Changes in Measured Spirometric Indices

Pennock, Bernard E.; Rogers, Robert M.; McCaffree, D. R.

doi:10.1378/chest.80.1.97

Cited by 153 publications

(67 citation statements)

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“…Intersession variability of spirometry has been studied in normal adults and patients with COPD. In a meta-analysis including 73 patients, Pennock and colleagues found that week-to-week variability, expressed as percent change, was greater in patients with asthma or COPD than in normal patients, and recommended that a significant change was 12% in normal subjects and 23% in patients with obstructive disease (4). Another study showed that day-to-day FEV 1 must change by 17% in patients with chronic bronchitis to be significant, as compared with the 5% change needed in normal patients (17).…”

Section: Discussionmentioning

confidence: 99%

“…The current proposed ATS/European Respiratory Society guidelines for spirometry standardization recommend within-session reproducibility within 150 ml for FEV 1 and FVC (3). Small previous studies suggested that patients with COPD may have greater variability within and between spirometry test sessions than do individuals with normal lung function (4). Previous articles have reported the clinical predictors associated with variability in FEV 1 in the Lung Health Study (LHS) (5).…”

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confidence: 99%

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Variability of Spirometry in Chronic Obstructive Pulmonary Disease

Herpel

Kanner

Lee

et al. 2006

Am J Respir Crit Care Med

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Objective: Our goal is to determine short-term intraindividual biologic and measurement variability in spirometry of patients with a wide range of stable chronic obstructive pulmonary disease severity, using datasets from the National Emphysema Treatment Trial (NETT) and the Lung Health Study (LHS). This may be applied to determine criteria that can be used to assess a clinically meaningful change in spirometry. Methods: A total of 5,886 participants from the LHS and 1,215 participants from the NETT performed prebronchodilator spirometry during two baseline sessions. We analyzed varying criteria for absolute and percent change of FEV 1 and FVC to determine which criterion was met by 90% of the participants. Results: The mean Ϯ SD FEV 1 for the initial session was 2.64 Ϯ 0.60 L (75.1 Ϯ 8.8% predicted) for the LHS and 0.68 Ϯ 0.22 L (23.7 Ϯ 6.5% predicted) for the NETT. The mean Ϯ SD number of days between test sessions was 24.9 Ϯ 17.1 for the LHS and 85.7 Ϯ 21.7 for the NETT. As the degree of obstruction increased, the intersession percent difference of FEV 1 increased. However, the absolute difference between tests remained relatively constant despite the severity of obstruction (0.106 Ϯ 0.10 L). Over 90% of participants had an intersession FEV 1 difference of less than 225 ml irrespective of the severity of obstruction. Conclusions: Absolute changes in FEV 1 rather than percent change should be used to determine whether patients with chronic obstructive pulmonary disease have improved or worsened between test sessions. Keywords: forced expiratory volume; obstructive lung diseases; reproducibility of measurements; spirometry; vital capacity (Received in original form June 24, 2005; accepted in final form February 23, 2006 ) Supported by contract N01-HR-46002 from the Division of Lung Diseases, National Heart, Lung, and Blood Institute, and National Institutes of Health (The Lung Health Study). The National Emphysema Treatment Trial is supported by contracts with the National Heart, Lung, and Blood Institute (N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105, N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110, N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115, In patients with chronic obstructive pulmonary disease (COPD), spirometry, including FEV 1 and FVC, is a widely used measure of progression of disease and response to treatment. According to past American Thoracic Society (ATS) standards for spirometry, within-session reproducibility was considered to be 200 ml or a 5% change in FEV 1 , whichever is larger (1), based on data from the Third National Health and Nutrition Examination Survey (NHANES III) (2). The current proposed ATS/European Respiratory Society guidelines for spirometry standardization recommend within-session reproducibility within 150 ml for FEV 1 and FVC (3). Small previous studies suggested that patients with COPD may have greater variability within and between spirometry test sessions than do individuals with normal lung function (4). Previous articles have...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Variability of Spirometry in Chronic Obstructive Pulmonary Disease

Herpel

Kanner

Lee

et al. 2006

Am J Respir Crit Care Med

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“…The American Thoracic Society (ATS) acceptability and reproducibility criteria [7] were not applied in this population sample. However, for the purpose of the present study, subjects who did not meet the reproducibility criteria were excluded as individuals with asthma often have problems with reproducibility criteria [8].…”

Section: Methodsmentioning

confidence: 99%

Prediction equations for normal and low lung function from the Health Survey for England

