Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations

The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5–95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3–95 yrs for Caucasians (n=57,395), African–Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV1) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV1/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3–95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.

[1]  S. Stanojevic,et al.  Age- and height-based prediction bias in spirometry reference equations , 2011, European Respiratory Journal.

[2]  T. Dwyer,et al.  Longitudinal Associations of Adiposity With Adult Lung Function in the Childhood Determinants of Adult Health (CDAH) Study , 2011, Obesity.

[3]  G. Smith,et al.  Patterns and trends of adult height in India in 2005-2006. , 2011, Economics and human biology.

[4]  J. Hankinson,et al.  Similar relation of age and height to lung function among Whites, African Americans, and Hispanics. , 2011, American journal of epidemiology.

[5]  P. Enright,et al.  Interpreting lung function data using 80% predicted and fixed thresholds misclassifies more than 20% of patients. , 2011, Chest.

[6]  C. Rotimi,et al.  Ancestry and disease in the age of genomic medicine. , 2010, The New England journal of medicine.

[7]  S. Stanojevic,et al.  Influence of secular trends and sample size on reference equations for lung function tests , 2010, European Respiratory Journal.

[8]  Alex P. Reiner,et al.  Genetic ancestry in lung-function predictions. , 2010, The New England journal of medicine.

[9]  Mark E. Cohen,et al.  Comparison of pulmonary function in immigrant vs US-born Asian Indians. , 2010, Chest.

[10]  S. Stanojevic,et al.  Changes in the FEV1/FVC ratio during childhood and adolescence: an intercontinental study , 2010, European Respiratory Journal.

[11]  Wei Huang,et al.  Dermatoglyphics from All Chinese Ethnic Groups Reveal Geographic Patterning , 2010, PloS one.

[12]  E. Love,et al.  Predictive Equations for Lung Function Based on a Large Occupational Population in North China , 2009, Journal of occupational health.

[13]  S. Seubsman,et al.  Validity of self-reported weight, height, and body mass index among university students in Thailand: Implications for population studies of obesity in developing countries , 2009, Population health metrics.

[14]  S. Stanojevic,et al.  Spirometry centile charts for young Caucasian children: the Asthma UK Collaborative Initiative. , 2009, American journal of respiratory and critical care medicine.

[15]  M. Stein,et al.  Measurement of admixture proportions and description of admixture structure in different U.S. populations , 2009, Human mutation.

[16]  Rachel Booker,et al.  Diagnostic spirometry in primary care: Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations: a General Practice Airways Group (GPIAG)1 document, in association with the Association for Respiratory Technology & Physiology (A , 2009, Primary care respiratory journal : journal of the General Practice Airways Group.

[17]  J. Balaji,et al.  Normal Spirometric Reference Values for Omani Adults , 2009, Lung.

[18]  J Stocks,et al.  Age- and size-related reference ranges: A case study of spirometry through childhood and adulthood , 2009, Statistics in medicine.

[19]  J. Hankinson,et al.  Cross-sectional and longitudinal spirometry in children and adolescents: interpretative strategies. , 2008, American journal of respiratory and critical care medicine.

[20]  Z. Tabka,et al.  Factors affecting the development of lung function in Tunisian children , 2008, American journal of human biology : the official journal of the Human Biology Council.

[21]  Yusuke Nakamura,et al.  Japanese population structure, based on SNP genotypes from 7003 individuals compared to other ethnic groups: effects on population-based association studies. , 2008, American journal of human genetics.

[22]  S. Harding,et al.  Ethnic differences in adolescent lung function: anthropometric, socioeconomic, and psychosocial factors. , 2008, American journal of respiratory and critical care medicine.

[23]  Mark G Birchette,et al.  Comparing Genetic Ancestry and Self-Described Race in African Americans Born in the United States and in Africa , 2008, Cancer Epidemiology Biomarkers & Prevention.

[24]  I. Bougmiza,et al.  Équations de référence spirométriques des Algériens âgés de 19 à 73 ans , 2008 .

[25]  R. Mei,et al.  Genome-wide screen for asthma in Puerto Ricans: evidence for association with 5q23 region , 2008, Human Genetics.

[26]  K. Ashizawa,et al.  Growth of height and leg length of children in Beijing and Xilinhot, China , 2008 .

