gender. Conclusions: The fact that the predicted spirometry values derived for the population of Black adults in Brazil were lower than those previously derived for White adults in the country justifies the use of an equation specific to the former population.

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Reference values for pulmonary volumes by plethysmography in a Brazilian sample of white adults

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20180065 ◽

2019 ◽

Vol 45 (3) ◽

Author(s):

Thamine Lessa ◽

Carlos Alberto de Castro Pereira ◽

Maria Raquel Soares ◽

Renato Matos ◽

Virgínia Pacheco Guimarães ◽

...

Keyword(s):

Reference Values ◽

Mean Values ◽

Brazilian Sample ◽

Lung Capacity ◽

Upper Limits ◽

Residual Capacity ◽

Reference Equations ◽

Predicted Values ◽

Pulmonary Volumes ◽

White Adults

ABSTRACT Objective: To derive reference values for healthy white Brazilian adults who have never smoked and to compare the obtained values with reference values derived by Crapo and by Neder. Methods: Reference equations by quantile regressions were derived in 122 men and 122 women, non-obese, living in seven cities in Brazil. Age ranged from 21 to 92 years in women and from 25 to 88 years in men. Lung function tests were performed using SensorMedics automated body plethysmographies according ATS/ERS recommendations. Lower and upper limits were derived by specific equations for 5 and 95 percentiles. The results were compared to those suggested by Crapo in 1982, and Neder in 1999. Results: Median values for total lung capacity (TLC) were influenced only by stature in men, and by stature and age in women. Residual volume was influenced by age and stature in both genders. Weight was directly related to inspiratory capacity and inversely with functional residual capacity and expiratory reserve volume in both genders. A comparison of observed TLC data with values predicted by Neder equations showed significant lower values by the present data. Mean values were similar between data from present study and those derived by Crapo. Conclusion: New predicted values for lung volumes were obtained in a sample of white Brazilians. The values differ from those derived by Neder, but are similar to those derived by Crapo.

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Global Lung Function Initiative 2012 reference equations for spirometry in the Norwegian population

European Respiratory Journal ◽

10.1183/13993003.00443-2016 ◽

2016 ◽

Vol 48 (6) ◽

pp. 1602-1611 ◽

Cited By ~ 33

Author(s):

Arnulf Langhammer ◽

Ane Johannessen ◽

Turid L. Holmen ◽

Hasse Melbye ◽

Sanja Stanojevic ◽

...

Keyword(s):

Lung Function ◽

Reference Values ◽

Vital Capacity ◽

Population Based ◽

Forced Expiratory Volume ◽

Female Adolescents ◽

Norwegian Population ◽

Reference Equations ◽

Z Scores ◽

Lower Limit Of Normal

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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Normal spirometry predictive values for the Western Indian adult population

European Respiratory Journal ◽

10.1183/13993003.02129-2019 ◽

2020 ◽

Vol 56 (3) ◽

pp. 1902129

Author(s):

Dhiraj Agarwal ◽

Richard A. Parker ◽

Hilary Pinnock ◽

Sudipto Roy ◽

Deesha Ghorpade ◽

...

Keyword(s):

Lung Function ◽

Adult Population ◽

Additive Model ◽

Forced Expiratory Volume ◽

Routine Practice ◽

Generalised Additive Model ◽

Predictive Values ◽

Reference Equations ◽

Predicted Values ◽

Severity Of The Disease

Interpretation of spirometry involves comparing lung function parameters with predicted values to determine the presence/severity of the disease. The Global Lung Function Initiative (GLI) derived reference equations for healthy individuals aged 3–95 years from multiple populations but highlighted India as a “particular group” for whom further data are needed. We aimed to derive predictive equations for spirometry in a rural Western Indian adult population.We used spirometry data previously collected (2008–2012) from 1258 healthy adults (aged 18 years and over) by the Vadu Health and Demographic Surveillance System. We constructed sex-stratified prediction equations for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC using the Generalised Additive Model for Location, Scale and Shape (GAMLSS) method to derive the best fitting model of each outcome as a function of age and height.When compared with GLI Ethnicity Codes 1 (White Caucasian) and 5 (Other/Mixed), the Western Indian adult population appears to have lower lung volumes on average, though the FEV1/FVC ratio is comparable. Both age and height were predictive of mean FEV1 and FVC; and for females, the variability of response was also dependent on age. FEV1/FVC appears to have a very strong age effect, highlighting the limitations of using a fixed 0.7 cut-off value.The use of GLI normal values may result in overdiagnosis of lung disease in this population. We recommend that the values and equations generated from this study should be used by physicians in their routine practice for diagnosing disease and its severity in adults from the Western Indian population.

