Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians
TL;DR: In this article, the Global Lung Function Initiative (GLI) all-age reference values for carbon monoxide were derived for Caucasians aged 5-85 years using the LMS (lambda, mu, sigma) method and the GAMLSS (generalised additive models for location, scale and shape) program.
Abstract: There are numerous reference equations available for the single-breath transfer factor of the lung for carbon monoxide ( T LCO ); however, it is not always clear which reference set should be used in clinical practice. The aim of the study was to develop the Global Lung Function Initiative (GLI) all-age reference values for T LCO . Data from 19 centres in 14 countries were collected to define T LCO reference values. Similar to the GLI spirometry project, reference values were derived using the LMS (lambda, mu, sigma) method and the GAMLSS (generalised additive models for location, scale and shape) programme in R. 12 660 T LCO measurements from asymptomatic, lifetime nonsmokers were submitted; 85% of the submitted data were from Caucasians. All data were uncorrected for haemoglobin concentration. Following adjustments for elevation above sea level, gas concentration and assumptions used for calculating the anatomic dead space volume, there was a high degree of overlap between the datasets. Reference values for Caucasians aged 5–85 years were derived for T LCO , transfer coefficient of the lung for carbon monoxide and alveolar volume. This is the largest collection of normative T LCO data, and the first global reference values available for T LCO .
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TL;DR: This document presents a reporting format in test‐specific units for spirometry, lung volumes, and diffusing capacity that can be assembled into a report appropriate for a laboratory's practice that can improve the interpretation, communication, and understanding of test results.
Abstract: Background: The American Thoracic Society committee on Proficiency Standards for Pulmonary Function Laboratories has recognized the need for a standardized reporting format for pulmonary function tests. Although prior documents have offered guidance on the reporting of test data, there is considerable variability in how these results are presented to end users, leading to potential confusion and miscommunication.Methods: A project task force, consisting of the committee as a whole, was approved to develop a new Technical Standard on reporting pulmonary function test results. Three working groups addressed the presentation format, the reference data supporting interpretation of results, and a system for grading quality of test efforts. Each group reviewed relevant literature and wrote drafts that were merged into the final document.Results: This document presents a reporting format in test-specific units for spirometry, lung volumes, and diffusing capacity that can be assembled into a report appropriate fo...
436 citations
TL;DR: 3 months after discharge, a quarter of COVID-19 survivors have reduced gas diffusion capacity and persistent parenchymal opacities, but not with dyspnoea or reduced diffusing capacity.
Abstract: The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function and chest computed tomography (CT) findings 3 months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICUs), compared with non-ICU patients.Discharged COVID-19 patients from six Norwegian hospitals were enrolled consecutively in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. The modified Medical Research Council (mMRC) dyspnoea scale, the EuroQol Group's questionnaire, spirometry, diffusing capacity of the lung for carbon monoxide (D LCO), 6-min walk test, pulse oximetry and low-dose CT scan were performed 3 months after discharge.mMRC score was >0 in 54% and >1 in 19% of the participants. The median (25th-75th percentile) forced vital capacity and forced expiratory volume in 1 s were 94% (76-121%) and 92% (84-106%) of predicted, respectively. D LCO was below the lower limit of normal in 24% of participants. Ground-glass opacities (GGO) with >10% distribution in at least one of four pulmonary zones were present in 25% of participants, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted OR 4.2, 95% CI 1.1-15.6) and lower performance in usual activities.3 months after admission for COVID-19, one-fourth of the participants had chest CT opacities and reduced diffusing capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function.
223 citations
Cites methods from "Official ERS technical standards: G..."
...The Global Lung Function Initiative Network (GLI) reference values were used to calculate the percentage of predicted values, the lower limit of normal (LLN), and z-scores [17, 18]....
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207 citations
TL;DR: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.
Abstract: Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known a...
139 citations
Cites methods from "Official ERS technical standards: G..."
...Predicted values and lower limits of normal for pulmonary function tests were calculated as previously described by the Global Lung Initiative (17, 18)....
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TL;DR: More than half of patients with COVID-19 pneumonia exhibit abnormal lung function 30 days after symptom onset, without clear relationship with pneumonia extent on chest CT, and this pleads for systematic and long-term follow-up of Patients with CO VID-19.
Abstract: More than half of patients with COVID-19 pneumonia exhibit abnormal lung function 30 days after symptom onset, without clear relationship with pneumonia extent on chest CT This pleads for systematic and long-term follow-up of patients with COVID-19 https://bitly/2TFMPqE
136 citations
Cites methods from "Official ERS technical standards: G..."
...Among patients without HRCT, 3 had normal PFT, one had restrictive pattern and one had isolated low TLCO....
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...We found no difference in FVC, TLC or TLCO (% pred. values) between groups of CT-extent, but a significant difference in the proportion of abnormal values (i.e. restriction and/or altered DLCO) (p=0.0277)....
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...Lower TLCO was significantly associated with older age (> 50 years) (p=0.0351), but neither was TLC nor FVC. Finally, FVC, TLC and TLCO were not significantly different between groups of clinical severity (i.e. oxygen requirement)....
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...One patient could not perform TLCO and HRCT was not performed in 5 patients....
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...Predicted values from Global Lung Initiative (GLI) were used for FVC and TLCO [6]....
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References
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Journal Article•
5,203 citations
TL;DR: This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTS most commonly ordered for clinical purposes.
Abstract: SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING”
Edited by V. Brusasco, R. Crapo and G. Viegi
Number 5 in this Series
This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTs most commonly ordered for clinical purposes. Specifically, this section addresses the interpretation of spirometry, bronchodilator response, carbon monoxide diffusing capacity ( D L,CO) and lung volumes.
The sources of variation in lung function testing and technical aspects of spirometry, lung volume measurements and D L,CO measurement have been considered in other documents published in this series of Task Force reports 1–4 and in the American Thoracic Society (ATS) interpretative strategies document 5.
An interpretation begins with a review and comment on test quality. Tests that are less than optimal may still contain useful information, but interpreters should identify the problems and the direction and magnitude of the potential errors. Omitting the quality review and relying only on numerical results for clinical decision making is a common mistake, which is more easily made by those who are dependent upon computer interpretations.
Once quality has been assured, the next steps involve a series of comparisons 6 that include comparisons of test results with reference values based on healthy subjects 5, comparisons with known disease or abnormal physiological patterns ( i.e. obstruction and restriction), and comparisons with self, a rather formal term for evaluating change in an individual patient. A final step in the lung function report is to answer the clinical question that prompted the test.
Poor choices made during these preparatory steps increase the risk of misclassification, i.e. a falsely negative or falsely positive interpretation for a lung function abnormality or a change …
5,078 citations
TL;DR: Spirometric prediction equations for the 3–95-age range are now available that include appropriate age-dependent lower limits of normal for spirometric indices, which can be applied globally to different ethnic groups.
Abstract: The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5-95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3-95 yrs for Caucasians (n=57,395), African-Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV(1)) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV(1)/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3-95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.
3,975 citations
Journal Article•
3,516 citations
TL;DR: The LMS method summarizes the changing distribution of a measurement as it changes according to some covariate by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power.
Abstract: Refence centile curves show the distribution of a measurement as it changes according to some covariate, often age The LMS method summarizes the changing distribution by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power Using penalized likelihood the three curves can be fitted as cubic splines by non-linear regression, and the extent of smoothing required can be expressed in terms of smoothing parameters or equivalent degrees of freedom The method is illustrated with data on triceps skinfold in Gambian girls and women, and body weight in USA girls
2,460 citations