Диффузионная способность легких при хронической обструктивной болезни легких: гендерные, возрастные и расовые аспекты

Введение. Диффузионная способность легких является вторым по значимости респираторным тестом, следующим за спирометрией. Оценке диффузионной способности легких при хронической обструктивной болезни легких (ХОБЛ) не уделяется должного внимания, хотя данный параметр отражает изменения функционального объема легких и транспорт газа через альвеолярно-капиллярную мембрану, тем самым предоставляя больше информации о физиологии дыхания, чем результаты спирометрии. Измерение диффузионной способности легких по монооксиду углерода (DLCO) является стандартом в пульмонологии, однако в последние годы пристальное внимание направлено на определение диффузионной способности легких по оксиду азота (DLNO), который дает лучшее представление о переносе газа через альвеолярно-капиллярную мембрану по сравнению с DLCO. В литературе последних лет активно обсуждаются вопросы включения возрастного, расового и гендерного аспектов в спирометрические эталонные уравнения, которые применяются для оценки спирометрических параметров и диффузионной способности легких.
Цель. Анализ литературы за последние пять лет, отражающей взгляды современных исследователей на методы диагностики диффузионной способности легких, а также вклад возрастного, расового и гендерного аспектов в оценку данного параметра при ХОБЛ.
Материалы и методы. В базе данных PubMed проводился поиск информации за период 2017-2022 гг. по выбранным критериям включения. Информационные запросы включали следующую совокупность ключевых слов: «diffusion capacity», «chronic obstructive pulmonary disease», «gender», «age», «race», «DLNO», «DLCO». Были проанализированы 123 статьи.
Результаты. Современные данные подчеркивают важность включения диффузионной способности легких в прогностические программы оценки ХОБЛ. Определение диффузионной способности легких по оксиду азота может быть перспективным направлением исследований в ближайшем будущем. Гендерные и возрастные аспекты играют важную роль в интерпретации спирометрических данных и диффузионной способности легких. Вопрос включения расового признака в оценку диффузионной способности легких при ХОБЛ находится под сомнением.

1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (2020 report). URL: https://goldcopd.org/gold-reports/

2. Sandelowsky H., Weinreich U.M., Aarli B.B., Sundh J., Høines K., Stratelis G., Løkke A., Janson C., Jensen C., Larsson K. COPD − do the right thing // BMC Fam. Pract. 2021. Vol.22, Iss.1. Article number: 244. https://doi.org/10.1186/s12875-021-01583-w

3. Halpin D.M.G., Criner G.J., Papi A., Singh D., Anzueto A., Martinez F.J., Agusti A.A., Vogelmeier C.F. Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD science committee report on COVID-19 and chronic obstructive pulmonary disease // Am. J. Respir. Crit. Care Med. 2021. Vol.203, Iss.1. P.24–36. https://doi.org/10.1164/rccm.202009-3533SO

4. Adeloye D., Song P., Zhu Y., Campbell H., Sheikh A., Rudan I. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir. Med. // 2022. Vol.10, Iss.5. P.447–458. https://doi.org/10.1016/S2213-2600(21)00511-7

5. Rodrigues S.O., Cunha C.M.C.D., Soares G.M.V., Silva P.L., Silva A.R., Gonçalves-de-Albuquerque C.F. Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease // Pharmaceuticals (Basel). 2021. Vol.14, Iss.10. Article number: 979. https://doi.org/10.3390/ph14100979

6. Balasubramanian A., MacIntyre N.R., Henderson R.J., Jensen R.L., Kinney G., Stringer W.W., Hersh C.P., Bowler R.P., Casaburi R., Han M.K., Porszasz J., Barr R.G. Make B.J., Wise R.A., McCormack M.C. Diffusing capacity of carbon monoxide in assessment of COPD // Chest. 2019. Vol.156., Iss.6. P.1111–1119. https://doi.org/10.1016/j.chest.2019.06.035

