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Reference ranges for spirometry across all ages: a new approach
Sanja Stanojevic1, Angie Wade, Janet Stocks
1Portex Respiratory Physiology Unit, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK. s.stanojevic@ich.ucl.ac.uk
Insights
New spirometry reference ranges were developed using an extended LMS method, improving pediatric lung function assessment from age 4 to adulthood. These dynamic models offer a biologically plausible and statistically robust solution for continuous reference data.
Area of Science:
- Pulmonary Medicine
- Biostatistics
- Pediatric Health
Background:
- Current spirometry interpretation relies on the NHANES III reference, which has limitations for younger children and lacks continuous age modeling.
- There is a need for improved reference ranges that accurately capture lung function across all pediatric ages and transition seamlessly into adulthood.
Purpose of the Study:
- To develop more accurate pediatric spirometry reference ranges by integrating data from multiple large-population surveys.
- To establish continuous lung function reference curves from early childhood through adulthood.
Main Methods:
- Applied an extended LMS (lambda, mu, sigma) method to collated spirometry data from four surveys, including 3,598 subjects aged 4-80 years.
- Developed sex-specific models initially limited to non-Hispanic white subjects.
Main Results:
- Extended reference data down to 4 years of age, addressing a key limitation of the NHANES III reference.
- Incorporated biologically plausible relationships between height and age for more accurate lung function modeling.
- Provided smoothly changing curves for childhood-to-adulthood transition and highlighted age-dependent normal value ranges.
Conclusions:
- The developed modeling technique offers an elegant, statistically robust, and biologically plausible solution for continuous spirometry reference ranges.
- These dynamic models provide a foundation for future research to enhance pulmonary function test reference data accuracy.
- The improved reference ranges facilitate more accurate interpretation of lung function in children and adults.
Rationale:
The Third National Health and Nutrition Examination Survey (NHANES III) reference is currently recommended for interpreting spirometry results, but it is limited by the lack of subjects younger than 8 years 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 and height and age within the pediatric age range, and allow a seamless transition to adulthood.
Methods:
Data were obtained from four surveys and included 3,598 subjects aged 4-80 years. The original analyses were sex specific and limited to non-Hispanic white subjects. An extension of the LMS (lambda, mu, sigma) method, widely used to construct growth reference charts, was applied.
Measurements And Main Results:
The extended models have four important advantages over the original NHANES III analysis as follows: (1) they extend the reference data down to 4 years of age, (2) they incorporate the relationship between height and age in a way that is biologically plausible, (3) they provide smoothly changing curves to describe the transition between childhood and adulthood, and (4) they highlight the fact that the range of normal values is highly dependent on age.
Conclusions:
The modeling 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.
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