Interpretation of pediatric lung function: Impact of ethnicity

Abstract

SUMMARY Rationale To evaluate the appropriateness of spirometric and plethysmographic reference equations in healthy young children according to ethnic origin. Methods Spirometry data were collated in 400 healthy children (214 Black and 186 White) aged 6 to 12 years. Of these children, 68 Black and 115 White children also undertook plethysmography. Results were expressed as percent predicted according to commonly used equations for spirometry and plethysmography. Results Black children had lower lung function for a given height compared to White children. The magnitude and direction of these differences varied according to specific outcome. In the studied age range (6–12yrs) the ethnic-specific Wang equations were adequate for spirometry (mean results approximating 100% predicted in both ethnic groups). By contrast, significant differences were found between observed and % predicted plethysmographic lung volumes according to published equations derived from White children: Among the Black children, FRC and TLC for were, on average, 14% and 6% lower than predicted, whereas mean RV and RV/TLC were 4% and 10% higher. Among White children, the Rosenthal equations gave the best fit, with the exception of FRC which was, on average, 9% lower than predicted. Conclusion Spirometry equations may suffice in Black children; however interpretation of static lung volumes in Black children is limited due to inappropriate reference equations. More appropriate plethysmographic reference equations that are applicable to all ethnic groups across the entire age range are urgently needed.

Lung function, transfusion, pulmonary capillary blood volume and sickle cell disease

“…Patients were diagnosed with an obstructive abnormality if their FEV1:FVC was less than the lower limit of normal (LLN) (Pellegrino et al, 2005), based on the ethnic specific reference range of Quanjer et al A restrictive abnormality was diagnosed if the TLC was below the LLN (Pellegrino et al, 2005) based on the reference range of Rosenthal et al, with a −12% correction factor applied (Kirkby et al, 2013). A mixed abnormality was diagnosed if the TLC and FEV1/VC were less than the LLNs (Pellegrino et al, 2005).…”

Environmental Tobacco Smoke and Airway Obstruction in Children With Sickle Cell Anemia

“…Linear regression models examined the association between ETS exposure and lung function (with data expressed as % predicted values based on age, sex, height, and race 19,22 ). Logistic regression models were used to examine associations between ETS and airway obstruction and bronchodilator responsiveness.…”

Airway and alveolar nitric oxide production, lung function, and pulmonary blood flow in sickle cell disease

“…Forced expiratory volume in 1 s (FEV 1 ), VC, mean maximum expiratory flow (FEF [25][26][27] ), TLC, residual volume, transfer factor for carbon monoxide (DLCO), and transfer coefficient (K CO ) were assessed and the results expressed as the percent predicted for height (30,31). Ethnic-specific reference equations were not available for static lung volumes or gas transfer; therefore the predicted values were adjusted using appropriate correction factors (32). The transfer factor for nitric oxide (DLNO) was obtained by the addition of 40 ppm NO to the inspired gas mixture prior to commencing the single-breath DLCO measurement (33).…”