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Mozun, R; Ardura-Garcia, C; Pedersen, ESL; Usemann, J; Singer, F; Latzin, P; Moeller, A; Kuehni, CE.
Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren.
ERJ Open Res. 2022; 8(2): Doi: 10.1183/23120541.00618-2021 [OPEN ACCESS]
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Co-authors Med Uni Graz: Singer Florian
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Abstract:: Background: References from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren. Methods: LuftiBus in the School was a population-based cross-sectional study undertaken in 2013-2016 in the canton of Zurich, Switzerland. Parents and their children aged 6-17 years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC and forced expiratory flow for 25-75% of FVC (FEF_25-75) for healthy White participants. We defined appropriate fit to GLI references by mean values between +0.5 and -0.5 z-scores. We assessed whether fit varied by age, body mass index, height and sex using linear regression models. Results: We analysed data from 2036 children with valid FEV₁ measurements, of whom 1762 also had valid FVC measurements. The median age was 12.2 years. Fit was appropriate for children aged 6-11 years for all indices. In adolescents aged 12-17 years, fit was appropriate for FEV₁/FVC z-scores (mean±sd -0.09±1.02), but not for FEV₁ (-0.62±0.98), FVC (-0.60±0.98) and FEF_25-75 (-0.54±1.02). Mean FEV₁, FVC and FEF_25-75 z-scores fitted better in children considered overweight (-0.25, -0.13 and -0.38, respectively) than normal weight (-0.55, -0.50 and -0.55, respectively; p-trend <0.001, 0.014 and <0.001, respectively). FEV₁, FVC and FEF_25-75 z-scores depended on both age and height (p-interaction 0.033, 0.019 and <0.001, respectively). Conclusion: GLI-based FEV₁, FVC, and FEF_25-75 z-scores do not fit White Swiss adolescents well. This should be considered when using reference equations for clinical decision-making, research and international comparison.