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Reference equations for pulmonary function testing in healthy Chinese children aged 4-18 years
Jinhong Wu1, Hao Zhang2, Yufen Wu1
1Department of Internal Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 400127, China.
Insights
New spirometry reference equations were developed for healthy Chinese children, offering improved accuracy for diagnosing respiratory conditions. These equations account for contemporary growth and regional diversity, outperforming existing global and Chinese models.
Area of Science:
- Pulmonary Medicine
- Pediatric Respiratory Health
- Biostatistics
Background:
- Accurate spirometry reference equations are crucial for diagnosing and managing pediatric respiratory diseases.
- Existing global equations (e.g., GLI) have limited data from Asian populations.
- There is a need for spirometric reference equations specific to healthy Chinese children.
Purpose of the Study:
- To develop and validate new spirometric reference equations for healthy Chinese children aged 4-18 years.
- To compare the performance of these new equations against existing Caucasian and Chinese pediatric reference equations.
- To provide accurate tools for assessing lung function in the Chinese pediatric population.
Main Methods:
- A cross-sectional study of 8929 healthy Chinese Han children (aged 4-18) was conducted across 24 regions in China.
- Spirometry, physical measurements (height, weight), and demographic data were collected.
- Multiple linear regression models incorporating age, height, and weight were used to develop new prediction equations.
Main Results:
- Age, weight, and height were significant predictors of lung function (p < 0.001).
- Newly developed sex-specific equations showed high accuracy in internal validation (mean z-scores: -0.004 to -0.069).
- Existing Zapletal and GLI equations demonstrated over/underestimations of lung function parameters compared to the new Chinese equations.
Conclusions:
- New spirometry reference equations tailored for healthy Chinese children have been developed.
- These equations reflect current growth patterns and regional variations within China.
- The new equations offer a valuable, accurate clinical tool for pediatric respiratory assessments in China.
Background:
Accurate spirometry reference equations are essential for diagnosing and managing respiratory conditions in children. Although the GLI Global Equations have been proposed for general use, there were few Asian populations available for inclusion. This study aims to develop and validate spirometric reference equations for healthy Chinese children.
Methods:
From May 2018 to May 2021, a cross-sectional study involving healthy Chinese Han children aged 4 to 18 years was conducted by 33 research centers across 24 regions in China. Participants were recruited directly from schools, and physical growth indices (height, weight) were measured. Spirometry tests were performed and demographic and medical history data were collected through questionnaires. New prediction equations were developed using multiple linear regression models with age, height, and weight as predictors. And comparisons were made with existing Caucasian and Chinese pediatric reference equations.
Results:
Lung function was assessed in 8929 healthy Chinese Han children. Age, weight, and height emerged as strong predictors of lung function (p < 0.001), and sex-specific reference equations incorporating these factors demonstrated high accuracy in internal validation, yielding mean z-scores within a narrow range of -0.004 to -0.069. In comparison, the Zapletal equations overestimated FEV1 and FEV1/FVC while underestimating other lung function parameters. Additionally, the GLI equations underestimated lung function parameters, including FEV1, FVC, and FEV1/FVC, for both boys and girls. Compared to previous Chinese studies, the z-scores in this study ranged from - 0.97 to 0.93, with some cases showing significant deviations, highlighting the limitations of existing equations.
Conclusion:
This study developed new spirometry reference equations tailored for healthy Chinese children, with differences noted compared to existing equations. These equations reflect contemporary growth patterns and regional diversity in China, providing an additional option for clinical use.
Trial Registration:
NO.: ChiCTR: 1,800,019,029. Registered 22 October 2018.
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