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Published in: Multidisciplinary Respiratory Medicine 1/2018

Open Access 01-12-2018 | Original research article

Reference values for spirometry in elderly individuals: a cross-sectional study of different reference equations

Authors: Joana Belo, Teresa Palmeiro, Iolanda Caires, Ana L. Papoila, Marta Alves, Pedro Carreiro-Martins, Maria A. Botelho, Nuno Neuparth

Published in: Multidisciplinary Respiratory Medicine | Issue 1/2018

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Abstract

Background

Spirometry is the single most important test for the evaluation of respiratory function. The results are interpreted by comparing measured data with predicted values previously obtained from a reference population. Reference equations for spirometry have been discussed previously. The aim of this study was to compare reference values based on National Health and Nutrition Assessment Survey (NHANES III), European Community of Steel and Coal (ECSC), and Global Lung Initiative (GLI) equations in an elderly sample population.

Methods

Subjects from the Geriatric Study on Health Effects of Air Quality in elder care centres who met the inclusion criteria were enrolled. Spirometry was performed according to international guidelines. The forced vital capacity, forced expiratory volume in 1 s, and FEV1/FVC ratio were reported as percentages of the predicted value, and the lower limit of normality was calculated.

Results

Out of 260 elderly patients, 69.6% were women; the mean age was 83.0 ± 6.46 years with an age range of 65–95 years. The lowest %FVC and %FEV1 values were obtained using the GLI reference equations. However, when NHANES III equations were used, the FEV1/FVC ratio was higher than ratios obtained from GLI and ECSC equations. The prevalence of airway obstruction was highest using ECSC equations, while GLI equations demonstrated more restrictive defects.