7. Xu X., Huang K., Dong F., Qumu S., Zhao Q., Niu H., Ren X., Gu X., Yu T., Pan L., Yang T., Wang C. The Heterogeneity of Inflammatory Response and Emphysema in Chronic Obstructive Pulmonary Disease // Front. Physiol. 2021. Vol.12. Article number: 783396. https://doi.org/10.3389/fphys.2021.783396

8. Bakker J.T., Klooster K., Bouwman J., Pelgrim G.J., Vliegenthart R., Slebos D.J. Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients // ERJ Open Res. 2022. Vol.8, Iss.1. Article number: 00492-2021. https://doi.org/10.1183/23120541.00492-2021

9. Radovanovic D., Contoli M., Marco F.D., Sotgiu G., Pelaia G., Braido F., Corsico A.G., Micheletto C., Rogliani P., Scichilone N., Saderi L., Santus P., Solidoro P. Clinical and functional characteristics of COPD Patients across GOLD Classifications: results of a multicenter observational study // COPD. 2019. Vol.16, Iss.3-4. P.215–226. https://doi.org/10.1080/15412555.2019.1659760

10. Ni Y., Yu Y., Dai R., Shi G. Diffusing capacity in chronic obstructive pulmonary disease assessment: A metaanalysis // Chron. Respir. Dis. 2021. Vol.8. Article number: 14799731211056340. https://doi.org/10.1177/14799731211056340

11. Wardyn P.M., de Broucker V., Chenivesse C., Sobaszek A., Van Bulck R., Perez T., Edmé J.L., Hulo S. Assessing the applicability of the new Global Lung Function Initiative reference values for the diffusing capacity of the lung for carbon monoxide in a large population set // PLoS One. 2021. Vol.16, Iss.1. Article number: e0245434. https://doi.org/10.1371/journal.pone.0245434

12. Ogata H., Katahira K., Enokizu-Ogawa A., Jingushi Y., Ishimatsu A., Taguchi K., Nogami H., Aso H., Moriwaki A., Yoshida M. The association between transfer coefficient of the lung and the risk of exacerbation in asthma-COPD overlap: an observational cohort study // BMC Pulm Med. 2022. Vol.22, Iss.1. Article number: 22. https://doi.org/10.1186/s12890-021-01815-w

13. Masekela R., Hall G.L., Stanojevic S., Sartorius B., MacGinty R., Saad H.B., Trabelsi Y., Messan F., Arigliani M., Ketfi A., Gray D. An urgent need for African spirometry reference equations: the Paediatric and Adult African Spirometry study // Int. J. Tuberc. Lung Dis. 2019. Vol.23, Iss.8. P.952–958. https://doi.org/10.5588/ijtld.18.0442

14. Madanhire T., Ferrand R.A., Attia E.F., Sibanda E.N., Rusakaniko S., Rehman A.M. Validation of the global lung initiative 2012 multi-ethnic spirometric reference equations in healthy urban Zimbabwean 7-13 year-old school children: a cross-sectional observational study // BMC Pulm. Med. 2020. Vol.20, Iss.1. Article number: 56. https://doi.org/10.1186/s12890-020-1091-4

15. Casanova C., Gonzalez-Dávila E., Martínez-Gonzalez C., Cosio B.G., Fuster A., Feu N., Solanes I., Cabrera C., Marin J.M., Balcells E., Peces-Barba G., de Torres J.P., Marín-Oto M., Calle M., Golpe R., Ojeda E., Divo M., Pinto-Plata V., Amado C., López-Campos J.L., Celli B.R. Natural course of the diffusing capacity of the lungs for carbon monoxide in COPD: importance of sex // Chest. 2021. Vol.160, Iss.2. Р.481–490. https://doi.org/10.1016/j.chest.2021.03.069

16. Scicluna V., Han M. COPD in Women: Future Challenges // Arch. Bronconeumol. 2022. Article number: S0300-2896(22)00485-9. https://doi.org/10.1016/j.arbres.2022.06.008

