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Correspondence |

Discordance in Spirometric Interpretations Using Different Reference Equations FREE TO VIEW

Simon Kwok Fai Leung, BM, MPhil; Wing Wai Yew, MBBS, FCCP; Chi Chiu Leung, MBBS, FCCP
Author and Funding Information

Affiliations: Grantham Hospital Hong Kong, People's Republic of China,  Department of Health Hong Kong, People's Republic of China

Correspondence to: Simon Kwok Fai Leung, BM, MPhil, Respiratory Laboratory, Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong, People's Republic of China; e-mail: skfleung@netvigator.com


The authors declare that the material here submitted is original and is not currently under consideration nor has been accepted for publication elsewhere. All authors have read the manuscript and approved its submission. The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):324-325. doi:10.1378/chest.09-0553
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To The Editor:

Collen et al (November 2008)1 unveiled significant discordance in the classification of spirometric patterns of non-Hispanic white patients under the American Thoracic Society/European Respiratory Society 2005 guidelines2 when different reference equations were gauged against those of the National Health and Nutrition Examination Study III. As the American Thoracic Society/European Respiratory Society 2005 guidelines are increasingly adopted worldwide, it would be of relevance to explore whether there is similar discordance in other populations.

In Hong Kong, machine built-in equations by Knudson et al,3 old equations for the Chinese in Hong Kong by Lam et al,4 and equations for the Chinese in Singapore by Chin et al5 have been in regular use by many lung function laboratories. In 2006, Ip et al6 updated the spirometric reference equations based on local Chinese subjects who were 18 to 80 years of age. Using methods of analysis that were similar to those of Collen et al,1 we retrospectively analyzed spirometric data from 563 patients (mean age, 65 years; 63% men) who had been referred by the pulmonologists in a local tertiary cardiopulmonary center. These lung function tests were performed from May 2006 through March 2008. Discordance in classification was common when the results from equations by Knudson et al,3 Lam et al,4 and Chin et al5 were compared with those of Ip et al6 (31.4%, 27.0%, and 19.2%, respectively; all p < 0.05). Reclassification from obstructive to normal is the most common type of discrepancy. Sixty-three patients (11.2%), 56 patients (9.9%), and 67 patients (11.9%), respectively, would be reclassified to normal from obstructive if the three sets of equations alluded were switched to those of Ip et al.6

It would therefore appear that such discordance could be widespread with changes in reference equations in different populations. Further research is indicated to address this outstanding question in lung function test interpretation so as to minimize the potential impact on patient care.

Collen J, Greenburg D, Holley A, et al. Discordance in spirometric interpretations using three commonly used reference equations vs National Health and Nutrition Examination Study III. Chest. 2008;134:1009-1016. [PubMed] [CrossRef]
 
Pellegrino R, Viegi G, Brusasco V, et al. Interpretation strategies for lung function tests. Eur Respir J. 2005;26:948-968. [PubMed]
 
Knudson RJ, Slatin RC, Lebowitz MD, et al. The maximal expiratory flow-volume curve: normal standards, variability, and effects of age. Am Rev Respir Dis. 1976;113:587-600. [PubMed]
 
Lam KK, Pang SC, Allen WG, et al. A survey of ventilatory capacity in Chinese subjects in Hong Kong. Ann Hum Biol. 1982;9:459-472. [PubMed]
 
Chin NK, Ng TP, Hui KP, et al. Population based standards for pulmonary function in non-smoking adults in Singapore. Respirology. 1997;2:143-149. [PubMed]
 
Ip MS, Ko FW, Lau AC, et al. Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest. 2006;129:384-392. [PubMed]
 

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References

Collen J, Greenburg D, Holley A, et al. Discordance in spirometric interpretations using three commonly used reference equations vs National Health and Nutrition Examination Study III. Chest. 2008;134:1009-1016. [PubMed] [CrossRef]
 
Pellegrino R, Viegi G, Brusasco V, et al. Interpretation strategies for lung function tests. Eur Respir J. 2005;26:948-968. [PubMed]
 
Knudson RJ, Slatin RC, Lebowitz MD, et al. The maximal expiratory flow-volume curve: normal standards, variability, and effects of age. Am Rev Respir Dis. 1976;113:587-600. [PubMed]
 
Lam KK, Pang SC, Allen WG, et al. A survey of ventilatory capacity in Chinese subjects in Hong Kong. Ann Hum Biol. 1982;9:459-472. [PubMed]
 
Chin NK, Ng TP, Hui KP, et al. Population based standards for pulmonary function in non-smoking adults in Singapore. Respirology. 1997;2:143-149. [PubMed]
 
Ip MS, Ko FW, Lau AC, et al. Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest. 2006;129:384-392. [PubMed]
 
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