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Published ahead of print on November 15, 2007, doi:10.1164/rccm.200708-1248OC
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American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 253-260, (2008)
© 2008 American Thoracic Society
doi: 10.1164/rccm.200708-1248OC

Original Article

Reference Ranges for Spirometry Across All Ages

A New Approach

Sanja Stanojevic1,2, Angie Wade1, Janet Stocks2, John Hankinson3, Allan L. Coates4, Huiqi Pan1, Mark Rosenthal5, Mary Corey4, Patrick Lebecque6 and Tim J. Cole1

1 Medical Research Council Centre of Epidemiology for Child Health, and 2 Portex Respiratory Unit, University College London Institute of Child Health, London, United Kingdom; 3 Hankinson Consulting, Valdosta, Georgia; 4 Department of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada; 5 Royal Brompton Hospital, London, United Kingdom; and 6 Pediatric Pulmonology and Cystic Fibrosis Unit, Cliniques St. Luc, Université Catholique de Louvain, Brussels, Belgium

Correspondence and requests for reprints should be addressed to Sanja Stanojevic, M.Sc., Portex Respiratory Physiology Unit, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK. E-mail: s.stanojevic{at}ich.ucl.ac.uk

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.

Key Words: spirometry • pulmonary function • reference values


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
Accurate interpretation of lung function tests relies on reference ranges which distinguish the effects of disease from growth and development. Limited data from young children limit the accuracy with which early lung disease may be identified.

What This Study Adds to the Field
These extended models provide more accurate reference ranges for spirometry with transition into adulthood and also incorporate age-related differences in between-subject variability, improving the definition of lower limits of normal.

 



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