17. Han MK. Chronic Obstructive Pulmonary Disease in Women: A Biologically Focused Review with a Systematic Search Strategy // Int. J. Chron. Obstruct. Pulmon. Dis. 2020. Vol.15. P.711–721. https://doi.org/10.2147/COPD.S237228

18. Zarrabian B., Mirsaeidi M.A. Trend Analysis of Chronic Obstructive Pulmonary Disease Mortality in the United States by Race and Sex // Ann. Am. Thorac. Soc. 2021. Vol.18, Iss.7. P.1138–1146. https://doi.org/10.1513/AnnalsATS.202007-822OC

19. DeMeo DL. Sex and Gender Omic Biomarkers in Men and Women With COPD: Considerations for Precision Medicine // Chest. 2021. Vol.160, Iss.1. P.104–113. https://doi.org/10.1016/j.chest.2021.03.024

20. Gut-Gobert C., Cavaillès A., Dixmier A., Guillot S., Jouneau S., Leroyer C., Marchand-Adam S., Marquette D., Meurice J.C., Desvigne N., Morel H., Person-Tacnet C., Raherison C. Women and COPD: do we need more evidence? // Eur. Respir. Rev. 2019. Vol.28, Iss.151. Article number: 180055. https://doi.org/10.1183/16000617.0055-2018

21. Hernández Cordero A.I., Yang C.X., Li X., Milne S., Chen V., Hollander Z., Ng R., Criner G.J., Woodruff P.G., Lazarus S.C., Connett J.E., Han M.K., Martinez F.J., Reed R.M., Man S.F.P., Leung J.M., Sin D.D. Epigenetic marker of telomeric age is associated with exacerbations and hospitalizations in chronic obstructive pulmonary disease // Respir. Res. 2021. Vol.22, Iss.1. Article number: 316. https://doi.org/10.1186/s12931-021-01911-9

22. Yang W., Li F., Li C., Meng J., Wang Y. Focus on Early COPD: Definition and Early Lung Development // Int. J. Chron. Obstruct. Pulmon. Dis. 2021. Vol.16. P.3217–3228. https://doi.org/10.2147/COPD.S338359

23. Wang G., Hallberg J., Charalampopoulos D., Sanahuja M.C., Breyer-Kohansal R., Langhammer A., Granell R., Vonk J.M., Mian A., Olvera N., Laustsen L.M., Rönmark E., Abellan A., Agusti A., Arshad S.H., Bergström A., Boezen H.M., Breyer M.K., Burghuber O., Bolund A.C. et al. Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study // ERJ Open Res. 2021. Vol.7, Iss.4. Article number: 00457–2021. https://doi.org/10.1183/23120541.00457-2021

24. Laffey K.G., Nelson A.D., Laffey M.J., Nguyen Q., Sheets L.R., Schrum A.G. Chronic respiratory disease disparity between American Indian/Alaska Native and white populations, 2011-2018 // BMC Public Health. 2021. Vol.21, Iss.1. Article number: 1466. https://doi.org/10.1186/s12889-021-11528-8

25. Elmaleh-Sachs A., Balte P., Oelsner E.C., Allen N.B., Baugh A., Bertoni A.G., Hankinson J.L., Pankow J., Post W.S., Schwartz J.E., Smith B.M., Watson K., Barr R.G. Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events: The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study // Am. J. Respir. Crit. Care Med. 2022. Vol.205, Iss.6. P.700–710. https://doi.org/10.1164/rccm.202107-1612OC

26. Guillien A., Soumagne T., Regnard J., Degano B. Groupe Fonction de la SPLF. The new reference equations of the Global Lung function Initiative (GLI) for pulmonary function tests // Rev. Mal. Respir. 2018. Vol.35, Iss.10. P.1020–1027. https://doi.org/10.1016/j.rmr.2018.08.021

27. Tanabe N., Rhee C.K., Sato S., Muro S., Shima H., Tanimura K., Jung K.S., Yoo K.H., Hirai T. Disproportionally Impaired Diffusion Capacity Relative to Airflow Limitation in COPD // COPD. 2020. Vol.17, Iss.6. P.627–634. https://doi.org/10.1080/15412555.2020.1845639

