Spirometry: how to evaluate the results?
https://doi.org/10.36604/1998-5029-2022-83-91-99
Abstract
Introduction. The European Respiratory Society, the American Thoracic Society, and the Russian Respiratory Society are currently working on updating the technical standards and interpretive strategies for routine lung function tests. There is a search for recommendations for the best choice of reference values, the optimal limits of normal and severity grading of detected impairments. An important step in this work is the standartization of pulmonary function tests interpretation, including spirometry.
Aim. Review of existing concepts for the spirometry interpretation, according to new approaches to their quantitative and qualitative assessment. Materials and methods. The scientific publications on the PubMed and eLIBRARY.RU platforms were analyzed. The materials posted on the official websites of the European Respiratory Society, the Russian Respiratory Society, the American Thoracic Society and the Global Lung Function Initiative
were also used.
Results. A brief overview of the main reference values for spirometry is presented: the European Coal and Steel Community (1993), Global Lung Function Initiative (2012, 2021), R.F.Klement et al. (1986, 1991). The issues of defining the lower limit of the normal, diagnosing ventilatory impairments and assessing the severity of lung function reduction using the z-score and a percentage of the predicted value when analyzing the results of spirometry are considered.
Conclusion. The type of ventilatory impairment and severity should be presented in the spirometry interpretation just like the vital capacity assessment. The obstructive ventilatory impairment is generally diagnosed by spirometry, if the signs of restrictive or mixed patterns are present, it is recommended to determine the total lung capacity by body plethysmography
method. Assessment of the limits of normal and the severity levels for any spirometry indices should be carried out using the z-score values.
Keywords
About the Author
M. Yu. KamenevaRussian Federation
Marina Yu. Kameneva, MD, PhD, DSc (Med.), Leading Staff Scientist
197022
6/8 L'va Tolstogo Str.
Saint Petersburg
References
1. Quanjer P. H., Stanojevic S., Cole T. J., Baur X., Hall G. L., Culver B. H., Enrigh P. L., Hankinson J. L., Ip M. S. M., Zheng J., Stocks J. and the ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations // Eur. Respir. J. 2012. Vol.40, Iss. 10. P. 1324–1343. https://doi.org/10.1183/09031936.00080312
2. Stanojevic S., Graham B. L., Cooper B. G., Bruce R., Thompson B. R., Carter K. W., Francis R. W., Graham L., Hall G. L. on behalf of the Global Lung Function Initiative TLCO working group. Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians // Eur. Respir. J. 2017. Vol. 50, Iss. 3. Article number: 1700010. https://doi.org/10.1183/13993003.00010-2017
3. Hall G. L., Filipow N., Ruppel G., Okitika T., Thompson B., Kirkby J., Steenbruggen I., Cooper B. G., Stanojevic S. on behalf of the contributing GLI Network members. Official ERS technical standard: Global Lung Function Initiative reference values for static lung volumes in individuals of European ancestry // Eur. Respir. J. 2021. Vol.57, Iss.3. Article number: 2000289. https://doi.org/10.1183/13993003.00289-2020
4. Quanjer P. H., Tammeling G. J., Cotes J. E., Pedersen O. F., Peslin R., Yernault J.-C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society // Eur. Respir. J. 1993. Vol. 6, Suppl.16. P. 5–40.
5. Klement R. F., Lavrushin A. A., Ter-Pogasyan P. A., Kotegov Yu. M. [Users instructions of main spirometry indexes predicted values formulas and tables]. Leningrad; 1986 (in Russian).
6. Klement R. F., Zil'ber N. A. [Methodological features of the indicators of the flow-volume curve in persons under 18 years of age]. Pulmonologiya 1994; (2): 17–21 (in Russian).
7. Kameneva M. Y., Tishkov A. V., Byhova A. V., Pokhaznikova M. A., Trophimov V. I. [Consistency analysis of some reference systems in the interpretation of spirometry]. Rossiyskiy semeynyy vrach 2012; 16 (2): 23–28 (in Russian).
