The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Maio, Sara; Sherrill, Duane L.; MacNee, William; Lange, Peter; Costabel, Ulrich; Dahlén, Sven Erik; Sybrecht, Gerhard W.; Burghuber, Otto Chris; Stevenson, Robin; Tønnesen, Philip; Haeußinger, Karl; Hedlin, Gunilla; Bauer, Torsten T.; Riedler, Josef; Nicod, Laurent P.; Carlsen, Kai Håkon; Viegi, Giovanni

doi:10.1183/09031936.00111910

Cited by 27 publications

(23 citation statements)

References 37 publications

(57 reference statements)

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“…Although our study protocol for intervention in Chinese patients with early COPD has been published (24), the accuracy of diagnosis for COPD with the fixed 0.7 of FEV 1 /FVC is still questioned. Instead, LLNs were suggested to provide more accurate diagnosis in Caucasians (33). The controversy that whether the LLN or the fixed 0.7 is better for clinical practice still needs further longitudinal study to clarify.…”

Section: Comparisons With Previous Reference Values Derived From Chinesementioning

confidence: 99%

Reference values for spirometry in Chinese aged 4–80 years

et al. 2017

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Chinese measured spirometry data. The present study also compared with other published Chinese equations for spirometry. Results: A total of 7,115 eligible individuals aged 4 to 80 years (50.9% females) were recruited. Reference equations against age and height by gender were established, including predicted values and lower limits of normal (LLNs). Validated with Chinese data, the mean percentage differences of Caucasian reference values adjusted with ethnic conversion factors were −10.2% to 1.8%, and the percentages of total subjects under LLNs were 0.1% to 8.9%. Compared with this study, the percentage differences of previous Chinese studies ranged from −17.8% to 11.4%, which were found to significantly overestimate or underestimate lung IntroductionSpirometry has been widely used for diagnosing respiratory diseases, quantifying disease severity, and assessing disease prognosis (1,2). Accurate interpretation of spirometry requires appropriate reference values derived from its own ancestry population (3), including lower limits of normal (LLNs), which could be helpful for assessment of abnormal pulmonary function in patients with pulmonary diseases.There are over 40 million overseas Chinese (4) and 1.3 billion mainland Chinese (5) in the world (about 22% of the global population), indicating the huge medical demand (6). Embarrassingly, standardized nationwide spirometric reference values for Chinese were unavailable.In 2012, Global Lung Function Initiative (3) recommended multi-ethnic reference values for African-Americans, Southeast Asians (SEA-GLI2012) and Northeast Asians (NEA-GLI2012), which were largely established with Caucasian data and adjusted with fixed ethnic conversion factors in the whole age range. In addition, other Caucasian reference values adjusted with fixed ethnic conversion factors were also applied in China (7,8), such as European Committee of Steel and Coal equations adjusted for Chinese with the suggestion of Zheng et al. (Chinese-ECSC1993) (9,10), and the third national health and nutrition examination surveys equations adjusted with 0.88 times for Asian-American (Asian-NHANESIII 0.88) (11,12). Given the dynamic changes of gene, economic, environment, nutrition and et al., it remains unknown whether those fixed ethnic conversion factors reliably reflect the difference of spirometry between Caucasians and Chinese.Although several spirometric reference values for Chinese have been published (13-22), the major disadvantages in these studies limited the nationwide use, including small samples, limited age ranges, small local regions, as well as different study protocols and quality control. Without LLNs for nationwide Chinese, a fixed 0.7 of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) instead of LLNs was frequently applied for the diagnosis of "airflow limitation" in previous studies (7,23,24), leading possible underdiagnosis in younger subjects and over diagnosis in elderly. Moreover, In the nationwide questionnaire surveys on clinical application of pulmon...

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Section: Comparisons With Previous Reference Values Derived From Chinesementioning

confidence: 99%

Reference values for spirometry in Chinese aged 4–80 years

et al. 2017

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“…Five studies were conducted in multiple sites. They included the BOLD study [40], European Community of Respiratory Health Survey (ECRHS) [113], the PLATINO study in Latin America [23] and two other studies in Europe [61,89].…”

Section: Study Characteristicsmentioning

confidence: 99%

Global and regional estimates of COPD prevalence: Systematic review and meta–analysis

Rudan¹,

Chua²,

Lee³

et al. 2015

Journal of Global Health

963

593

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Section: @Erspublicationsmentioning

confidence: 99%

“…Consequently, a suitable alternative to spirometry has yet to be discovered. Spirometry is simple, inexpensive, and remains the best practical method for use in early detection and screening of undiagnosed airflow obstruction [16].The rationale for identifying subjects with previously undiagnosed COPD and for early diagnosis of COPD in subjects at risk is that it would benefit the patient, either because symptoms and quality of life would be improved, exacerbations and complications would be limited, and survival would be enhanced, or because …”

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confidence: 99%

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

2014

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@ERSpublicationsEarly screening of chronic diseases and COPD needs attention in the elderly population to properly assess management http://ow.ly/ACbi3The working hypotheses for screening and early diagnosis of chronic obstructive pulmonary disease (COPD) have been that: 1) long-term exposure to cigarette smoke or pollutants damages the airways and/or the lungs, and causes airflow obstruction [1, 2]; 2) airflow obstruction occurs primarily in the small airways, is asymptomatic in the early stages of the disease and is progressive in the majority of COPD patients [1][2][3][4]; and 3) forced expiratory volume in 1 s (FEV1) and its ratio with forced vital capacity are necessary in establishing the diagnosis of COPD, and in assessing the excessive decline in lung function [1], but are of little use, if any, in making the early, pre-symptomatic diagnosis of COPD [5].These working hypotheses have been helpful in stimulating research in the field of structure-function relationships in the lung, and particularly in defining the role of airway and lung inflammation in the development of central and peripheral airway remodelling and emphysema [2, 3,6]. Research focused on the respiratory system has also brought about the development of physiological and imaging methods to assess peripheral airways and lung parenchyma [7][8][9], and has furthered understanding of the natural history of COPD, particularly the progressive decline in lung function and its modulation by pharmacological intervention [10]. Thanks to the results of these studies, we now know much more about COPD, about the potential and limitations of screening [11] and early diagnosis based on spirometry, and about interventions in early asymptomatic and newly discovered COPD.Screening subjects at risk, such as smokers, workers and populations exposed to environmental pollution, with serial measurements of FEV1 has been shown to identify COPD at an early stage, with a diagnostic yield that is significant even in asymptomatic individuals [12]. Studies including measurement of small airway function, though inconclusive, have been used in an attempt to identify more subtle changes in airway function, without success [5,13]. Novel imaging methods [8,9] and biomarker profiles [14,15] show promise, but we are not there yet. Consequently, a suitable alternative to spirometry has yet to be discovered. Spirometry is simple, inexpensive, and remains the best practical method for use in early detection and screening of undiagnosed airflow obstruction [16].The rationale for identifying subjects with previously undiagnosed COPD and for early diagnosis of COPD in subjects at risk is that it would benefit the patient, either because symptoms and quality of life would be improved, exacerbations and complications would be limited, and survival would be enhanced, or because

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The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Cited by 27 publications

References 37 publications

Reference values for spirometry in Chinese aged 4–80 years

Reference values for spirometry in Chinese aged 4–80 years

Global and regional estimates of COPD prevalence: Systematic review and meta–analysis

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

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