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Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

European Respiratory Journal ◽

10.1183/13993003.01995-2019 ◽

2020 ◽

Vol 56 (2) ◽

pp. 1901995 ◽

Cited By ~ 1

Author(s):

Andrei Malinovschi ◽

Xingwu Zhou ◽

Björn Bake ◽

Göran Bergström ◽

Anders Blomberg ◽

...

Keyword(s):

Lung Function ◽

Reference Values ◽

Airflow Limitation ◽

Diffusing Capacity ◽

High Resolution Computed Tomography ◽

Swedish Population ◽

Reference Equations ◽

Lms Method ◽

Never Smokers ◽

Lower Limit Of Normal

The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide (DLCO). Lower limit of normal (LLN), i.e. the 5th percentile, usually defines impaired DLCO. We examined if the GLI LLN for DLCO differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.Spirometry, DLCO, chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15 040 participants, aged 50–64 years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).Both the median and LLN for DLCO from SCAPIS were above the median and LLN from the GLI (p<0.05). The prevalence of DLCO <GLI LLN (and also <SCAPIS LLN) was 3.9%, while the prevalence of DLCO >GLI LLN but <SCAPIS LLN was 5.7%. Subjects with DLCO >GLI LLN but <SCAPIS LLN (n=860) had more emphysema (14.3% versus 4.5%, p<0.001), chronic airflow limitation (8.5% versus 3.9%, p<0.001) and chronic bronchitis (8.3% versus 4.4%, p<0.01) than subjects (n=13 600) with normal DLCO (>GLI LLN and >SCAPIS LLN). No differences were found with regard to physician-diagnosed asthma.The GLI LLN for DLCO is lower than the estimated LLN in healthy, never-smoking, middle-aged Swedish adults. Individuals with DLCO above the GLI LLN but below the SCAPIS LLN had, to a larger extent, an increased respiratory burden. This suggests clinical implications for choosing an adequate LLN for studied populations.

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Prediction of peak expiratory flow rate in a Ugandan population

South African Respiratory Journal ◽

10.7196/sarj.2015.v21i4.36 ◽

2015 ◽

Vol 21 (4) ◽

pp. 96

Author(s):

Susan Kiwanuka Nakubulwa ◽

K Baisley ◽

J Levin

Keyword(s):

Lung Function ◽

Reference Values ◽

Regression Equations ◽

East African ◽

Cross Sectional ◽

African Populations ◽

Study Population ◽

Males And Females ◽

Western Uganda ◽

Ugandan Population

Background. Peak expiratory ow rate (PEFR) measurement is one of the commonly used methods for assessing lung function in general practice consultations. e reference values for use by this method are mainly from Caucasian populations; data for African populations are limited. e existence of ethnic and racial dierences in lung function necessitates further generation of PEFR reference values for use in African populations. Objective. To generate equations for predicting PEFR in a Ugandan population. Methods. e PEFR study was cross-sectional and based in rural south-western Uganda. Participants were aged 15 years or more, without respiratory symptoms and were residents of the study area. Multiple regression equations for predicting PEFR were tted separately for males and females. e model used for PEFR prediction was: logePEFR = intercept + a(age, y) + b(logeage) + c(1/height in cm), where a, b and c are the regression coecients. Results. e eligible study population consisted of 774 males and 781 females. Median height was 164 cm (males) and 155 cm (females). e majority of participants had never smoked (males 76.7%; females 98.3%). e equation which gave the best t for males was logePEFR = 6.188 – 0.019age + 0.557logeage – 199.945/height and for females: logePEFR = 5.948 – 0.014 age + 0.317logeage – 85.147/height. Conclusion. e curvilinear model obtained takes into consideration the changing trends of PEFR with increasing age from adolescence to old age. It provides PEFR prediction equations that can be applied in East African populations.

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The Global Lung Function Initiative (GLI) Network: bringing the world’s respiratory reference values together

Breathe ◽

10.1183/20734735.012717 ◽

2017 ◽

Vol 13 (3) ◽

pp. e56-e64 ◽

Cited By ~ 32

Author(s):

Brendan G. Cooper ◽

Janet Stocks ◽

Graham L. Hall ◽

Bruce Culver ◽

Irene Steenbruggen ◽

...

Keyword(s):

Lung Function ◽

Reference Values ◽

Age Groups ◽

Data Repository ◽

Gas Transfer ◽

List Type ◽

Lung Function Testing ◽

Recent Developments ◽

Reference Equations ◽

Function Testing

The Global Lung Function Initiative (GLI) Network has become the largest resource for reference values for routine lung function testing ever assembled. This article addresses how the GLI Network came about, why it is important, and its current challenges and future directions. It is an extension of an article published inBreathein 2013 [1], and summarises recent developments and the future of the GLI Network.Key pointsThe Global Lung Function Initiative (GLI) Network was established as a result of international collaboration, and altruism between researchers, clinicians and industry partners. The ongoing success of the GLI relies on network members continuing to work together to further improve how lung function is reported and interpreted across all age groups around the world.The GLI Network has produced standardised lung function reference values for spirometry and gas transfer tests.GLI reference equations should be adopted immediately for spirometry and gas transfer by clinicians and physiologists worldwide.The recently established GLI data repository will allow ongoing development and evaluation of reference values, and will offer opportunities for novel research.Educational aimsTo highlight the advances made by the GLI Network during the past 5 years.To highlight the importance of using GLI reference values for routine lung function testing (e.g. spirometry and gas transfer tests).To discuss the challenges that remain for developing and improving reference values for lung function tests.

