Editorial
New Spirometric Reference Values
Nuevos valores espirométricos de referencia
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Gáldiz, Juana Martinez Llorens" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Juan B." "apellidos" => "Gáldiz" "email" => array:1 [ 0 => "juanbautista.galdiziturri@osakidetza.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juana" "apellidos" => "Martinez Llorens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Laboratorio de Exploración Funcional, Servicio de Neumología Ciberes, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital del Mar-IMIM, Parc de Salut Mar, Dep. CEXS, UPF, Ciberes ISCII, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevos valores espirométricos de referencia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Spirometry is an essential technique in the study of patients with respiratory symptoms, both in the hospital setting and in primary care, where its use has become widespread in recent years.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The parameters for lung function tests have large interindividual variability and, unlike other biological variables, depend on the patients’ anthropometric characteristics (sex, age, height, weight, and race). Spirometry interpretation is usually based on comparing the values produced by the patient with those that would theoretically correspond to a healthy individual with the same anthropometric characteristics, the theoretical values. This theoretical or reference value is obtained from prediction equations, in which a fixed value of 80% of the predicted value has been used as the limit of normal. Although this figure is close to the 5th percentile in subjects of average age and stature, if subjects fall outside the normal range for age or height, this fixed value may classify them incorrectly.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Alternatively, the results can be expressed in relation to the expected range, using the lower limit of normal (LLN) equivalent to the 5th percentile as the cut-off point. If they are not included in the prediction equations provided by the spirometers, the percentiles can be calculated using the estimated standard error (SE) of the equation. The LLN is equal to the predicted value minus the result of 1.645×SE.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Recently, authors like Quanjer et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who initially formed the <span class="elsevierStyleItalic">Global Lung Function Initiative</span> (GLI 2012) before subsequently becoming the <span class="elsevierStyleItalic">Task Force</span> (ERS), published reference values that are intended to derive prediction equations and LLN which are applicable at world level and for population groups between 3 and 95 years old. More than 160<span class="elsevierStyleHsp" style=""></span>000 data points from 72 centres in 33 countries were evaluated. Finally, 97<span class="elsevierStyleHsp" style=""></span>759 records from healthy non-smokers (55.3% females) aged between 2.5 and 95 years, who met standardised measurement conditions with well-documented data on the equipment and software used, were analysed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After discarding 23<span class="elsevierStyleHsp" style=""></span>572 records, mostly because they could not be included in defined ethnic or geographic groups, reference equations were obtained for healthy individuals aged between 3 and 95 years for Caucasians (n=57<span class="elsevierStyleHsp" style=""></span>395), African-Americans (n=3545), and North and South East Asians (n=4992 and n=8255, respectively). Of the total number of subjects originally included in the study, 47.7% were in the age range <20 years and 0.8% in the age range >80 years.