Reference Ranges for Spirometry Across All Ages

Abstract

Rationale: The Third National Health and Nutrition Examination Survey (NHANES III) reference is currently recommended for interpreting spirometry results, but it is limited by the lack of subjects younger than 8 years and does not continuously model spirometry across all ages. Objectives: By collating pediatric data from other large-population surveys, we have investigated ways of developing reference ranges that more accurately describe the relationship between spirometric lung function and height and age within the pediatric age range, and allow a seamless transition to adulthood. Methods: Data were obtained from four surveys and included 3,598 subjects aged 4-80 years. The original analyses were sex specific and limited to non-Hispanic white subjects. An extension of the LMS (lambda, mu, sigma) method, widely used to construct growth reference charts, was applied. Measurements and Main Results: The extended models have four important advantages over the original NHANES III analysis as follows: (1) they extend the reference data down to 4 years of age, (2) they incorporate the relationship between height and age in a way that is biologically plausible, (3) they provide smoothly changing curves to describe the transition between childhood and adulthood, and (4) they highlight the fact that the range of normal values is highly dependent on age. Conclusions:The modeling technique provides an elegant solution to a complex and longstanding problem. Furthermore, it provides a biologically plausible and statistically robust means of developing continuous reference ranges from early childhood to old age. These dynamic models provide a platform from which future studies can be developed to continue to improve the accuracy of reference data for pulmonary function tests.

Lung function after preterm birth: development from mid-childhood to adulthood

“…BPD, bronchopulmonary dysplasia; EP, subjects born extreme preterm (ie, gestational age ≤28 weeks or birth weight ≤1000 g); FEF , forced expiratory flow at 25-75% of FVC; FEV 1 , forced expiratory volume in 1 s; FVC, forced vital capacity; m/s BPD, moderate/severe BPD (ie, oxygen supplement at gestational age 36 weeks); mild BPD, oxygen supplement at 28 postnatal days; z Score, (observed value − expected value)/(SE of the expected value), calculated with the all-age reference equation. 17 the NICU. Subjects were retrospectively included in 2001, but the organisation of medical care in the region and identical algorithms for determination of gestational age at birth ensured that recruitment would have been the same if performed prospectively.…”

“…16 Forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and forced expiratory flow at 25-75% of FVC (FEF ) were recorded and standardised to z scores and percentages of predicted using the all-age reference equation, correcting raw data for differences in age, sex and height. 17 …”

Pulmonary function impairment after trachea‐esophageal fistula: A minor role for gastro‐esophageal reflux disease

“…(10) TEF patients with a history of GERD were more likely to have pulmonary function abnormalities and many authors have suggested that GERD in the first years after TEF repair may play a major role in TEF-associated pulmonary pathology. (7;8;11-13) The purpose of this study was to assess the influence of GERD on pulmonary function and exercise capacity in a group of patients aged [8][9][10][11][12][13][14][15][16][17][18] years, who had undergone neonatal surgical repair of TEF. We categorized TEF in two groups: those who had undergone anti-reflux surgery (and consequently were considered to have had severe GERD (s-GERD)) and those who had not (considering to have had mild GERD).…”

Relationship between frailty and respiratory function in the community-dwelling elderly

“…The disappearance of synovial joints between the sternum and the costal cartilages decreases the chest-wall compliance and tension forces, with consequent decrease in maximal respiratory pressure and hypotrophy of accessory respiratory muscles [7][8][9] .…”

“…These changes, associated with respiratory infections and frequent exposure to stressors, such as toxic particles from the environment and smoking, can lead to airflow limitation, which is defined by a decrease in the ratio between forced expiratory volume (FEV 1 ) and forced vital capacity (FVC), and may be accompanied by an increase in residual volume and functional residual capacity [7][8][9] .…”