28. Stanojevic S., Graham B.L., Cooper B.G., Thompson B.R., Carter K.W., Francis R.W., Hall G.L. 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: 170010. https://doi.org/10.1183/13993003.00010-2017

29. Измерение диффузионной способности легких по монооксиду углерода методом одиночного вдоха: стандарты Американского торакального и Европейского респираторного обществ (часть 1-я) (По материалам: Graham B.L., Brusasco V., Burgos F., Cooper B.G., Jensen R., Kendrick A., MacIntyre N.R.,Thompson B.R., Wanger J. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49(1):pii:1600016. https://doi.org/10.1183/13993003.00016-2016) // Пульмонология. 2019. Т.29, №2. С.149–158. https://doi.org/10.18093/0869-0189-2019-29-2-149-158

30. Dridi R., Dridi N., Govindasamy K., Gmada N., Aouadi R., Guénard H., Laher I., Saeidi A., Suzuki K., Hackney A.C., Zouhal H. Effects of Endurance Training Intensity on Pulmonary Diffusing Capacity at Rest and after Maximal Aerobic Exercise in Young Athletes // Int. J. Environ. Res. Public Health. 2021. Vol.18, Iss.23. Article number: 12359. https://doi.org/10.3390/ijerph182312359

31. DeCato T.W., Hegewald M.J. Diffusing Capacity, the Too Often Ignored Lung Function Test in COPD // Chest. 2021. Vol.160, Iss.2. P.389–390. https://doi.org/10.1016/j.chest.2021.05.005

32. Johnson D.C. Interpretation of Diffusing Capacity // Chest. 2021. Vol.159, Iss.6. P.2513–2514. https://doi.org/10.1016/j.chest.2020.12.054

33. Borland C., Hughes J.M. Lung Diffusing Capacities (DL) for Nitric Oxide (NO) and Carbon Monoxide (CO): The Evolving Story // Compr. Physiol. 2019. Vol.10, Iss.1. P.73–97. https://doi.org/10.1002/cphy.c190001

34. Zavorsky G.S., Almamary A.S., Alqahtani M.K., Shan S.HS., Gardenhire D.S. The need for race-specific reference equations for pulmonary diffusing capacity for nitric oxide // BMC Pulm. Med. 2021. Vol.21, Iss.1. Article number: 232. https://doi.org/10.1186/s12890-021-01591-7

35. Elbehairy A.F., O'Donnell C.D., Abd Elhameed A., Vincent S.G., Milne K.M., James M.D., Webb K.A., Neder J.A., O'Donnell D.E. Canadian Respiratory Research Network. Low resting diffusion capacity, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease // J. Appl. Physiol. (1985). 2019. Vol.127, Iss.4. P.1107–1116. https://doi.org/10.1152/japplphysiol.00341.2019

36. Celli B.R., Locantore N., Tal-Singer R., Riley J., Miller B., Vestbo J., Yates J.C., Silverman E.K., Owen C.A., Divo M., Pinto-Plata V., Wouters E.F.M., Faner R., Agusti A. Emphysema and extrapulmonary tissue loss in COPD: a multiorgan loss of tissue phenotype // Eur. Respir. J. 2018. Vol.51, Iss.2. 1702146 doi: 10.1183/13993003.02146-2017

37. Uemasu K., Sato S., Muro S., Sato A., Tanabe N., Hasegawa K., Hamakawa Y., Mizutani T., Fuseya Y., Tanimura K., Takahashi T., Hirai T. Annual decline in arterial blood oxygen predicts development of chronic respiratory failure in COPD with mild hypoxaemia: a 6-year follow-up study // Respirology. 2019. Vol.24, Iss.3. P.262–269. https://doi.org/10.1111/resp.13402