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study by Quanjer et al. is an attempt to standardise subjects into single reference ranges that can be used regardless of ethnicity or age. The current difficulties in standardising evaluation criteria and classification of patients according to the spirometric values obtained are well known, as they can vary substantially according to the theoretical values used or evaluation criteria employed, by predicted value or LLN. There are a few studies<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> that have evaluated populations other than Caucasian, and have correctly determined the LLN in these populations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This study has helped to determine the differences between the different ethnic groups with respect to their spirometric values. The authors found that the forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s (FEV1) and forced vital capacity (FVC) values differ in their lower limit values in ethnic groups other than Caucasian, in similar proportions for both parameters, so that the FEV1/FVC is independent of the ethnic group, which is important when determining normal levels, as other authors have learned.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The use of predicted values implies significant restrictions in patients outside the normal range with limitations when assessing the bias involved in growth changes in relation to age changes, which can cause errors especially in the young population.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It has been observed that for the same height and sex, a one year difference in age can alter the predicted valued by 8.5% in subjects aged under 20 years. Stature is a determining factor in the determination of lung function, with a major influence in the preschool age group, where very large coefficients of variation that decline in adolescence are observed, with a subsequent decrease in this variation in the third decade until stabilisation towards old age. This implies a pattern in which the FEV1/FVC, instead of decreasing steadily from childhood to adolescence, increases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">It has been observed that the non-Caucasian population have lower values, which means that falls over time are 15% smaller in the African-American population than in Caucasian males of the same age and height.</p><p id="par0055" class="elsevierStylePara elsevierViewall">With respect to non-Caucasian ethnic groups, the Latin American population should be mentioned. The authors assume that this is a population with difficulties associated with factors such as height, body morphology and the fact that this group tends to be a mix of people of Spanish descent and the indigenous population, which leads to a diversity of populations that limits the usefulness of these reference values in the Latin American population of non-European descent.</p><p id="par0060" class="elsevierStylePara elsevierViewall">With respect to the presentation of results, the authors agree on the need to express the results using the LLN. They make reference to the general use of 80% of the predicted value as the LLN, which implies a potential error, as this ratio varies considerably with age and leads to misclassification.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> A value outside the normal range, defined as the mean±SE (1.96) is compatible with disease. Both the <span class="elsevierStyleItalic">American Thoracic Society</span> (ATS) and the <span class="elsevierStyleItalic">European Respiratory Society</span> (ERS) accept the use of the 5th percentile to define this LLN, which unlike the percentage of the predicted, is free from bias due to age, height, sex or ethnic group. However, the authors observed that a substantial percentage of subjects (±10.4%) have values lower than the 5th percentile. The authors suggest the possibility of using the 2.5th percentile in epidemiological studies and using the 5th percentile where there is evidence or suspicion of disease in a clinical context.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The authors confirm international society (ATS/ERS) criteria with respect to limiting the use of a parameter such as the FEF 25%–75% as a diagnostic value, as it has intra-individual variations, both its own and others attributable to variations in the FVC, the parameter on which it depends.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary, it can be concluded that the <span class="elsevierStyleItalic">Global Lung Function Initiative</span> (GLI2012) is a real approximation to achieving uniformity when evaluating spirometry results that aims to be useful in all geographical areas and likewise attempts to standardise the expression of results. As the authors agree, this initiative needs further study in ethnic groups that are not clearly represented, and in those age ranges with a small population, where the application of theoretical reference values presents major difficulties.