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Spirometry Centile Charts for Young Caucasian Children

The Asthma UK Collaborative Initiative

¹ Portex Unit, Respiratory Physiology and Medicine, Institute of Child Health, University College London, London; ² Medical Research Council, Center of Epidemiology for Child Health, Institute of Child Health, University College London, London; ³ University of Manchester and National Institute of Health Research Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester, Manchester; ⁴ Child Health, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; ⁵ Respiratory Medicine, Princess Margaret Hospital and School of Paediatric and Child Health, University of Western Australia, Perth, Australia; ⁶ Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; ⁷ Lung Function Laboratory, Hôpital Sainte Marguerite, Marseille, France; ⁸ Department of Pediatrics, North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ⁹ Academic Child Health, University of Aberdeen, Aberdeen, Scotland; ¹⁰ Pneumology, National Health Service, Turin, Italy; ¹¹ Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel Aviv, Israel; ¹² Section of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; ¹³ Division of Respiratory Medicine, Department of Pediatrics, Center Hospitalier Universitaire de Sherbrooke-Hôpital Fleurimont, University of Sherbrooke, Sherbrooke, Canada; ¹⁴ State Key Laboratory of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; ¹⁵ Department of Physiopathology of the Respiratory System, Institute for Tuberculosis and Lung Diseases, Rabka Branch, Rabka, Poland; ¹⁶ Division of Pediatric Pulmonary, Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; and ¹⁷ Hankinson Consulting, Inc., Valdosta, Georgia

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

Rationale: Advances in spirometry measurement techniques have made it possible to obtain measurements in children as young as 3 years of age; however, in practice, application remains limited by the lack of appropriate reference data for young children, which are often based on limited population-specific samples.

Objectives: We aimed to build on previous models by collating existing reference data in young children (aged 3–7 yr), to produce updated prediction equations that span the preschool years and that are also linked to established reference equations for older children and adults.

Methods: The Asthma UK Collaborative Initiative was established to collate lung function data from healthy young children aged 3 to 7 years. Collaborators included researchers with access to pulmonary function test data in healthy preschool children. Spirometry centiles were created using the LMS (, µ, ) method and extend previously published equations down to 3 years of age.

Measurements and Main Results: The Asthma UK centile charts for spirometry are based on the largest sample of healthy young Caucasian children aged 3–7 years (n = 3,777) from 15 centers across 11 countries and provide a continuous reference with a smooth transition into adolescence and adulthood. These equations improve existing pediatric equations by considering the between-subject variability to define a more appropriate age-dependent lower limit of normal. The collated data set reflects a variety of equipment, measurement protocols, and population characteristics and may be generalizable across different populations.

Conclusions: We present prediction equations for spirometry for preschool children and provide a foundation that will facilitate continued updating.

Key Words: spirometry • pulmonary function tests • reference values • preschool

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Preschool lung function testing is relatively novel and clinical use of spirometry in this age group is further limited by the lack of appropriate reference data. What This Study Adds to the Field The Asthma UK Collaborative Initiative has collated all available reference data for spirometry in young children. These data have been used to produce reference equations that may improve interpretation of spirometry in early childhood.