Falaschetti¹,

Laiho²,

Primatesta³

et al. 2004

Eur Respir J

159

170

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The aim of this study was to derive new spirometric reference equations for the English population, using the 1995/1996 Health Survey for England, a large nationally representative cross-sectional study.The measurements used were the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of a sample of 6,053 "healthy" (nonsmokers with no reported diagnosis of asthma or respiratory symptoms) White people aged o16 yrs. Multiple regression analysis, with age and height as predictors, was carried out to estimate prediction equations for mean FEV1, FVC and FEV1/FVC, separately for males and females. A method based on smoothing multiple estimates of the fifth percentiles of residuals was used to derive prediction equations for the lower limit of normal lung function.The new equations fit the current English adult population considerably better than the European Coal and Steel Community equations, and the proportions of people with "low" (below the fifth percentile) lung function are closer to those expected throughout the whole adult age range (16 to w75 yrs). For the age ranges the studies share in common, the new equations give estimates close to those derived from other nonlinear equations in recent studies.It is, therefore, suggested that these newly developed prediction equations be used for the White English population in both epidemiological studies and clinical practice. Reference values, predicted for normal healthy nonsmokers, are generally used in epidemiological work as well as in clinical surveillance to determine low lung function and assess the effect of environmental exposure. A number of sets of prediction equations are currently available for different populations, with those most widely used based on relatively old studies [1][2][3][4].In 1995 and 1996, the general population Health Survey for England (HSE) had a focus on respiratory disease, and the lung function of respondents was measured. Use of European Coal and Steel Community (ECSC) reference values [4] for analysis in the published reports showed that these values were not predictive of normal lung function for the English population [5]. This poor fit for the ECSC reference values prompted the present study, to derive a new set of reference values based on the HSE 1995 and 1996 combined datasets. These newly derived reference values are presented here and compared with the ECSC and other recent reference values. MethodsThe design of the HSE, an annual nationwide household survey of the English population, has been described in detail elsewhere [6]. Briefly, members of a stratified random sample, sociodemographically representative of the English population, were invited to participate in 1995 and 1996. The mean response rate was w75% in both years, but slightly lower than average amongst males and in inner cities. Data on each respondent were collected during two visits, with identical methods used in 1995 and 1996: an interviewer9s visit, during which a questionnaire was administered and height and weight m...

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“…This tracheal growth is a process indicative of the airway growth that one would expect to accompany the increase in lung vol associated with the maturation component. We chose to investigate FEVl because of its reproducibility (20,21) and to avoid the possible effects of chest wall limitation on the complete expiration of the vital capacity. It is important to note, however, that FVC behaved essentially the same as FEVl (Table 3).…”

Section: Resultsmentioning

confidence: 99%

A Mathematical Procedure for Estimating the Spatial Relationships between Lung Function, Somatic Growth, and Maturation

et al. 1989

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ABSTRACT. A mathematical procedure is described for examining growth velocity rates of lung function (FEVI) in relationship to somatic growth and maturation. This procedure uses a polynomial smoothing spline model to yield a fitted curve through the data and to estimate the process first derivatives (i.e. growth velocity curves). We demonstrate this technique using data from children and adolescents enrolled in the Tucson Epidemiological Study of Airway Obstructive Diseases. The study group consisted of 772 healthy normal subjects, aged 3 to 25 y. The results for the normal subjects (male and female) indicate that the growth velocity peak (GVP) of somatic growth leads the GVP of functional growth (FEVI) by approximately 7 and 11 mo for females and male subjects, respectively, and that the GVP of maturation lags behind that of functional growth (FEVI) by approximately 1 y (male and female subjects). In addition, the normal subjects' growth velocity curves for FVC and FEVl/FVC were examined. The FEVI/ FVC ratio was consistently high, and its growth velocity was not significantly different than 0 over the age range studied. This suggests that in normal children, the GVP seen in FEVl is primarily due to a GVP in vital capacity or lung vol, rather than to a direct effect on expiratory flow rates alone. From this study we concluded that the polynomial smoothing spline procedure can adequately model the inherently noisy pulmonary function data and additionally yield an accurate estimate of the process first derivative. (Pediatr Res 25:316-321, 1989) Abbreviations FVC, forced vital capacity FEVI, forced expired volume in one second SG, somatic growth M, maturation GVP, growth velocity peakThe relationships between lung function and anthropometric growth in adolescents have been studied by several investigators (1-9). Although some reports have focused on the reproducibility of lung function and anthropometric variables (6) thoracic growth and stature (2,3,5,6). The latter studies have all reported an apparent lag time between growth in stature and subsequent growth in lung function. That is to say, increases in lung function continue to occur for at least 1 y after cessation of increase in stature. These results were also suggested by Simon et al. (8), who showed that the growth spurt for lung length (determined from chest radiographs) occurred 6 mo after that for standing height, for males and females ages 6-15 y. The two major contributing factors of functional lung development are: I ) SG assessed by a power function of height, which as mentioned above, leads functional growth; and 2) M, which we propose lags behind the functional growth component. For our purposes, lung M is defined as that portion of functional lung development which is not directly related to changes in SG. An estimate of M is then determined as that portion of the observed FEVl not predicted, using a power function of simple allometry. This approach assumes that FEV1 growth can be described by a simple allometry model and that any deviations f...

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Changes in Measured Spirometric Indices

Cited by 153 publications

References 5 publications

Variability of Spirometry in Chronic Obstructive Pulmonary Disease

Variability of Spirometry in Chronic Obstructive Pulmonary Disease

Prediction equations for normal and low lung function from the Health Survey for England

A Mathematical Procedure for Estimating the Spatial Relationships between Lung Function, Somatic Growth, and Maturation

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