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The publication of this article will probably lead both medical professionals and manufacturers to enter these theoretical values in their equipment in the coming years. It is likely that in the near future, these values will be considered for common use for the performance and interpretation of spirometry tests carried out in any setting.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gáldiz JB, Martinez Llorens J. Nuevos valores espirométricos de referencia. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 70 | 22 | 92 |
| 2024 September | 55 | 17 | 72 |
| 2024 August | 86 | 45 | 131 |
| 2024 July | 54 | 27 | 81 |
| 2024 June | 57 | 35 | 92 |
| 2024 May | 70 | 44 | 114 |
| 2024 April | 45 | 32 | 77 |
| 2024 March | 33 | 16 | 49 |
| 2024 February | 29 | 26 | 55 |
| 2023 July | 16 | 2 | 18 |
| 2023 May | 1 | 0 | 1 |
| 2023 March | 4 | 4 | 8 |
| 2023 February | 31 | 18 | 49 |
| 2023 January | 23 | 31 | 54 |
| 2022 December | 34 | 26 | 60 |
| 2022 November | 43 | 21 | 64 |
| 2022 October | 38 | 33 | 71 |
| 2022 September | 38 | 30 | 68 |
| 2022 August | 40 | 41 | 81 |
| 2022 July | 31 | 38 | 69 |
| 2022 June | 30 | 27 | 57 |
| 2022 May | 32 | 33 | 65 |
| 2022 April | 40 | 23 | 63 |
| 2022 March | 54 | 46 | 100 |
| 2022 February | 32 | 30 | 62 |
| 2022 January | 52 | 33 | 85 |
| 2021 December | 42 | 44 | 86 |
| 2021 November | 47 | 40 | 87 |
| 2021 October | 43 | 58 | 101 |
| 2021 September | 38 | 55 | 93 |
| 2021 August | 286 | 26 | 312 |
| 2021 July | 30 | 31 | 61 |
| 2021 June | 32 | 39 | 71 |
| 2021 May | 32 | 43 | 75 |
| 2021 April | 50 | 76 | 126 |
| 2021 March | 49 | 26 | 75 |
| 2021 February | 24 | 22 | 46 |
| 2021 January | 23 | 16 | 39 |
| 2020 December | 37 | 11 | 48 |
| 2020 November | 23 | 12 | 35 |
| 2020 October | 10 | 14 | 24 |
| 2020 September | 22 | 6 | 28 |
| 2020 August | 21 | 13 | 34 |
| 2020 July | 28 | 15 | 43 |
| 2020 June | 17 | 2 | 19 |
| 2020 May | 28 | 11 | 39 |
| 2020 April | 31 | 16 | 47 |
| 2020 March | 33 | 12 | 45 |
| 2020 February | 33 | 11 | 44 |
| 2020 January | 34 | 12 | 46 |
| 2019 December | 40 | 15 | 55 |
| 2019 November | 36 | 14 | 50 |
| 2019 October | 33 | 14 | 47 |
| 2019 September | 23 | 15 | 38 |
| 2019 August | 23 | 13 | 36 |
| 2019 July | 44 | 13 | 57 |
| 2019 June | 28 | 7 | 35 |
| 2019 May | 37 | 11 | 48 |
| 2019 April | 62 | 16 | 78 |
| 2019 March | 61 | 31 | 92 |
| 2019 February | 32 | 23 | 55 |
| 2019 January | 26 | 13 | 39 |
| 2018 December | 37 | 24 | 61 |
| 2018 November | 57 | 23 | 80 |
| 2018 October | 76 | 24 | 100 |
| 2018 September | 29 | 14 | 43 |
| 2018 May | 16 | 2 | 18 |
| 2018 April | 35 | 18 | 53 |
| 2018 March | 23 | 18 | 41 |
| 2018 February | 28 | 9 | 37 |
| 2018 January | 21 | 16 | 37 |
| 2017 December | 21 | 11 | 32 |
| 2017 November | 42 | 7 | 49 |
| 2017 October | 34 | 16 | 50 |
| 2017 September | 39 | 20 | 59 |
| 2017 August | 54 | 20 | 74 |
| 2017 July | 55 | 12 | 67 |
| 2017 June | 59 | 28 | 87 |
| 2017 May | 41 | 20 | 61 |
| 2017 April | 33 | 12 | 45 |
| 2017 March | 39 | 29 | 68 |
| 2017 February | 29 | 12 | 41 |
| 2017 January | 18 | 12 | 30 |
| 2016 December | 45 | 11 | 56 |
| 2016 November | 120 | 13 | 133 |
| 2016 October | 138 | 18 | 156 |
| 2016 September | 66 | 22 | 88 |
| 2016 August | 64 | 12 | 76 |
| 2016 July | 32 | 10 | 42 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 59 | 3 | 62 |
| 2015 September | 61 | 14 | 75 |
| 2015 August | 54 | 9 | 63 |
| 2015 July | 69 | 14 | 83 |
| 2015 June | 31 | 6 | 37 |
| 2015 May | 58 | 17 | 75 |
| 2015 April | 39 | 14 | 53 |
| 2015 March | 31 | 7 | 38 |
| 2015 February | 53 | 7 | 60 |
| 2015 January | 37 | 9 | 46 |
| 2014 December | 31 | 8 | 39 |
| 2014 November | 59 | 13 | 72 |
| 2014 October | 58 | 18 | 76 |
| 2014 September | 47 | 11 | 58 |
| 2014 August | 47 | 16 | 63 |
| 2014 July | 40 | 10 | 50 |
| 2014 June | 57 | 11 | 68 |
| 2014 May | 52 | 16 | 68 |
| 2014 April | 45 | 10 | 55 |
| 2014 March | 70 | 12 | 82 |
| 2014 February | 47 | 10 | 57 |
| 2014 January | 36 | 13 | 49 |
| 2013 December | 3 | 2 | 5 |
| 2013 November | 0 | 2 | 2 |
| 2013 October | 4 | 2 | 6 |
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