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Christopher S. King, MD, MAJ, MC, USA; Jacob Collen, MD, CPT, MC, USA; Aaron B. Holley, MD; David Greenburg, MD, MPH, CPT, MC, USA; Oleh Hnatiuk, MD, FCCP
Author and Funding Information

Affiliations: Walter Reed Army Medical Center Washington, DC,  Madigan Army Medical Center Seattle, WA,  National Heart, Lung, and Blood Institute Bethesda, MD

Correspondence to: Christopher S. King, MD, MAJ, MC, USA, Walter Reed Army Medical Center, Department of Medicine, 6900 Georgia Ave, Washington, DC 20350; e-mail: christopher.king@amedd.army.mil


The material submitted here is original and is not currently under consideration for publication or has been published elsewhere. All authors have read the manuscript and approve its submission. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government.

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):325. doi:10.1378/chest.09-0820
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To the Editor:

We commend Leung and colleagues on their interest and contribution to the research on this subject. As mentioned in our article (November 2008),1 the American Thoracic Society/European Respiratory Society published guidelines2 in 2005 recommending the use of the reference values from the National Health and Nutrition Examination Study III population data set in the United States for patients 8 to 80 years of age. Currently, no guidance exists regarding the optimal reference equations for use outside the United States. The American Thoracic Society/European Respiratory Society guidelines2 only recommend that pulmonary function testing laboratories should use a reference equation “derived from a population similar to the individual subject using the same kind of instrument and testing procedure.”

The results presented by Leung et al show the greatest discordance between the reference values of Ip et al3 and Knudson et al,4 which is not surprising given the populations from which they were derived. These results reinforce the need for the development and use of reference equations that are reflective of the population being evaluated throughout the world. These equations could even be applied to specific populations in the United States. Doing so will enable clinicians here and abroad to more accurately identify and quantify pulmonary dysfunction, which may in turn result in the earlier detection and treatment of lung disease, and the conservation of valuable resources. We look forward to further research and subsequent guidance regarding these important questions.

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;134:1009-1116. [PubMed] [CrossRef]
 
Pellegrino R, Viegi G, Brusasco V, et al. Interpretive strategies for lung function tests. Eur Respir J. 2005;26:948-968. [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]
 
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]
 

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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;134:1009-1116. [PubMed] [CrossRef]
 
Pellegrino R, Viegi G, Brusasco V, et al. Interpretive strategies for lung function tests. Eur Respir J. 2005;26:948-968. [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]
 
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]
 
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