Evaluation of the global lung function initiative 2012 reference values for spirometry in a Swedish population sample

Abstract

BackgroundThe Global Lung Function Initiative 2012 (GLI) reference values are currently endorsed by several respiratory societies but evaluations of applicability for adults resident in European countries are lacking. The aim of this study was to evaluate if the GLI reference values are appropriate for an adult Caucasian Swedish population.MethodsDuring 2008–2013, clinical examinations including spirometry were performed on general population samples in northern Sweden, in which 501 healthy Caucasian non-smokers were identified. Predicted GLI reference values and Z-scores were calculated for each healthy non-smoking subject and the distributions and mean values for FEV1, FVC and the FEV1/FVC ratio were examined. The prevalence of airway obstruction among these healthy non-smokers was calculated based on the Lower Limit of normal (LLN) criterion (lower fifth percentile) for the FEV1/FVC ratio. Thus, by definition, a prevalence of 5% was expected.ResultsThe Z-scores for FEV1, FVC and FEV1/FVC were reasonably, although not perfectly, normally distributed, but not centred on zero. Both predicted FEV1 and, in particular, FVC were lower compared to the observed values in the sample. The deviations were greater among women compared to men. The prevalence of airway obstruction based on the LLN criterion for the FEV1/FVC ratio was 9.4% among women and 2.7% among men.ConclusionsThe use of the GLI reference values may produce biased prevalence estimates of airway obstruction in Sweden, especially among women. These results demonstrate the importance of validating the GLI reference values in different countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0022-2) contains supplementary material, which is available to authorized users.

The multi‐ethnic global lung initiative 2012 (GLI-2012) norms reflect contemporary adult's Algerian spirometry

“…Table 4 presents the main characteristics and results of some studies reporting Z-scores data [14–20] .…”

“…The age scattering and other anthropometric, ethnic, socioeconomic and environmental factors should be equivalent since such factors can mark lung function [14] . Furthermore, the methodology for performing spirometric tests ( eg ; protocol and equipment) must be stringent [4, 25] .…”

The Global Lung Function Initiative 2012 Equations Are as Well-Suited as Local Population Derived Equations to a Sample of Healthy Professional Firefighters

“…The Global Lung Function Initiative (GLI) 2012 therefore developed a new set of multiethnic predicted normal equations [4, 5] using the pooled resources of 26 countries and data from more than 74000 subjects. They have been evaluated and shown to be well matched to some adult populations (in Australasia [6] and Europe [7, 8]) but not others, such as Finland [9] and Sweden [10], where local population-specific reference values may be more relevant. Therefore, care needs to be taken when recommending whether GLI equations should be implemented in any particular population or laboratory.…”

Global Lung Function Initiative reference equations better describe a middle-aged, healthy French population than the European Community for Steel and Coal values

“…Indeed, we found z-score means closer to zero and that sex differences disappeared when GLI equations were used (table 1). BACKMAN et al [3] showed that GLI equations better described a healthy Swedish population than the ECSC equations, but the average z-scores of each parameter were further from zero than ours when applying the GLI reference values. For example, the mean z-score was 0.41±0.92 versus 0.24±0.98 for FVC and 0.25±0.86 versus 0.03±1.00 for FEV1, respectively, among women in the Swedish study versus women in our northern French population.…”

“…BACKMANet al [3] have recently shown that the GLI reference values were better suited than the ECSC reference values to the Swedish population but less relevant than local population-specific reference values. In particular, forced volume capacity (FVC) and forced expiratory volume in 1 s (FEV1), expressed as percentages of predicted values, tended to be overestimated among women to a greater extent by the ECSC reference values than the GLI values.…”