8. Stanojevic S., Kaminsky D. A., Miller M., Thompson B., Aliverti A., Barjaktarevic I., Cooper B. G., Culver B., Derom E., Hall G. L., Hallstrand T. S., Leuppi J. D., MacIntyre N., McCormack M., Rosenfeld M., Swenson E. R. ERS / ATS technical standard on interpretive strategies for routine lung function tests // Eur. Respir. J. 2021. Article number: 2101499. https://doi.org/10.1183/13993003.01499-2021
9. Hansen J. E. Lower limit of normal is better than 70 % or 80 % // Chest. 2011. Vol. 139, Iss. 1. P. 6–8. DOI:10.1378/chest.10-1117
10. Miller M. R., Quanjer P. H., Swanne M. P., Ruppel G., Enright P. L. Interpreting lung function data using 80 % predicted and fixed thresholds misclassifies more than 20 % of patients // Chest. 2011. Vol. 139, Iss. 1. P. 52–59. https://doi.org/10.1378/chest.10-0189
11. Pellegrino R., Viegi G., Brusasco V., Crapo R. O., Burgos F., Casaburi R., Coates A., Van der Grinten C. P. M., Gustafsson P., Hankinson J., Jensen R., Johnson D. C., MacIntyre N., McKay R., Miller M. R., Navajas D., Pedersen O. F., Wangeret J. Interpretative strategies for lung function tests // Eur. Respir. J. 2005. Vol. 26, Iss. 5. P. 948–968. https://doi.org/10.1183/09031936.05.00035205
12. Brusasco V., Pellegrino R., Rodarte J. R. Vital capacities in acute and chronic airway obstruction: dependence on flow and volume histories // Eur. Respir. J. 1997. Vol. 10, Iss. 6. P. 1316–1320. https://doi.org/10.1183/09031936.97.10061316
13. Graham B. L., Steenbruggen I., Miller M. R., Barjaktarevic I. Z., Cooper B. G., Hall G. L., Hallstrand T. S., Kaminsky D .A., McCarthy K., McCormack M. C., Oropez C. E., Rosenfeld M., Stanojevic S., Swanney M. P., Thompson B. R. on behalf of the American Thoracic Society and the European Respiratory Society. Standardization of spirometry 2019. Update an official American Thoracic Society and European Respiratory Society technical statement // Am. J. Respir. Crit. Care Med. 2019. Vol. 200, Iss. 8. P. e70–e88. https://doi.org/10.1164/rccm.201908-1590ST
14. Crenesse D., Berlioz M., Bourrier T., Albertini M. Spirometry in children aged 3 to 5 years: reliability of forced expiratory maneuvers // Pediatr. Pulmonol. 2001. Vol. 32, Iss. 1. P. 56–61. https://doi.org/10.1002/ppul.1089
15. Piccioni P., Borraccino A., Forneris M. P., Migliore E., Carena C., Bignamini E., Fassio S., Cordola G., Arossa W., Bugianiet M. Reference values of forced expiratory volumes and pulmonary flows in 3-6 year children: a cross-sectional study // Respir. Res. 2007. Vol. 8, Iss. 1. Article number: 14. https://doi.org/10.1186/1465-9921-8-14
16. Saint-Pierre М., Ladha J., Berton D. C., Reimao G., Castelli G., Marillier M., Bernard A.-C., O'Donnell D. E., Alberto Neder J. A. Is the slow vital capacity clinically useful to uncover airflow limitation in subjects with preserved FEV1 / FVC ratio? // Chest. 2019. Vol. 156, Iss. 3. P. 497−506. https://doi.org/10.1016/j.chest.2019.02.001
17. Chuchalin A.G., Aysanov Z.R., Chikina S.Yu., Chernyak A.V., Kalmanova E.N. [Federal guidelines of Russian Respiratory Society on spirometry]. Pulmonologiya 2014; 6:11–24 (in Russian) https://doi.org/10.18093/0869-0189-2014-0-6-11-24
18. Aysanov Z. R., Kameneva M. Yu., Chernyak A. V., Perelman J. M., Prikhod'ko A.G., Chushkin M.I., Kalmanova E. N., Avdeev S. N., Belevskiy A. S., Chikina S. Yu., Kravchenko N. Yu. [Spirometry. Guidelines of Russian Respiratory Society]. 2021 (in Russian). Available at: https://spulmo.ru/upload/spirometriya_16_12_2021_extEd.pdf?t=1
19. Shik L.L., Kanaev N.N., editors. [Manual of clinical respiratory physiology]. Moscow: Meditsina; 1980 (in Russian).
20. Quanjer P. H., Pretto J. J., Danny J., Brazzale D. J., Boros P. W. Grading the severity of airways obstruction: new wine in new bottles // Eur. Respir. J. 2014. Vol. 43, Iss. 2. P. 505–512. https://doi.org/10.1183/09031936.00086313
21. Klement R. F., Aganezova E. S., Kotegov Yu. M. [Criteria for deviation from the normal of some parameters of the forced expiratory curve. In: Klement R. F., Kuznetsova V. K., editors. Modern problems of clinical respiratory physiology: collection of scientific papers]. Leningrad; 1987. P. 20–27 (in Russian).
Review
For citations:
Kameneva M.Yu. Spirometry: how to evaluate the results? Bulletin Physiology and Pathology of Respiration. 2022;(83):91-99. (In Russ.) https://doi.org/10.36604/1998-5029-2022-83-91-99