[27]  C. Schindler,et al.  Reference equations for lung function screening of healthy never-smoking adults aged 18–80 years , 2008, European Respiratory Journal.

[28]  S. Stanojevic,et al.  Reference ranges for spirometry across all ages: a new approach. , 2008, American journal of respiratory and critical care medicine.

[29]  I. Bougmiza,et al.  [Spirometric reference equations for Algerians aged 19 to 73 years]. , 2008, Revue des maladies respiratoires.

[30]  M. Tremblay,et al.  Methodological Issues in Anthropometry: Self-reported versus Measured Height and Weight 1 , 2008 .

[31]  E. Burchard,et al.  Population admixture associated with disease prevalence in the Boston Puerto Rican health study , 2008, Human Genetics.

[32]  P. Harber,et al.  Limits of longitudinal decline for the interpretation of annual changes in FEV1 in individuals , 2007, Occupational and Environmental Medicine.

[33]  Ieva Braziuniene,et al.  Accuracy of self-reported height measurements in parents and its effect on mid-parental target height calculation , 2007, BMC endocrine disorders.

[34]  S. Morgan Stature and Famine in China: The Welfare of the Survivors of the Great Leap Forward Famine, 1959-61 , 2007 .

[35]  Z. Tabka,et al.  Spirometric values in Tunisian children: Relationship with pubertal status , 2007, Annals of human biology.

[36]  Z. Tabka,et al.  Facteurs influençant les variables ventilatoires des Tunisiennes âgées de 45 ans et plus: Influence de la parité, de l’activité sportive, des données anthropométriques et socioéconomiques , 2006 .

[37]  Z. Tabka,et al.  [Factors influencing pulmonary function in Tunisian women aged 45 years and more]. , 2006, Revue des maladies respiratoires.

[38]  J. Brug,et al.  Differences in Measured and Self-Reported Height and Weight in Dutch Adolescents , 2006, Annals of Nutrition and Metabolism.

[39]  J. Jardim,et al.  Valores de referencia espirométrica en 5 grandes ciudades de Latinoamérica para sujetos de 40 o más años de edad , 2006 .

[40]  B. Amra,et al.  Normative reference values for lung transfer factor in Isfahan, Iran , 2006, Respirology.

[41]  G. Valdivia,et al.  [Spirometric reference values in 5 large Latin American cities for subjects aged 40 years or over]. , 2006, Archivos de bronconeumologia.

[42]  M. Chan-yeung,et al.  Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. , 2006, Chest.

[43]  Min Zhang,et al.  [Feasibility and predicted equations of spirometry in Shenzhen preschool children]. , 2005, Zhonghua er ke za zhi = Chinese journal of pediatrics.

[44]  J. Hankinson,et al.  Interpretative strategies for lung function tests , 2005, European Respiratory Journal.

[45]  H Toyoshima,et al.  Validity of self-reported height and weight in a Japanese workplace population , 2005, International Journal of Obesity.

[46]  R. Rigby,et al.  Generalized additive models for location, scale and shape , 2005 .

[47]  Wiley Interscience,et al.  Influence of socioeconomic status on lung function and prediction equations in Indian children , 2005, Pediatric pulmonology.

[48]  D. Paek,et al.  Normal Predictive Values of Spirometry in Korean Population , 2005 .

[49]  Adrian Bowman,et al.  Generalized additive models for location, scale and shape - Discussion , 2005 .

[50]  R. Wise,et al.  Racial difference in lung function in African-American and White children: effect of anthropometric, socioeconomic, nutritional, and environmental factors. , 2004, American journal of epidemiology.

[51]  L. Jorde,et al.  Genetic variation, classification and 'race' , 2004, Nature Genetics.

[52]  K. Murthy,et al.  Pulmonary function tests in Indian girls — Prediction equations , 2004, Indian journal of pediatrics.

[53]  Z. Tabka,et al.  Spirometric Reference Values in Tunisian Children , 2004, Respiration.

[54]  Mark E. Cohen,et al.  Reference values for pulmonary function in Asian Indians living in the United States. , 2004, Chest.

[55]  O. Al-Rawas,et al.  Normal spirometric reference values for Omani children and adolescents , 2004, Respirology.

[56]  E. Petsonk,et al.  Repeated Measures of FEV1 Over Six to Twelve Months: What Change is Abnormal? , 2004, Journal of occupational and environmental medicine.