Conclusions

The present study showed meaningful differences in the reference values, and consequently, in the results obtained using NHANES III, ECSC, and GLI reference equations. The spirometry interpretation was also influenced by the reference equations used.
Literature
1.
go back to reference Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.
2.
go back to reference Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.
3.
go back to reference Stanojevic S, Wade A, Stocks J. Reference values for lung function: past, present and future. Eur Respir J. 2010;36:12–9.CrossRefPubMed Stanojevic S, Wade A, Stocks J. Reference values for lung function: past, present and future. Eur Respir J. 2010;36:12–9.CrossRefPubMed
4.
go back to reference Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43.
5.
go back to reference Swanney MP, Miller MR. Adopting universal lung function reference equations. Eur Respir J. 2013;42:901–3.CrossRefPubMed Swanney MP, Miller MR. Adopting universal lung function reference equations. Eur Respir J. 2013;42:901–3.CrossRefPubMed
6.
go back to reference Kuster SP, Kuster D, Schindler C, Rochat MK, Braun J, Held L, et al. Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years. Eur Respir J. 2008;31:860–8. Kuster SP, Kuster D, Schindler C, Rochat MK, Braun J, Held L, et al. Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years. Eur Respir J. 2008;31:860–8.
7.
go back to reference Loth DW, Ittermann T, Lahousse L, Hofman A, Leufkens HG, Brusselle GG, et al. Normal spirometry values in healthy elderly: the Rotterdam study. Eur J Epidemiol. 2013;28:329–34. Loth DW, Ittermann T, Lahousse L, Hofman A, Leufkens HG, Brusselle GG, et al. Normal spirometry values in healthy elderly: the Rotterdam study. Eur J Epidemiol. 2013;28:329–34.
8.
go back to reference Narancić NS, Pavlović M, Zuskin E, Milicić J, Skarić-Jurić T, Barbalić M, et al. New reference equations for forced spirometry in elderly persons. Respir Med. 2009;103:621–8. Narancić NS, Pavlović M, Zuskin E, Milicić J, Skarić-Jurić T, Barbalić M, et al. New reference equations for forced spirometry in elderly persons. Respir Med. 2009;103:621–8.
9.
go back to reference García-Río F, Pino JM, Dorgham A, Alonso A, Villamor J. Spirometric reference equations for European females and males aged 65-85 years. Eur Respir J. 2004;24:397–405. García-Río F, Pino JM, Dorgham A, Alonso A, Villamor J. Spirometric reference equations for European females and males aged 65-85 years. Eur Respir J. 2004;24:397–405.
10.
go back to reference Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age: cardiovascular health study. Am Rev Respir Dis. 1993;147:125–33. Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age: cardiovascular health study. Am Rev Respir Dis. 1993;147:125–33.
11.
go back to reference Hall GL, Thompson BR, Stanojevic S, Abramson MJ, Beasley R, Coates A, et al. The global lung initiative 2012 reference values reflect contemporary Australasian spirometry. Respirology. 2012;17:1150–1. Hall GL, Thompson BR, Stanojevic S, Abramson MJ, Beasley R, Coates A, et al. The global lung initiative 2012 reference values reflect contemporary Australasian spirometry. Respirology. 2012;17:1150–1.
12.
go back to reference Quanjer P, Brazzale DJ, Boros PW, Pretto JJ. Implication of adopting global lung initiative 2012 all-age reference equations for spirometry. Eur Respir J. 2013;42:1046–54. Quanjer P, Brazzale DJ, Boros PW, Pretto JJ. Implication of adopting global lung initiative 2012 all-age reference equations for spirometry. Eur Respir J. 2013;42:1046–54.
13.
go back to reference Quanjer PH, Weiner DJ. Interpretative consequences of adopting the global lungs 2012 reference equations for spirometry for children and adolescents. Pediatr Pulmonol. 2014;49:118–25.CrossRefPubMed Quanjer PH, Weiner DJ. Interpretative consequences of adopting the global lungs 2012 reference equations for spirometry for children and adolescents. Pediatr Pulmonol. 2014;49:118–25.CrossRefPubMed
14.
go back to reference Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.
15.
go back to reference Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159:179–87.CrossRefPubMed Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159:179–87.CrossRefPubMed
16.
go back to reference Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows - report working party standardization of lung function tests. Eur Respir J. 1993;16:5–40. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows - report working party standardization of lung function tests. Eur Respir J. 1993;16:5–40.
17.
go back to reference Brazzale DJ, Hall GL, Pretto JJ. Effects of adopting the new global lung function initiative 2012 reference equations on the interpretation of spirometry. Respiration. 2013;86:183–9. Brazzale DJ, Hall GL, Pretto JJ. Effects of adopting the new global lung function initiative 2012 reference equations on the interpretation of spirometry. Respiration. 2013;86:183–9.
18.
go back to reference [No authors listed]. Standardization of spirometry: 1994 update. Am J Respir Crit Care Med. 1995;152:1107–36. [No authors listed]. Standardization of spirometry: 1994 update. Am J Respir Crit Care Med. 1995;152:1107–36.
19.
go back to reference Sharp DS, Enright PL, Chiu D, Burchfiel CM, Rodriguez BL, Curb JD. Reference values for pulmonary function tests of Japanese-American men aged 71 to 90 years. Am J Respir Crit Care Med. 1996;153:805–11. Sharp DS, Enright PL, Chiu D, Burchfiel CM, Rodriguez BL, Curb JD. Reference values for pulmonary function tests of Japanese-American men aged 71 to 90 years. Am J Respir Crit Care Med. 1996;153:805–11.
