Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city
Background The Global Lung Function Initiative (GLI-2012) focused on race/ethnicity as an important factor in determining reference values. This study evaluated the effects of changing from Canadian reference equations developed from an all-Caucasian cohort with European ancestry to the GLI-2012 on...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-02-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/9/1/e001389.full |
| _version_ | 1827898300094742528 |
|---|---|
| author | Clodagh M Ryan Haruna Kitazawa Annie Jiang Cynthia Nohra Honami Ota |
| author_facet | Clodagh M Ryan Haruna Kitazawa Annie Jiang Cynthia Nohra Honami Ota |
| author_sort | Clodagh M Ryan |
| collection | DOAJ |
| description | Background The Global Lung Function Initiative (GLI-2012) focused on race/ethnicity as an important factor in determining reference values. This study evaluated the effects of changing from Canadian reference equations developed from an all-Caucasian cohort with European ancestry to the GLI-2012 on the interpretation of spirometry in a multiethnic population and aimed to identify the ethnic groups affected by discrepant interpretations.Methods Clinically indicated spirometry in a multiethnic population (aged 20–80 years) collected from 2018 to 2021 was analysed. The predicted and lower limit of normal (LLN) values were calculated using three sets of reference equations: Canadian, GLI-race/ethnic-based (GLI-Race) and GLI-race/ethnic-neutral (GLI-Other). We compared the prevalence of concordance in the abnormal diagnoses (defined as <LLN) for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC among the three reference values, and evaluated whether race/ethnicity was associated with discordance.Results Data from 406 participants were evaluated (non-Caucasian 43.6%). There was 85%–87% concordance for normal/abnormal FVC and FEV1 interpretations among the Canadian, GLI-Race and GLI-Other reference equations. In all ethnic groups, application of the Canadian references for interpretation led to a higher prevalence of abnormal (<LLN) FVC and FEV1compared with GLI-Race and GLI-Other. This trend was more prominent in Black, South-East Asian and Mixed/other ethnic groups when comparing the Canadian to the GLI-Race equations. In contrast, the discordance rates were similar among ethnic groups when compared with the GLI-Other reference equations. Interpretation of FEV1/FVC had a high rate of agreement among all equations.Conclusion Interpretation using Canadian reference equations was associated with a higher prevalence of restrictive physiology compared with the GLI-2012 equations, particularly if the GLI-Race were used. These observations were mostly found in non-white Caucasian groups, highlighting the need to choose reference equations that reflect closely the ethnic mix of the population being evaluated in order to optimise patient management. |
| first_indexed | 2024-03-12T23:01:42Z |
| format | Article |
| id | doaj.art-5854beab88b443e6bb6225756d1dfbab |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-12T23:01:42Z |
| publishDate | 2022-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-5854beab88b443e6bb6225756d1dfbab2023-07-19T11:00:07ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392022-02-019110.1136/bmjresp-2022-001389Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan cityClodagh M Ryan0Haruna Kitazawa1Annie Jiang2Cynthia Nohra3Honami Ota4Sleep Research Laboratory, Toronto Rehabilitation Institute University Health Network, Toronto, Ontario, CanadaMedicine, Division of Respirology, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine, University Health Network, Toronto, Ontario, CanadaDepartment of Medicine, University Health Network, Toronto, Ontario, CanadaDepartment of Medicine, University Health Network, Toronto, Ontario, CanadaBackground The Global Lung Function Initiative (GLI-2012) focused on race/ethnicity as an important factor in determining reference values. This study evaluated the effects of changing from Canadian reference equations developed from an all-Caucasian cohort with European ancestry to the GLI-2012 on the interpretation of spirometry in a multiethnic population and aimed to identify the ethnic groups affected by discrepant interpretations.Methods Clinically indicated spirometry in a multiethnic population (aged 20–80 years) collected from 2018 to 2021 was analysed. The predicted and lower limit of normal (LLN) values were calculated using three sets of reference equations: Canadian, GLI-race/ethnic-based (GLI-Race) and GLI-race/ethnic-neutral (GLI-Other). We compared the prevalence of concordance in the abnormal diagnoses (defined as <LLN) for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC among the three reference values, and evaluated whether race/ethnicity was associated with discordance.Results Data from 406 participants were evaluated (non-Caucasian 43.6%). There was 85%–87% concordance for normal/abnormal FVC and FEV1 interpretations among the Canadian, GLI-Race and GLI-Other reference equations. In all ethnic groups, application of the Canadian references for interpretation led to a higher prevalence of abnormal (<LLN) FVC and FEV1compared with GLI-Race and GLI-Other. This trend was more prominent in Black, South-East Asian and Mixed/other ethnic groups when comparing the Canadian to the GLI-Race equations. In contrast, the discordance rates were similar among ethnic groups when compared with the GLI-Other reference equations. Interpretation of FEV1/FVC had a high rate of agreement among all equations.Conclusion Interpretation using Canadian reference equations was associated with a higher prevalence of restrictive physiology compared with the GLI-2012 equations, particularly if the GLI-Race were used. These observations were mostly found in non-white Caucasian groups, highlighting the need to choose reference equations that reflect closely the ethnic mix of the population being evaluated in order to optimise patient management.https://bmjopenrespres.bmj.com/content/9/1/e001389.full |
| spellingShingle | Clodagh M Ryan Haruna Kitazawa Annie Jiang Cynthia Nohra Honami Ota Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city BMJ Open Respiratory Research |
| title | Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city |
| title_full | Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city |
| title_fullStr | Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city |
| title_full_unstemmed | Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city |
| title_short | Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city |
| title_sort | changes in interpretation of spirometry by implementing the gli 2012 reference equations impact on patients tested in a hospital based pft lab in a large metropolitan city |
| url | https://bmjopenrespres.bmj.com/content/9/1/e001389.full |
| work_keys_str_mv | AT clodaghmryan changesininterpretationofspirometrybyimplementingthegli2012referenceequationsimpactonpatientstestedinahospitalbasedpftlabinalargemetropolitancity AT harunakitazawa changesininterpretationofspirometrybyimplementingthegli2012referenceequationsimpactonpatientstestedinahospitalbasedpftlabinalargemetropolitancity AT anniejiang changesininterpretationofspirometrybyimplementingthegli2012referenceequationsimpactonpatientstestedinahospitalbasedpftlabinalargemetropolitancity AT cynthianohra changesininterpretationofspirometrybyimplementingthegli2012referenceequationsimpactonpatientstestedinahospitalbasedpftlabinalargemetropolitancity AT honamiota changesininterpretationofspirometrybyimplementingthegli2012referenceequationsimpactonpatientstestedinahospitalbasedpftlabinalargemetropolitancity |