Choosing the Better Global Lung Initiative 2012 Equation in South African Population Groups

Smith, Sara-Jane; Gray, Diane; MacGinty, Rae; Hall, Graham L.; Stanojevic, Sanja; Mphahlele, Reratilwe; Masekela, Refiloe

doi:10.1164/rccm.202005-2085le

Cited by 27 publications

(25 citation statements)

References 10 publications

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“…Z-standardisation of lung function parameters was performed using Global Lung Initiative (GLI) reference data and software [ 27 – 29 ]. Z-scores of spirometry data wer estimated using the ‘Other’ ethnic reference population which has been demonstrated to best fit South African participants of African and mixed ethnic origin [ 30 ]. Plethysmography and diffusing capacity Z-scores were estimated using Caucasian reference values as no data for other ethnic groups are available.…”

Section: Methodsmentioning

confidence: 99%

“…Z-standardization of lung function parameters was performed using Global Lung Initiative (GLI) reference data and software [27][28][29]. Z-scores of spirometry data was estimated using the "Other" ethnic reference population which has been demonstrated to best fit South African participants of african and mixed ethnic origin [30]. [30].…”

Section: Hiv+: Perinatal Hiv Infection Diagnosed By a Positive Polyme...mentioning

confidence: 99%

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Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation; a cross-sectional study

et al. 2022

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Despite the introduction of ART, HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased, however non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life.We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV exposed-uninfected (HEU) and perinatally HIV infected children on early ART (HIV+) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardization of lung function by sex, age and height.In total 394 children (HU n=90, HEU n=162, HIV+ n=142) underwent PFT, median age 8.7 (IQR 7.7–9.8) years. HIV+ had ART initiated at a median age of 17.6 (8.0–36.7) weeks. FEV1, FVC, FEV1/FVC, Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV) and RV/TLC Z-scores in HIV+. There were no differences in alveolar volume, however diffusing capacity was increased in HIV+.Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associate lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV+. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.

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Section: Methodsmentioning

confidence: 99%

Section: Hiv+: Perinatal Hiv Infection Diagnosed By a Positive Polyme...mentioning

confidence: 99%

Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation; a cross-sectional study

et al. 2022

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“…50 Variable use of race in guidelines 51,52 Criteria not validated 53 Pulmonary function not always related to potential benefit [54][55][56] Referral guidelines do not rely on a single threshold 57,58 Outcomes chestjournal.org populations. 71,72 Beyond minimal smoking history and absence of a respiratory condition, the extent to which we should limit other factors that influence lung function such as obesity and nonsmoking exposures in the definition of healthy is not clear. For some tests such as the diffusing capacity or tests of respiratory muscle strength, even reference datasets all derived in White populations differ from one another by a very large amount.…”

Section: Limitations Of Pfts and Reference Values That Place Concerns About Race In Perspectivementioning

confidence: 99%

Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception

Bhakta

Kaminsky

Bime

et al. 2022

CHEST

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The practice of using race or ethnicity in medicine to explain differences between individuals is being called into question because it may contribute to biased medical care and research that perpetuates health disparities and structural racism. A commonly cited example is the use of race or ethnicity in the interpretation of pulmonary function test (PFT) results, yet the perspectives of practicing pulmonologists and physiologists are missing from this discussion. This discussion has global relevance for increasingly multicultural communities in which the range of values that represent normal lung function is uncertain. We review the underlying sources of differences in lung function, including those that may be captured by race or ethnicity, and demonstrate how the current practice of PFT measurement and interpretation is imperfect in its ability to describe accurately the relationship between function and health outcomes. We summarize the arguments against using race-specific equations as well as address concerns about removing race from the interpretation of PFT results. Further, we outline knowledge gaps and critical questions that need to be answered to change the current approach of including race or ethnicity in PFT results interpretation thoughtfully. Finally, we propose changes in interpretation strategies and future research to reduce health disparities.

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“…In 2012, the Global Lung Function Initiative (GLI) (www.lungfunction.org) published the first all age multiethnic reference standard, in an attempt to standardize robust lung function assessment around the world. [51] Recently, this reference has been validated for central African (Madagascar, Angola, and DRC), [52] North (Algeria), [53] and Southern Africa (South Africa) [54] pediatric populations, each showing a different GLI ethnic fit confirming that standards need to be population specific. [55] These papers have provided key data in providing evidence for reference standards for African children.…”

Section: Pediatric Lung Functionmentioning

confidence: 99%

Advancing pediatric lung health in Africa: COVID-19 and beyond

Zampoli

Gray

Lake

et al. 2020

JPATS

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Respiratory illnesses in children are an important cause of morbidity and mortality in Africa where poverty, food insecurity, malnutrition, and human immunodeficiency virus infection are aggravating factors in many countries. These factors, in addition to under resourced health-care infrastructure, remain important barriers to improving child lung health outcomes in Africa. However, despite these challenges, there have been significant recent advancements in understanding the epidemiology, causes, measurement tools, and treatment of childhood respiratory illnesses. In this review, we highlight some advances in childhood pneumonia, tuberculosis, asthma, and other important non-communicable lung diseases common in children. Furthermore, we discuss the role of environmental influences on children’s lung health in Africa and highlight novel methods of measuring lung function in children. Although children contribute a small role in the global epidemiology of COVID-19 pandemic, socioeconomic and health-care delivery disruptions caused by government responses to contain the pandemic have resulted in significant indirect setbacks to child health. We further highlight how the COVID-19 pandemic has impacted areas of pediatric lung health and discuss ways to mitigate effects of COVID-19 in Africa.

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Choosing the Better Global Lung Initiative 2012 Equation in South African Population Groups

Cited by 27 publications

References 10 publications

Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation; a cross-sectional study

Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation; a cross-sectional study

Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception

Advancing pediatric lung health in Africa: COVID-19 and beyond

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