The nhanes iii is the most recent in a series of studies designed to assess the health and nu trition status of adults and children in the united states through inter. Spirometry interpretation compares measured data with previously obtained predicted values, preferably obtained from a reference. The first in line for newly published predicted values. Observed spirometric data are compared to reference data and are expressed as percent predicted values, based on age, gender, height and race american. The prediction tables are available in pdf format and contain reference values for the following variables.
It is an extension of an article published in breathe in 20 11, and summarises recent developments and. What is recommended regarding interpretation of spirometry. Impact of new occupational and clinical standards on. Nhanes normal values select your preferred regression set from the links below then enter the subjects demographics in the boxes below to automatically find the correct values within the reference tables. In the nhanes 20078, baseline 1st test spirometry data was collected for 6,444 sample persons. These nhanes 1999 regressions are recommended for ethnically appropriate individuals by the atsers task force. The kappa agreement coefficient was for lung volumes, the reference values used were those published by crapo 19 with respect to fefet al. Spirometry in the occupational health setting2011 update.
Gli2012 multiethnic spirometry reference values are recommended for use in north america and elsewhere for the ethnic groups represented. Following a grading system range of af, spirometry tests with grades of ac are clinically useful. Pdf spirometry reference values for american indian adults. The nhanes iii reference standard was used to define abnormality in this study, instead of an extensive clinical workup of symptoms, pulmonary function, and radiographic testing. Use gli2012 multiethnic reference ranges when available. In the united states, normal values and lower limits of normal defined by hankinson et alref2 the national health and nutrition examination survey nhanes iii predicted set has been.
Using nhanesiii predicted values, the copd6 measures and displays fev1, fev6, fev1fev6 and percent of predicted. Spirometric reference values from a sample of the general u. The nhanes iii reference data are recommended by the atsers 2005 guidelines for establishing spirometry predicted values for north americans. Participants completing baseline 1st test spirometry were selected for followup bronchodilator 2nd test spirometry only if their baseline spirometry values indicated possible airflow obstruction that might indicate the presence of asthma or copd. The use of the gli spirometry reference equations is recommended, although the nhanes iii spirometry reference equations are considered acceptable if continuity is important. By collating pediatric data from other largepopulation surveys, we have investigated ways of developing. The tables below are for mean normal value predicted and the lower limit of normality lln. For clinical purposes, nhanes iii spirometry reference equations for white adults may be used when testing american indian women and men aged 45 to 74 years. Their smooth continuity throughout growth is advantageous for laboratories testing children or adolescents. Predicted values use global lung function initiative gli2012 reference equations validated in multiple ethnic groups and age groups.
Ethnic correction factors defined in the easywarepro software are therefore only used for the ethnic groups asian and other. The administrative variable spdbronc indicates whether the participant was considered eligible for bronchodilator 2nd test spirometry. The most recent spirometry guidelines of the american thoracic society and european respiratory society atsers recommend reference values derived from the national health and nutrition survey nhanes iii for general use in the united states. By collating pediatric data from other largepopulation surveys, we have investigated ways of developing reference ranges. Spirometry was performed in 20,627 survey participants 16,484 adults and 4,143 youths as part of nhanes iii.
A stepwise approach to the interpretation of pulmonary. This article addresses how the gli network came about, why it is important, and its current challenges and future directions. The national health and nutrition examination survey nhanes iii reference values. These predicted values, together with relevant patient information can provide useful clinical information. Fev1, fev6, fvc, pef, fef2575, fev1 fvc, and fev6fvc. Spirometry reference equations from the hchssol hispanic community health studystudy of latinos. Nhanes iii caucasian predicted values fvc males, nhanes iii caucasian. They found that, for example, for persons aged 55 years and 175 cm tall, the difference was 20 ml, as it is in our current study. The lln was calculated for use with the ecsc reference values by using the following equation. Examinees who had breathing problem requiring oxygentaking deep breath, current ear infection, eyechestabdominal surgery, or strokeheart attack in the past three months, tuberculosis in the past year, or coughing up blood in the past month were excluded from a baseline spirometry.
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. Nhanes iii has predicted equations for caucasian, african and hispanic ethnic groups. Participants aged 679 years were eligible for spirometry tests in nhanes 20112012. Nhanes iii reference values these tables are provided for use in practicum sessions for students who wish to compare their own measured spirometry values to nhanes iii reference values. The dual zone indicators provide an instant indication of both the obstructive index and the copd classification.
