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Published ahead of print on November 15, 2007, doi:10.1164/rccm.200708-1248OC

Am. J. Respir. Crit. Care Med., Volume 177, Number 3, February 2008, 253-260

A more recent version of this article appeared on February 1, 2008
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Submitted on August 23, 2007
Accepted on November 14, 2007

Reference Ranges for Spirometry Across All Ages: A New Approach

Sanja Stanojevic1*, Angie Wade2, Janet Stocks3, John Hankinson4, Allan Coates5, Huiqi Pan2, Mark Rosenthal6, Mary Corey5, Patrick Lebecque7, and Tim J Cole2

1 MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom; Portex Respiratory Unit, UCL Institute of Child Health, London, United Kingdom, 2 MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom, 3 Portex Respiratory Unit, UCL Institute of Child Health, London, United Kingdom, 4 Hankinson Consulting, Minneapolis, MN, USA, 5 Department of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada, 6 Royal Bromptom Hospital, London, United Kingdom, 7 Pediatric Pulmonology and Cystic Fibrosis Unit, Cliniques St Luc, Universite Catholique de Louvain, Brussels, Belgium

* To whom correspondence should be addressed. E-mail: s.stanojevic{at}ich.ucl.ac.uk.

Rationale: The NHANES III reference is currently recommended for interpreting spirometry results, but it is limited by the lack of subjects below 8 years of age 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, height and age within the pediatric age range and allow a seamless transition to adulthood. Methods: Data were obtained from four surveys and included 3598 subjects aged 4-80 years. The original analyses were sex specific and limited to non-Hispanic Caucasian subjects. An extension of the LMS method, widely used to construct growth reference charts, was applied. Results: The extended models have three important advantages over the original NHANES III analysis in that they: 1) extend the reference data down to 4 years of age, 2) incorporate the relationship between height and age in a way that is biologically plausible 3) provide smoothly changing curves to describe the transition between childhood and adulthood, and 4) highlight the fact that the range of normal values is highly dependent on age. Conclusions: The modelling 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




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