The impact of switching to the new global lung function initiative equations on spirometry results in the UK CF Registry

Stanojevic, Sanja; Stocks, Janet; Bountziouka, Vassiliki; Aurora, Paul; Kirkby, Jane; Bourke, Stephen; Carr, S.B.; Gunn, E.; Prasad, Ammani; Rosenfeld, Margaret; Bilton, Diana

doi:10.1016/j.jcf.2013.11.006

Cited by 41 publications

(32 citation statements)

References 11 publications

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“…This suggests that the reference population is not perfectly representative, as we would not expect measures from children with CF (even with ‘normal’ lung function) to substantially exceed those predicted by a representative reference population. Although a recent study identified subgroups of children with CF where GLI and Wang reference equations provide different FEV 1 and FVC percent predicted results, 17 we did not find appreciable differences depending on equation used within our narrow age-range cohorts (Figure 5; available at www.jpeds.com), suggesting that the above normal FEV 1 and FVC distributions we observed in screened children are not peculiar to GLI reference equations.…”

Section: Discussioncontrasting

confidence: 63%

Improvements in Lung Function and Height among Cohorts of 6-Year-Olds with Cystic Fibrosis from 1994 to 2012

VanDevanter

Pasta

Konstan

2014

The Journal of Pediatrics

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Objective To characterize spirometry and height changes in cohorts of 6-year-olds with cystic fibrosis (CF). Study design Global Lung Initiative (GLI) forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC and CDC height-for-age (HFA) Z-scores were generated for 6-year-olds in the from the CF Foundation Patient Registry (CFFPR) each year from 1994 and 2012. Z-score mean differences were analyzed by t-test and time trends of means by least squares regression for all children and for subgroups (sex, F580del mutation genotype, Medicaid insurance, and prenatal/newborn screening identification). Z-score distributions were compared by two-sample Kolmogorov-Smirnov tests. Results 11,670 children with CF were studied, of whom 50.5% were males, 50.2% had the F508del/F508del genotype, and 46.6% were insured by Medicaid. Mean HFA, FEV1 and FVC Z-scores increased significantly over the period in the entire population and all subgroups (P<0.001), but FEV1/FVC Z-scores were below normal and did not change significantly. In 2012, children identified by screening had significantly higher mean HFA (P=0.002), FEV1 (P<0.001) and FVC (P<0.001) Z-scores than those not screened, with 90% of FVC and 71.4% of FEV1 Z-scores greater than predicted by the Normal distribution; FEV1/FVC Z-scores were not different between screening groups. Conclusions Consistent, significant increases in HFA, FEV1, and FVC occurred from 1994–2012, but FEV1/FVC, a measure of airway obstruction, did not appreciably change. FVC and FEV1 Z-score distributions suggest that normative equation reference populations under-predict lung volumes of children with CF, but the reason(s) for this remain unclear.

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Section: Discussioncontrasting

confidence: 63%

Improvements in Lung Function and Height among Cohorts of 6-Year-Olds with Cystic Fibrosis from 1994 to 2012

VanDevanter

Pasta

Konstan

2014

The Journal of Pediatrics

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“…A previous study found a near-linear %FEV 1 decline from childhood to adulthood with GLI equation, whereas there was accelerated %FEV 1 decline during adolescence and young adulthood when %FEV 1 was calculated with Knudson equation 21 . One advantage of using the GLI equation, which is seamless across all ages, is that it improves the interpretation of %FEV 1 decline 21, 22 . Another advantage is that %FEV 1 decline can be adjusted for baseline %FEV 1 using ESCF reference values (since the ESCF values for %FEV 1 decline were calculated using the GLI equation 20 ).…”