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A Comparison of Two Transcutaneous Monitors for the Measurement of Arterial Po2 and Pco2 in Neonates

Anaesthesia and Intensive Care ◽

10.1177/0310057x9502300610 ◽

1995 ◽

Vol 23 (6) ◽

pp. 708-714 ◽

Cited By ~ 19

Author(s):

B. Carter ◽

M. Hochmann ◽

A. Osborne ◽

A. Nisbet ◽

N. Campbell

Keyword(s):

Sensitivity And Specificity ◽

Electrode Temperature ◽

Average Sensitivity ◽

Limits Of Agreement ◽

Hewlett Packard ◽

Transcutaneous Oxygen ◽

The Mean ◽

Mean Differences ◽

Lower Limits ◽

Arterial Po2

We examined the ability of two transcutaneous devices (Fastrac, Sensormedics Corporation, Yorba Linda, California, U.S.A. and Hewlett Packard M1018A, Hewlett Packard Component Monitoring System, Hewlett Packard, North Hollywood, U.S.A.) to measure arterial Pco2 and Po2 in neonates. Thirty-seven neonates had transcutaneous oxygen measured with the Hewlett Packard (HPo2 group), 38 neonates had transcutaneous carbon dioxide measured with the Hewlett Packard (HPco2 group) and the Fastrac was used on 27 neonates (FTco2 group). Both devices were operated with electrode temperatures of 43.5 °C although an additional ten subjects were studied using the Fastrac with an electrode temperature of 43.0°C. The mean differences (transcutaneous—arterial) and upper and lower limits of agreement were calculated for each group. For the HPo2 group they were 3.78 mmHg (-12.23 to 19.80 mmHg), for the HPco2 group they were 0.40 mmHg (-4.50 to 5.30 mmHg) and for the FTco2 they were - 0.96 mmHg (- 7.85 to 5.92 mmHg). For the Fastrac group at an electrode temperature of 43.0°C the mean difference and limits of agreement were -1.00 mmHg and -4.58 mmHg to 2.58 mmHg. The average sensitivity and specificity for both machines for the detection of hypocarbia were 82% and 92% respectively while for hypercarbia they were 90% and 94% respectively. For hypoxaemia, the sensitivity and specificity were 40% and 94% while for hyperoxaemia the sensitivity and specificity were 83% and 97%. We conclude that both machines provide a useful supplement to arterial Pco2 measurements and the Fastrac performs better at 43.0°C. The measurement of Po2 is less accurate but is still of clinical use.

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Impact of using different predictive equations on the prevalence of chronic byssinosis in textile workers in Pakistan

Occupational and Environmental Medicine ◽

10.1136/oemed-2021-107680 ◽

2021 ◽

pp. oemed-2021-107680

Author(s):

Asaad Ahmed Nafees ◽

Muhammad Zia Muneer ◽

Sara De Matteis ◽

Andre Amaral ◽

Peter Burney ◽

...

Keyword(s):

Lung Function ◽

Controlled Trial ◽

Forced Expiratory Volume ◽

Textile Workers ◽

Middle Income ◽

Low Middle Income Countries ◽

Reference Equations ◽

Predicted Values ◽

Definition Of ◽

Randomised Controlled

ObjectiveByssinosis remains a significant problem among textile workers in low/middle-income countries. Here we share our experience of using different prediction equations for assessing ‘chronic’ byssinosis according to the standard WHO classification using measurements of forced expiratory volume in 1 s (FEV1).MethodsWe enrolled 1910 workers in a randomised controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with ‘North Indian and Pakistani’ conversion factor); the Global Lung Function Initiative (GLI, ‘other or mixed ethnicities’); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents.Results58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV1 (<80% predicted) identified using NHANES and GLI; Indian and Pakistani reference equations were 40%, 41%, 14% and 12%, respectively. Much of this variation was eliminated when we substituted FEV1/forced vital capacity (FVC) ratio (<lower limit of normality) as a measure of airway obstruction.ConclusionAccurate measures of occupational disease frequency and distribution require approaches that are both standardised and meaningful. We should reconsider the WHO definition of ‘chronic’ byssinosis based on changes in FEV1, and instead use the FEV1/FVC.

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