For example, for any patient it became possible to determine the expected respiratory parameters fvc, pef, etc. Reliable interpretation of pulmonary function results relies on the availability of appropriate reference data to help distinguish between health and disease and to assess the severity and nature of any functional impairment. The american thoracic society recommends racespecific spirometric reference values from the national health and nutrition survey nhanes iii for clinical evaluation of pulmonary function in whites, africanamericans, and mexicanamericans in the united states and a correction factor of 0. Aim of this study was to derive new lung function reference equations and compare the predicted values with those from three sets of existing reference equations. The revised nunn and gregg equation is as below and applies to ages 1585 years. The predicted values for subjects older than the maximum ages evaluated by the nhanes iii and ecsc were extrapolated beyond 80 and 70 years, respectively. Normal values for spirometry reference tables nhanes. Reference ranges for spirometry across all ages a new. Performance of american thoracic societyrecommended. Comparison of nhanes iii and ersgli 12 for airway obstruction classification and severity. The emis predicted peak flow calculation used within its clinical systems is based on a published revision to the original nunn and gregg equation in 1973. Effect of changing reference equations for spirometry interpretation. The nhanes iii is the most recent in a series of studies designed to assess the health and nutrition status of adults and children in the united states through interviews and direct physical examinations. Pulmonary function reference normal predicted values.
Linaresperdomo o, hegewald m, collingridge ds, et al. If nhanes iii reference values are not available to evaluate an african americans pulmonary function, and the only available reference values are drawn from studies of whites, for example, crapo 20 or knudson 21 predicted values, the white predicted values and llns for fvc and fev 1 need to be multiplied by 0. Ers predicted values only have predicted equations for caucasian ethnicity. The objective of this study was to better quantify the wellknown problem of the change in interpretation of spirometry, as a consequence of the change from the other commonly used reference standards morris, kory, crapo, knudson 1976, and knudson 1983 to. Comparison of the nhanes iii and gli 12 prediction equations. In dutch males aged 5069 years, the predicted value for lln did not appear to fit very well, which may be because of the limited number of men 39 in this age range. Spirometric reference values from a sample of the general.
The overwhelming number of published reference equations, with at least 15 published for spirometry alone in the past 3 yrs, complicates the selection of an appropriate. Observed minus predicted nhanes iii spirometry values among healthy, neversmoking men and women in the mesalung study. In a recent reference value study, glindmeyer and colleagues 9. The results of this study are therefore, of practical significance to an american treating physician. Global lung function initiative 2012 reference values for. The overall airway obstruction rate using the lln was slightly higher than the expected 5% in the nhanes iii data 5. This analysis of the nhanes iii spirometry data was conducted to. Additional reference equations for subjects 395 years of age of various ethnicities are available from the global lungs initiative gli 4. Nhanes iii reference values remain appropriate where maintaining continuity is important. Reference values for spirometry in elderly individuals. To see percent predicted, you must enter observed fvc, fev1, and fef2575% values in the appropriate boxes. The data and corresponding documentation for the survey interview and examination components are found in four separate data files. Spirometry must establish a solid baseline meeting all criteria for acceptability and repeatability. Assessing small airway disease in gli versus nhanes iii.
However, when actual variability of the three spirometric outcomes is plotted as a. This calculator is intended for use with the niosh spirometry workbook exercises and has not been approved by the fda for clinical use. As shown in other studies, the fev1 and fvc in africanamericans are smaller than in caucasians of similar height, while the fev1fvc% is the same. The published regression equations from ecsc, nhanes iii, and gli were used to calculate the predicted values. The third national health and nutrition examination survey nhanes iii, 19881994, contains data for 33,994 persons ages 2 months and older who participated in the survey. Comparison of nhanes iii and ersgli 12 for airway obstruction. Precision of the prediction equations derived from the full sample was greater than from ethnicspecific. How should the lower limit of the normal range be defined. The prediction tables are available in pdf format and contain reference values for the. The nhanes iii reference equations are valid for use among older adults who are white, africanamerican, or hispanic of mexican origin. Nhanes iii predicted values confirmed the 12 to 15% difference in lung volumes between caucasians and africanamericans. Since the software and hardware upgrade this summer our pft lab has switched to the nhanes iii spirometry reference equations but we have so far resisted changing our 95% cutoff to the lower limit of normal lln.
Comparison of white and asianamerican participants suggests that a correction factor of 0. The predicted and lower limit of normal lln values of fvc, fev1, and %fev1fvc were calculated from the gli2012. Predicted values for asians were calculated using nhanes equations for whites. Fev1, fev6, fvc, pef, fef2575, fev1fvc, and fev6fvc. The new vitalograph copd6 offers fast, simple and effective screening of those at risk for copd. Gli stanojevic 2009, quanjer 2012 nhanes iii north america platino south america ers europe and jrs, ip, chhabra asia. A recent reanalysis of nhanes iii data found no interaction of ethnicity with age or height for fvc, fev 1, or fev 1 fvc. The american thoracic society has recently recommended the use of nhanes iii spirometric reference standard in the united states. To see percent prediced, you must enter observed fvc, fev1, and fef2575% values in the appropriate boxes. Observed values of fev1fvc ratio among healthy, neversmoking participants minus predicted fev 1 fvc ratio from the nhanes iii reference equations by age for men and women. If gli2012 not available, use nhanes iii values for caucasian subjects and apply ethnic correction where appropriate. 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.