20.
go back to reference Korotzer B, Ong S, Hansen JE. Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. Am J Respir Crit Care Med. 2000;161:1101–8.CrossRefPubMed Korotzer B, Ong S, Hansen JE. Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. Am J Respir Crit Care Med. 2000;161:1101–8.CrossRefPubMed
21.
go back to reference Ware JH, Dockery DW, Louis T. A, Xu XP, Ferris BG Jr, Speizer FE. Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. Am J Epidemiol. 1990;132:685–700. Ware JH, Dockery DW, Louis T. A, Xu XP, Ferris BG Jr, Speizer FE. Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. Am J Epidemiol. 1990;132:685–700.
22.
go back to reference McDonnell WF, Enright PL, Abbey DE, Knutsen SF, Peters JA, Burchette RJ, et al. Spirometric reference equations for older adults. Respir Med. 1998;92:914–21. McDonnell WF, Enright PL, Abbey DE, Knutsen SF, Peters JA, Burchette RJ, et al. Spirometric reference equations for older adults. Respir Med. 1998;92:914–21.
23.
go back to reference Pruthi N, Multani NK. Influence of age on lung function tests. J Exerc Sci Physiother. 2012;8:1–6.CrossRef Pruthi N, Multani NK. Influence of age on lung function tests. J Exerc Sci Physiother. 2012;8:1–6.CrossRef
24.
go back to reference Hulo S, Broucker V, Giovannelli J, Cherot-Kornobis NNV, Sobaszek A, Dauchet LEJ. Global lung function initiative reference equations better describe a middle-aged, healthy french population than the European Community for steel and coal. Eur Respir J. 2016;49:1779–81.CrossRef Hulo S, Broucker V, Giovannelli J, Cherot-Kornobis NNV, Sobaszek A, Dauchet LEJ. Global lung function initiative reference equations better describe a middle-aged, healthy french population than the European Community for steel and coal. Eur Respir J. 2016;49:1779–81.CrossRef
25.
go back to reference Linares-Perdomo O, Hegewald M, Collingridge DS, Blagev D, Jensen RL, Hankinson J, et al. Comparison of NHANES III and ERS/GLI for airway obstruction classification and severity. Eur Respir J. 2016;48:133–41. Linares-Perdomo O, Hegewald M, Collingridge DS, Blagev D, Jensen RL, Hankinson J, et al. Comparison of NHANES III and ERS/GLI for airway obstruction classification and severity. Eur Respir J. 2016;48:133–41.
26.
go back to reference Kainu A, Tomonen K, Toika J, Qaiser B, Pitkäniemi J, Kotaniemi JT, et al. Reference values of spirometry for Finnish adults. Clin Physiol Func Imaging. 2016;36:346–58. Kainu A, Tomonen K, Toika J, Qaiser B, Pitkäniemi J, Kotaniemi JT, et al. Reference values of spirometry for Finnish adults. Clin Physiol Func Imaging. 2016;36:346–58.
27.
go back to reference Sluga R, Smeele IJ, Lucas AE, Thoonen BP, Grootens-Stekelenburg JG, Heijdra YF, et al. Impact of switching to new spirometric reference equations on severity staging of airflow obstruction in COPD: a cross-sectional observational study in primary care. Prim Care Respir J. 2014;23:85–91. Sluga R, Smeele IJ, Lucas AE, Thoonen BP, Grootens-Stekelenburg JG, Heijdra YF, et al. Impact of switching to new spirometric reference equations on severity staging of airflow obstruction in COPD: a cross-sectional observational study in primary care. Prim Care Respir J. 2014;23:85–91.
28.
go back to reference De C PCA, AAO D, Soares MR. 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. J Bras Pneumol. 2014;40:397–402.CrossRef De C PCA, AAO D, Soares MR. 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. J Bras Pneumol. 2014;40:397–402.CrossRef
29.
go back to reference Bellia V, Pistelli R, Catalano F, Antonelli-Incalzi R, Grassi V, Melillo G, et al. Quality control of spirometry in the elderly - the S..A.R.A. Study. Am J Respir Crit Care Med. 2000;161:1094–100. Bellia V, Pistelli R, Catalano F, Antonelli-Incalzi R, Grassi V, Melillo G, et al. Quality control of spirometry in the elderly - the S..A.R.A. Study. Am J Respir Crit Care Med. 2000;161:1094–100.
30.
go back to reference Pezzoli L, Giardini G, Consonni S, Dallera I, Bilotta C, Ferrario G, et al. Quality of spirometric performance in older people. Age Ageing. 2003;32:43–6. Pezzoli L, Giardini G, Consonni S, Dallera I, Bilotta C, Ferrario G, et al. Quality of spirometric performance in older people. Age Ageing. 2003;32:43–6.
31.
go back to reference Scarlata S, Pedone C, Conte ME, Antonelli Incalzi R. Accuracy of spirometry in diagnosing pulmonary restriction in elderly people. J Am Geriatr Soc. s2009;57:89. Scarlata S, Pedone C, Conte ME, Antonelli Incalzi R. Accuracy of spirometry in diagnosing pulmonary restriction in elderly people. J Am Geriatr Soc. s2009;57:89.
32.
go back to reference Mehrparvar AH, Sakhvidi MJZ, Mostaghaci M, Davari MH, Hashemi SH1, Zare Z. Hashemi SH, Zare Z. Spirometry values for detecting a restrictive pattern in occupational health settings. Tanaffos. 2014;13:27–34. Mehrparvar AH, Sakhvidi MJZ, Mostaghaci M, Davari MH, Hashemi SH1, Zare Z. Hashemi SH, Zare Z. Spirometry values for detecting a restrictive pattern in occupational health settings. Tanaffos. 2014;13:27–34.
Metadata
Title
Reference values for spirometry in elderly individuals: a cross-sectional study of different reference equations
Authors
Joana Belo
Teresa Palmeiro
Iolanda Caires
Ana L. Papoila
Marta Alves
Pedro Carreiro-Martins
Maria A. Botelho
Nuno Neuparth
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Multidisciplinary Respiratory Medicine / Issue 1/2018
Electronic ISSN: 2049-6958
DOI
https://doi.org/10.1186/s40248-017-0112-5

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