38. Kovacs G., Agusti A., Barberà J.A., Celli B., Criner G., Humbert M., Sin D.D., Voelkel N., Olschewski H. Pulmonary vascular involvement in chronic obstructive pulmonary disease: is there a pulmonary vascular phenotype? // Am. J. Respir. Crit. Care Med. 2018. Vol. 198, Iss.8. Р.1000–1011. https://doi.org/10.1164/rccm.201801-0095PP

39. Choi J., Sim J.K., Oh J.Y., Lee Y.S., Hur G.Y., Lee S.Y., Shim J.J., Rhee C.K., Min K.H. Prognostic marker for severe acute exacerbation of chronic obstructive pulmonary disease: analysis of diffusing capacity of the lung for carbon monoxide (DLCO) and forced expiratory volume in one second (FEV1) // BMC Pulm. Med. 2021. Vol.21, Iss.1. Article number: 152. https://doi.org/10.1186/s12890-021-01519-1

40. Kang J., Oh Y.M., Lee J.H., Kim E.K., Lim S.Y., Kim W.J., Yoon H.I., Kim T.H., Park T.S., Kim S.O., Lee S.W., Lee S.D., Lee J.S. Distinctive patterns of pulmonary function change according to baseline lung volume and diffusing capacity // Int. J. Tuberc. Lung Dis. 2020. Vol.24, Iss.6. P.597–605. https://doi.org/10.5588/ijtld.19.0401

41. de-Torres J.P., O'Donnell D.E., Marín J.M., Cabrera C., Casanova C., Marín M., Ezponda A., Cosio B.G., Martinez C., Solanes I., Fuster A,. Neder J.A., Gonzalez-Gutierrez J., Celli B.R. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD // Chest. 2021. Vol.160, Iss.3. P.872–878. https://doi.org/10.1016/j.chest.2021.04.033

42. Zou R.H., Bon J. Reduced Dlco in GOLD I COPD: Moving Towards a Multidimensional Approach to Risk Stratification // Chest. 2021. Vol.160, Iss.3. P.791–792. https://doi.org/10.1016/j.chest.2021.05.016

43. Hall G.L., Filipow N., Ruppel G., Okitika T., Thompson B., Kirkby J, Steenbruggen I, Cooper B.G., Stanojevic S. 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.

44. Baugh A.D., Shiboski S., Hansel N.N., Ortega V., Barjaktarevic I., Barr R.G., Bowler R., Comellas A.P., Cooper C.B., Couper D., Criner G., Curtis J.L., Dransfield M., Ejike C., Han M.K., Hoffman E., Krishnan J., Krishnan J.A., Mannino D., Paine R. 3rd, Parekh T, Peters S., Putcha N., Rennard S., Thakur N., Woodruff P.G. Reconsidering the Utility of Race-Specific Lung Function Prediction Equations // Am. J. Respir. Crit. Care Med. 2022. Vol.205, Iss.7. P.819–829. https://doi.org/10.1164/rccm.202105-1246OC

45. Kaminsky D.A. Is There a Role for Using Race-Specific Reference Equations? Yes and No // Am. J. Respir. Crit. Care Med. 2022. Vol.205, Iss.7. P.746–748. https://doi.org/10.1164/rccm.202201-0006ED

46. 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. 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. Р.e70–e88. https://doi.org/10.1164/rccm.201908-1590ST

47. Howarth T., Saad H.B., Perez A.J., Atos C.B., White E., Heraganahally S.S. Comparison of diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC) between Indigenous Australians and Australian Caucasian adults // PLoS One. 2021. Vol.16, Iss.4. Article number: e0248900. https://doi.org/10.1371/journal.pone.0248900

48. Vaz Fragoso C.A., Rochester C.L., McAvay G.J., Iannone L., Leo-Summers L.S. Diffusing capacity in normalfor- age spirometry and spirometric impairments, using reference equations from the global lung function initiative // Respir. Med. 2020. Vol.170. Article number: 106037. https://doi.org/10.1016/j.rmed.2020.106037