[57]  R. Garruto,et al.  Morphological growth and thorax dimensions among Tibetan compared to Han children, adolescents and young adults born and raised at high altitude , 2004, Annals of human biology.

[58]  P. Primatesta,et al.  Prediction equations for normal and low lung function from the Health Survey for England , 2004, European Respiratory Journal.

[59]  M. Wysocki,et al.  Changes in lung function determined longitudinally compared with decline assessed cross-sectionally. The Cracow study , 1986, European Journal of Epidemiology.

[60]  R. Crapo,et al.  Spirometric reference values in a large Middle Eastern population , 2003, European Respiratory Journal.

[61]  Z. Tabka,et al.  [Vital capacity and peak expiratory flow rates in a North-African population aged 60 years and over: influence of anthropometric data and parity]. , 2003, Revue des maladies respiratoires.

[62]  K. Murthy,et al.  Study on lung function tests and prediction equations in Indian male children. , 2003, Indian pediatrics.

[63]  T. Cole The secular trend in human physical growth: a biological view. , 2003, Economics and human biology.

[64]  D. Galuska,et al.  Reliability and validity of self-reported height and weight among high school students. , 2003, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[65]  N. Risch,et al.  The importance of race and ethnic background in biomedical research and clinical practice. , 2003, The New England journal of medicine.

[66]  R. Cooper,et al.  Race and genomics. , 2003, The New England journal of medicine.

[67]  R. Chapela,et al.  Spirometric function in children of Mexico City compared to Mexican‐American children , 2003, Pediatric pulmonology.

[68]  P. Mendola,et al.  Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994. , 2002, Pediatrics.

[69]  Hua Tang,et al.  Categorization of humans in biomedical research: genes, race and disease , 2002, Genome Biology.

[70]  N. Zhong,et al.  Normative values of pulmonary function testing in Chinese adults. , 2002, Chinese medical journal.

[71]  N. Maca-Meyer,et al.  Major genomic mitochondrial lineages delineate early human expansions , 2001, BMC Genetics.

[72]  S van Buuren,et al.  Worm plot: a simple diagnostic device for modelling growth reference curves , 2001, Statistics in medicine.

[73]  R. Kittles,et al.  Ancestral proportions and admixture dynamics in geographically defined African Americans living in South Carolina. , 2001, American journal of physical anthropology.

[74]  R. Crapo,et al.  FEV(6) is an acceptable surrogate for FVC in the spirometric diagnosis of airway obstruction and restriction. , 2000, American journal of respiratory and critical care medicine.

[75]  J. Leong,et al.  Lung function reference values in Chinese children and adolescents in Hong Kong. I. Spirometric values and comparison with other populations. , 2000, American journal of respiratory and critical care medicine.

[76]  S. Morgan Richer and Taller: Stature and Living Standards in China, 1979-1995 , 2000, The China Journal.

[77]  N. Chierakul,et al.  Reference spirometric values for healthy lifetime nonsmokers in Thailand. , 2000, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[78]  J. E. Hansen,et al.  Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. , 2000, American journal of respiratory and critical care medicine.

[79]  R. Crapo,et al.  Differences in spirometry reference values: a statistical comparison of a Mongolian and a Caucasian study. , 1999, The European respiratory journal.

[80]  J L Hankinson,et al.  Spirometric reference values from a sample of the general U.S. population. , 1999, American journal of respiratory and critical care medicine.

[81]  W. Pan,et al.  Reference spirometric values in healthy Chinese neversmokers in two townships of Taiwan. , 1997, The Chinese journal of physiology.

[82]  D. Postma,et al.  Decline of FEV1 by age and smoking status: facts, figures, and fallacies. , 1997, Thorax.

[83]  N. Saitou,et al.  Genetic origins of the Japanese: a partial support for the dual structure hypothesis. , 1997, American journal of physical anthropology.

[84]  G. Wong,et al.  Secular changes in standing height, sitting height and sexual maturation of Chinese--the Hong Kong Growth Study, 1993. , 1996, Annals of human biology.

[85]  J. Cotes,et al.  Longitudinal effects of change in body mass on measurements of ventilatory capacity. , 1996, Thorax.

[86]  J. Hankinson,et al.  Longitudinal and cross-sectional analyses of lung function in steelworkers. , 1996, American journal of respiratory and critical care medicine.

