A Comparison of Global Lung Initiative 2012 with Third National Health and Nutrition Examination Survey Spirometry Reference Values. Implications in Defining Obstruction

Huprikar, Nikhil; Holley, Aaron B.; Skabelund, Andrew; Hayes, Jackie; Hiles, Paul; Aden, James K; Morris, Michael J.; Hersh, Andrew

doi:10.1513/annalsats.201805-317oc

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…Although some studies have shown disagreement,21 GLI-Race reference equations generally fit for multiple race/ethnicities 6–12. The current study revealed that the Canadian reference equations, compared with GLI-Race, led to higher rates of abnormal FVC and FEV 1 , especially in non-Caucasian groups.…”

Section: Discussionmentioning

confidence: 54%

“…Studies comparing GLI-2012 to other reference equations in various races and respiratory diseases6–12 have shown that the GLI race/ethnic-based reference equations (GLI-Race) could fit the population in several validation samples. However, a recent publication found no evidence that interpretation using the GLI-Race reference equations improved the prediction of clinical events compared with the race/ethnic-neutral equations for Other/Mixed ethnicity (GLI-Other) 13.…”

Section: Introductionmentioning

confidence: 99%

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Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city

et al. 2022

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BackgroundThe Global Lung Function Initiative (GLI-2012) focused on race/ethnicity as an important factor in determining reference values. This study evaluated the effects of changing from Canadian reference equations developed from an all-Caucasian cohort with European ancestry to the GLI-2012 on the interpretation of spirometry in a multiethnic population and aimed to identify the ethnic groups affected by discrepant interpretations.MethodsClinically indicated spirometry in a multiethnic population (aged 20–80 years) collected from 2018 to 2021 was analysed. The predicted and lower limit of normal (LLN) values were calculated using three sets of reference equations: Canadian, GLI-race/ethnic-based (GLI-Race) and GLI-race/ethnic-neutral (GLI-Other). We compared the prevalence of concordance in the abnormal diagnoses (defined as <LLN) for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC among the three reference values, and evaluated whether race/ethnicity was associated with discordance.ResultsData from 406 participants were evaluated (non-Caucasian 43.6%). There was 85%–87% concordance for normal/abnormal FVC and FEV1interpretations among the Canadian, GLI-Race and GLI-Other reference equations. In all ethnic groups, application of the Canadian references for interpretation led to a higher prevalence of abnormal (<LLN) FVC and FEV1compared with GLI-Race and GLI-Other. This trend was more prominent in Black, South-East Asian and Mixed/other ethnic groups when comparing the Canadian to the GLI-Race equations. In contrast, the discordance rates were similar among ethnic groups when compared with the GLI-Other reference equations. Interpretation of FEV1/FVC had a high rate of agreement among all equations.ConclusionInterpretation using Canadian reference equations was associated with a higher prevalence of restrictive physiology compared with the GLI-2012 equations, particularly if the GLI-Race were used. These observations were mostly found in non-white Caucasian groups, highlighting the need to choose reference equations that reflect closely the ethnic mix of the population being evaluated in order to optimise patient management.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city

et al. 2022

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“…40 Despite evidence in the literature suggesting that adult Indigenous people have lower spirometry values compared with their non-Indigenous counterparts, [12][13][14] including a report by de Hamel and Glass 44 dating back to 1975 comparing LFPs among New Zealand Māori and people of European descent, there appears to be an unprecedented gap in developing guidelines and recommendations in classifying AFL in the overall management COPD among Indigenous people globally. Although there is continued debate regarding which reference norms to use in specific populations, [45][46][47] in the Australian context it is recommended to use GLI-2012 'others/mixed' reference norms for the adult Indigenous population. 23 This study has demonstrated the potential effects of using these recommendations [23][24][25][26] for the classification of [48][49][50][51] In this study, we observed that the agreement between clinical diagnosis of COPD as per medical records entry Open access against spirometry criteria was only about 54%.…”

Section: Discussionmentioning

confidence: 99%

Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

et al. 2021

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BackgroundAssessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) are observed to be 20%–30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts.MethodsAdult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV1/FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV1 values (mild, moderate, severe, very severe) as per the recommended classifications.ResultsFrom a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%–43%), GOLD (33%–65%), GLI-2012 (18%–75%)). The FVC and FEV1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X ‘moderate’ AFL almost matching ‘severe’ AFL categorisation by GOLD or GLI-2012.ConclusionsHealth professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

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“…Another study suggested that changing from the Stanojevic to the GLI2012 reference equations caused an increase of 32% in the rate of AO [10]. However, the other studies showed a concordance of the diagnosis associated with AO when changing between the NHANES III and GLI2012 [10,12,16,17] due to the higher LLN value of the FEV1/FVC ratio in the Siriraj reference equation when compared to the GLI 2012 reference equations. Thus, the differences in the rate of diagnosis associated with AO between the two references equations are likely to have occurred when the ratio of FEV1/FVC was close to the LLNs values.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is some discordance in the interpretation of AO when changing from the ECSC [10,14,15], and the Stanojevic [10] to the GLI2012. In addition, changing from the NHANES III, the ECSC, and the Stanojevic to the GLI 12 prediction equations will lead to significant changes in the diagnosis of AO in patients with advanced age [10,16,17]. The effect of applying the GLI2012 equations to Thai people is still limited.…”

Section: Introductionmentioning

confidence: 99%

Effect of the Application of the Global Lung Initiative 2012 Spirometry Reference Equation on the Diagnosing and Classifying Degree of Airway Obstruction in Thai Adults Aged 40 to 80 Years Old

et al. 2019

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Background and objective: Changing to a different spirometry reference equation can result in misinterpretation of spirometric findings. Currently, there is limited data about any discordance between the interpretations of airway obstruction (AO) using the Global Lungs Initiative (GLI) 2012 and the currently employed Thai reference equations (Siriraj) in Thai adults. Therefore, this study aimed to determine differences in diagnosis around AO and classification of the severity of AO using the GLI2012 and Siriraj reference equations in Thai adults. Materials and Methods: We analyzed spirometric results from Thai adults aged 40–80 years old (n = 2084), which were collected at the Lung Health Center, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January 2005 and December 2015. The diagnoses concerning the AO were interpreted using the GLI2012 and Siriraj reference equations. The severity of AO in each case was classified into five grades, including mild, moderate, moderately severe, severe, or very severe. McNemar’s test was used to analyze differences in diagnosis of AO and classification of the level of severity. The Kappa statistic was used to determine agreements of diagnosis of AO and classification of severity between the two reference equations. Results: There were significant differences in both diagnosis of AO and their classifying severity level between the two reference equations (p-value < 0.001). However, the levels of agreement between the two reference equations were moderate to very good in different age and sex groups (Kappa values ranged from 0.62 to 0.78 for the diagnosis of AO and 0.54 to 0.89 for the classification of severity). Conclusions: Changing from the Siriraj to the GLI2012 reference equations underestimates the proportion of airway obstruction in Thai adults.

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A Comparison of Global Lung Initiative 2012 with Third National Health and Nutrition Examination Survey Spirometry Reference Values. Implications in Defining Obstruction

Cited by 14 publications

References 13 publications

Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city

Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city

Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

Effect of the Application of the Global Lung Initiative 2012 Spirometry Reference Equation on the Diagnosing and Classifying Degree of Airway Obstruction in Thai Adults Aged 40 to 80 Years Old

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