Use of forced vital capacity and forced expiratory volume in 1 second quality criteria for determining a valid test

Abstract

The 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) spirometry guidelines define valid tests as having three acceptable blows and a repeatable forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). The aim of this study was to determine how reviewer and computer-determined ATS/ERS quality could affect population reference values for FVC and FEV1.Spirometry results from 7777 normal subjects aged 8–80 years (NHANES (National Health and Nutrition Examination Survey) III) were assigned quality grades A to F for FVC and FEV1 by a computer and one reviewer (reviewer 1). Results from a subgroup of 1466 Caucasian adults (aged 19–80 years) were reviewed by two additional reviewers. Mean deviations from NHANES III predicted for FVC and FEV1 were examined by quality grade (A to F).Reviewer 1 rejected (D and F grade) 5.2% of the 7777 test sessions and the computer rejected ∼16%, primarily due to end-of-test (EOT) failures. Within the subgroup, the computer rejected 11.5% of the results and the three reviewers rejected 3.7–5.9%. Average FEV1 and FVC were minimally influenced by grades A to C allocated by reviewer 1.Quality assessment of individual blows including EOT assessments should primarily be used as an aid to good quality during testing rather than for subsequently disregarding data. Reconsideration of EOT criteria and its application, and improved grading standards and training in over-reading are required. Present EOT criteria results in the exclusion of too many subjects while having minimal impact on predicted values.

The American Thoracic Society/European Respiratory Society Acceptability Criteria for Spirometry: Asking Too Much or Not Enough?

“…2 The authors' finding that failure to satisfy end-of-test criteria was a common error is consistent with data recently published by Hankinson et al, 3 who suggested that strict adherence to end-of-test criteria may result in the unnecessary rejection of valid data. Based on these data, it seems reasonable to expect that future ATS/ERS recommendations may curtail currently used end-of-test criteria.…”

Occupations associated with COPD risk in the large population-based UK Biobank cohort study

“…These were: ‘Blank’ (ie, no error message), ‘Accept’, ‘Accept Below6sec’ (acceptable blow, with plateau, even though expiration time less than 6 s) and ‘Below6sec’ (expiration below 6 s, but no other error message in the manoeuvre). Although this deviates from the ATS/ERS guidelines, a recent publication has suggested that strict end-of-test criteria are the ones most likely to lead to rejection of satisfactory manoeuvres 12. The highest value of both FEV 1 and FVC from acceptable curves was identified.…”

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

“…17 Patients also completed a short questionnaire to ascertain out of pocket expenses for attendance (Appendix 3) and health status (EQ-5D). 18 Patients' height was measured to the nearest cm using a portable stadiometer (or estimated using arm-span if necessary).…”