Effect of changing from the National Health and Nutritional Examination Survey III spirometry reference range to that of the Global Lung Initiative 2012 at Gold Coast Hospital and Health Service

Abstract

The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National with a TRVD pattern, and 11 (3.7%) with a mixed pattern. When the spirometry data were interpreted using the GLI 2012 equations 2 (0.7%) individuals changed from OVD to NVP, 2 (0.7%) changed from NVP to OVD and 14 (4.7%) changed from TRVD to NVP. Using the GLI 2012 reference range resulted in a change in diagnosis of lung disease in 5.9% of the individuals included in this study. This variance in diagnosis when changing reference ranges should be taken into account by clinicians as it may affect patient management.

Effect of changing reference equations for spirometry interpretation in Thai people

“…Our results are comparable to previous findings demonstrating that the rates of severity classification of AO were changed when changing from the Korean (Lee and Choi) to Caucasian (Morris and Knudson) reference equations (15). Other studies also showed that the rates of severity classification were changed when changing from the NHANES III to the GLI2012 reference equations in a Caucasian population (21,24).…”

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

“…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.…”

“…The GLI 2012 has also been recommended for use in every country, including Thailand. Previous studies have shown a concordance in the diagnosis associated with AO when using the GLI2012 and the Third National Health and Nutrition Examination Survey (NHANES III) [10,11,12,13], the European Community for Steel and Coal (ECSC) [11], and the Zapletal [14]. 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.…”

Validation of the GLI‐2012 spirometry reference equations in Argentinian children

“…The Global Lung Function Initiative (GLI) has produced spirometry reference equations for use in different ethnic groups from early childhood to the elderly years . Previous reports have shown that the GLI equations do not adequately describe lung function in all populations and that adopting the new equations into clinical practice can increase the number of patients considered to have abnormal lung function . Therefore, before adopting these equations into local practice, especially in communities not included in the GLI project, it is necessary to establish how well the equations represent the local population …”

“…2 Previous reports have shown that the GLI equations do not adequately describe lung function in all populations 3,4 and that adopting the new equations into clinical practice can increase the number of patients considered to have abnormal lung function. 5 Therefore, before adopting these equations into local practice, especially in communities not included in the GLI project, it is necessary to establish how well the equations represent the local population. 6 The present study was conducted to determine how well the GLI spirometry reference equation represented the young children in Argentina, a population not included in the GLI dataset, and to determine whether adoption of these equations would lead to misrepresentation of lung disease in local children.…”