49. Schallerer A.E., Duke J.W., Speros J.P., Mangum T.S., Norris H.C., Beasley K.M., Laurie S.S., Elliott J.E., Davis J.T., Lovering A.T. Lower transfer factor of the lung for carbon monoxide in women with a patent foramen ovale // Exp. Physiol. 2022. Vol.107, Iss.3. P.243–252. https://doi.org/10.1113/EP090176

50. Munkholm M., Marott J.L., Bjerre-Kristensen L., Madsen F., Pedersen O.F., Lange P. Reference equations for pulmonary diffusing capacity of carbon monoxide and nitric oxide in adult Caucasians // Eur. Respir. J. 2018. Vol.52, Iss.1. Article number: 1500677. https://doi.org/10.1183/13993003.00677-2015

51. Vyas D.A., Eisenstein L.G., Jones D.S. Hidden in plain sight - reconsidering the use of race correction in clinical algorithms // N. Engl. J. Med. 2020. Vol.383, Iss.9. P.874–882. https://doi.org/10.1056/NEJMms2004740

52. Culver B.H., Graham B.L., Coates A.L., Wanger J., Berry C.E., Clarke P.K., Hallstrand T.S., Hankinson J.L., Kaminsky D.A., MacIntyre N.R., McCormack M.C., Rosenfeld M., Stanojevic S, Weiner D.J. Recommendations for a standardized pulmonary function report. An official American thoracic society technical statement // Am. J. Respir. Crit. Care Med. 2017. Vol.196, Iss.11. P.1463–1472. https://doi.org/10.1164/rccm.201710-1981ST

53. Schluger N.W. The Vanishing Rationale for the Race Adjustment in Pulmonary Function Test Interpretation // Am. J. Respir. Crit. Care Med. 2022. Vol.205, Iss.6. P. 612–614. https://doi.org/10.1164/rccm.202112-2772ED

54. Gaffney A.W., McCormick D., Woolhandler S., Christiani D.C., Himmelstein D.U. Prognostic implications of differences in forced vital capacity in black and white US adults: findings from NHANES III with long-term mortality follow-up // EClinicalMedicine. 2021. Vol.39. Article number: 101073. https://doi.org/10.1016/j.eclinm.2021.101073

55. He B., Huang J.V., Kwok M.K., Au Yeung S.L., Hui L.L., Li A.M., Leung G.M, Schooling C.M. The association of early-life exposure to air pollution with lung function at ∼17.5 years in the “Children of 1997” Hong Kong Chinese Birth Cohort // Environ. Int. 2019. Vol.123. P.444–450. https://doi.org/10.1016/j.envint.2018.11.073

56. Voraphani N., Stern D.A., Zhai J., Wright A.L., Halonen M., Sherrill D.L., Hallberg J., Kull I., Bergström A., Murray C.S., Lowe L., Custovic A., Morgan W.J., Martinez F.D., Melén E., Simpson A., Guerra S. The role of growth and nutrition in the early origins of spirometric restriction in adult life: a longitudinal, multicohort, population-based study // Lancet Respir. Med. 2021. Vol.10, Iss.1. P.59–71. https://doi.org/10.1016/S2213-2600(21)00355-6

57. Braun L. Race correction and spirometry: why history matters // Chest. 2021. Vol.159, Iss.4. P.1670–1675. https://doi.org/10.1016/j.chest.2020.10.046

58. Ketfi A., Ben Saad H. The global lung function initiative 2021 (GLI-2021) norms provide mixed results for static lung volumes (SLVs) in Algerian adults // Libyan J. Med. 2022. Vol.17, Iss.1. Article number: 2059893. https://doi.org/10.1080/19932820.2022.2059893

59. Witonsky J., Elhawary J.R., Eng C., Rodríguez-Santana J.R., Borrell L.N., Burchard E.G. Race- and Ethnicity-Based Spirometry Reference Equations: Are They Accurate for Genetically Admixed Children? // Chest. 2022. Vol.162, Iss.1 . Р.184‒195. https://doi.org/10.1016/j.chest.2021.12.664