Section: Discussionmentioning

confidence: 99%

Using different methods to process forced expiratory volume in one second (FEV1) data can impact on the interpretation of FEV1 as an outcome measure to understand the performance of an adult cystic fibrosis centre: A retrospective chart review

et al. 2018

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Background: Forced expiratory volume in one second (FEV 1) is an important cystic fibrosis (CF) prognostic marker and an established endpoint for CF clinical trials. FEV 1 is also used in observation studies, e.g. to compare different centre’s outcomes. We wished to evaluate whether different methods of processing FEV 1 data can impact on a centre’s outcome. Methods: This is a single-centre retrospective analysis of routinely collected data from 2013-2016 which included 208 adults with CF. Year-to-year %FEV 1 change was calculated by subtracting best %FEV 1 at Year 1 from Year 2 (i.e. negative values indicate %FEV 1 decline), and compared using Friedman test. Three methods were used to process %FEV 1 data. First, %FEV 1 calculated with Knudson equation was extracted directly from spirometer machines. Second, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and Knudson equation. Third, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and GLI equation. In addition, %FEV 1 decline calculated using GLI equation was adjusted for baseline %FEV 1 to understand the impact of case-mix adjustment. Results: There was a trend of reduction in %FEV 1 decline with all three data processing methods but the magnitude of %FEV 1 decline differed. Median change in %FEV 1 for 2013-2014, 2014-2015 and 2015-2016 was –2.0, –1.0 and 0.0 respectively using %FEV 1 in Knudson equation whereas the median change was –1.1, –0.9 and –0.3 respectively using %FEV 1 in the GLI equation. A statistically significant p-value (0.016) was only obtained when using %FEV 1 in Knudson equation extracted directly from spirometer machines. Conclusions: Although the trend of reduction in %FEV 1 decline was robust, different data processing methods yielded varying results when %FEV 1 decline was compared using a standard related group non-parametric statistical test. Observational studies with %FEV 1 decline as an outcome measure should carefully consider and clearly specify the data processing methods used.

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“…It excites the interest of nearly all major pulmonological associations (and not only). Publications show that not always can the GLI2012 proposal be recognized as the ‘gold standard’ (Stanojevic et al ., ) for various ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

The multi‐ethnic global lung initiative 2012 and Third National Health and Nutrition Examination Survey reference values do not reflect spirometric measurements in Black boys and men from Tanzania

Rębacz-Maron

2016

Clin Physio Funct Imaging

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Black people; forced expiratory volume in one second; FEV 1 /FVC; forced vital capacity; GLI2012; PEF; reference valuesThe interpretation of spirometric results of Black Africans according to reference standards based on data from outside their native environment may lead to the wrong conclusions. This article aims to characterize the ventilatory capacity of boys and men from Tanzania according to forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), peak expiratory flow (PEF) and FEV 1 /FVC based on the collected anthropological material and to compare them to NHANES III, Third National Health and Nutrition Examination Survey (NHANES III) African American predicted values and GLI2012 equations. The analysis included spirometric measurements of n = 295 participants from Tanzania. Pearson's correlation analysis and the backward stepwise multiple regression analysis were performed. FEV 1 , FVC, PEF and FEV 1 /FVC results were compared to the NHANES III African American predicted values as well as to the GLI2012 equations. FEV 1 measurements are lower than the reference values according to NHANES III and GLI2012 equations by 22Á1% and 25Á8%. FVC results fell short of the NHANES III predicted by 29Á5% and of GLI2012 by 32Á5%. The average %FEV 1 /FVC scores for the boys and men exceeded the recommended GLI2012 predicted by 10Á5-15Á2%. All the spirometric measurements included in the analysis were statistically significantly correlated with age, body height, sitting height, trunk length and body weight. The application of prediction formulae developed for non-African populations overestimates the values for Black Africans. The results of spirometric measurements are ecosensitive and dependent on various external (environmental) factors.

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The impact of switching to the new global lung function initiative equations on spirometry results in the UK CF Registry

Cited by 41 publications

References 11 publications

Improvements in Lung Function and Height among Cohorts of 6-Year-Olds with Cystic Fibrosis from 1994 to 2012

Improvements in Lung Function and Height among Cohorts of 6-Year-Olds with Cystic Fibrosis from 1994 to 2012

Using different methods to process forced expiratory volume in one second (FEV1) data can impact on the interpretation of FEV1 as an outcome measure to understand the performance of an adult cystic fibrosis centre: A retrospective chart review

The multi‐ethnic global lung initiative 2012 and Third National Health and Nutrition Examination Survey reference values do not reflect spirometric measurements in Black boys and men from Tanzania

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