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Correspondence |

Clinimetric Properties of the Lung Clearance Index in Adults and Children With Cystic Fibrosis FREE TO VIEW

Esther Oude Engberink; Sanja Stanojevic, PhD; Felix Ratjen, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada

CORRESPONDENCE TO: Sanja Stanojevic, PhD, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1412-1413. doi:10.1016/j.chest.2016.08.1478
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In this issue of CHEST (December 2016), O’Neill et al presented data on the clinimetric properties of the lung clearance index (LCI) in children and adults with cystic fibrosis (CF). It was encouraging to see that the variability and intra-test repeatability of the LCI are comparable in adults and children with CF. The intra-visit and inter-visit repeatability findings provide insight into the normal variability of the LCI in health and disease and are necessary to establish thresholds for meaningful changes for interventional studies and to identify disease progression. Although O’Neill et al present valuable results, we believe that they have missed an opportunity to fully explore the clinimetric properties of the LCI.

The authors reported high repeatability of the coefficient of variation, the coefficient of repeatability, and Bland-Altman plots for LCI by using the data from patients with CF. However, it would also be meaningful to show the differences between health and CF for all three metrics to help further inform the thresholds for clinically meaningful changes.

In addition, the strength of these data is the repeated measures in the same individual on separate occasions, which provides an opportunity to define the inter-test repeatability. O’Neill et al used the intra-class correlation coefficient to define the inter-test repeatability and to describe the agreement between visits. Calculation of the coefficient of repeatability or Bland-Altman limits of agreement would also describe the magnitude of changes seen. Although there are advantages and disadvantages in describing each of these metrics for data in a disease group, these descriptive statistics nonetheless would inform future studies designed to defined thresholds for treatment effects or disease progression over time.

References

O'Neill K. .Tunney M.M. .Johnston E. .et al Lung clearance index in adults and children with cystic fibrosis. Chest. 2016;150:1323-1332 [PubMed]journal
 
Sonnappa S. .Bastardo C.M. .Wade A. .Bush A. .Stocks J. .Aurora P. . Repeatability and bronchodilator reversibility of lung function in young children. Eur Respir J. 2013;42:116-124 [PubMed]journal. [CrossRef] [PubMed]
 
Vaz S. .Falkmer T. .Passmore A.E. .Parsons R. .Andreou P. . The case for using the repeatability coefficient when calculating test-retest reliability. PLoS One. 2013;8:e73990- [PubMed]journal. [CrossRef] [PubMed]
 

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References

O'Neill K. .Tunney M.M. .Johnston E. .et al Lung clearance index in adults and children with cystic fibrosis. Chest. 2016;150:1323-1332 [PubMed]journal
 
Sonnappa S. .Bastardo C.M. .Wade A. .Bush A. .Stocks J. .Aurora P. . Repeatability and bronchodilator reversibility of lung function in young children. Eur Respir J. 2013;42:116-124 [PubMed]journal. [CrossRef] [PubMed]
 
Vaz S. .Falkmer T. .Passmore A.E. .Parsons R. .Andreou P. . The case for using the repeatability coefficient when calculating test-retest reliability. PLoS One. 2013;8:e73990- [PubMed]journal. [CrossRef] [PubMed]
 
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