[87]  N. Künzli,et al.  Lung function in healthy never smoking adults: reference values and lower limits of normal of a Swiss population. , 1996, Thorax.

[88]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[89]  D. Dockery,et al.  Age, period, and cohort effects on pulmonary function in a 24-year longitudinal study. , 1995, American journal of epidemiology.

[90]  B. Brunekreef,et al.  Spirometric reference values for white European children and adolescents: Polgar revisited , 1995, Pediatric pulmonology.

[91]  J. Parker,et al.  Impact of using stated instead of measured height upon screening spirometry. , 1994, American journal of respiratory and critical care medicine.

[92]  U. Lalloo,et al.  Review and analysis of variation between spirometric values reported in 29 studies of healthy African adults. , 1994, American journal of respiratory and critical care medicine.

[93]  G. Borsboom,et al.  Discrepancies between longitudinal and cross-sectional change in ventilatory function in 12 years of follow-up. , 1994, American journal of respiratory and critical care medicine.

[94]  M. Rosenthal,et al.  Lung function in white children aged 4 to 19 years: I--Spirometry. , 1993, Thorax.

[95]  W. Vollmer Reconciling cross-sectional with longitudinal observations on annual decline. , 1993, Occupational medicine.

[96]  S. Horne,et al.  Body weight and weight gain related to pulmonary function decline in adults: a six year follow up study. , 1993, Thorax.

[97]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[98]  J E Cotes,et al.  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. , 1993, The European respiratory journal. Supplement.

[99]  David Wypij,et al.  Pulmonary function between 6 and 18 years of age , 1993, Pediatric pulmonology.

[100]  A. Miller,et al.  Lung function testing: selection of reference values and interpretative strategies. , 1992, The American review of respiratory disease.

[101]  D. A. Etler Recent developments in the study of human biology in China: a review. , 1992, Human biology.

[102]  W. S. Lin,et al.  Physical growth of Chinese school children 7-18 years, in 1985. , 1992, Annals of human biology.

[103]  A. Woolcock,et al.  A review of the racial differences in the lung function of normal Caucasian, Chinese and Indian subjects. , 1991, The European respiratory journal.

[104]  A. Woolcock,et al.  What factors explain racial differences in lung volumes? , 1991, The European respiratory journal.

[105]  Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. , 1991, The American review of respiratory disease.

[106]  T A Louis,et al.  Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. , 1990, American journal of epidemiology.

[107]  D. Sherrill,et al.  A Mathematical Procedure for Estimating the Spatial Relationships between Lung Function, Somatic Growth, and Maturation , 1989, Pediatric Research.

[108]  P. Quanjer Predicted values: how should we use them? , 1988, Thorax.

[109]  A. Buist,et al.  Longitudinal versus cross-sectional estimation of lung function decline--further insights. , 1988, Statistics in medicine.

[110]  L. Greksa,et al.  Effect of altitude on the lung function of high altitude residents of European ancestry. , 1988, American journal of physical anthropology.

[111]  Buist As Standardization of spirometry. , 1987 .

[112]  Hugh A. Carithers,et al.  Human Growth: A Comprehensive Treatise , 1987 .

[113]  R M Malina,et al.  Relative lower extremity length in Mexican American and in American black and white youth. , 1987, American journal of physical anthropology.

[114]  P. Quanjer,et al.  Changing relationships between stature and lung volumes during puberty. , 1986, Respiration physiology.

[115]  M. Lebowitz,et al.  Longitudinal changes in forced expiratory volume in one second in adults. Methodologic considerations and findings in healthy nonsmokers. , 1986, The American review of respiratory disease.

[116]  J. Tanner Growth as a Target-Seeking Function , 1986 .

[117]  P. Quanjer,et al.  Changes in the FEV1-height relationship during pubertal growth. , 1984, Bulletin europeen de physiopathologie respiratoire.

[118]  K. H. Hsu,et al.  Ventilatory functions of normal children and young adults: Mexican-American, white, and black. III. Sitting height as a predictor. , 1983, The Journal of pediatrics.

[119]  M. Lebowitz,et al.  Changes in the normal maximal expiratory flow-volume curve with growth and aging. , 1983, The American review of respiratory disease.

[120]  H. Weill,et al.  Noncomparability of longitudinally and cross-sectionally determined annual change in spirometry. , 2015, American Review of Respiratory Disease.

[121]  J M Tanner,et al.  Increase in length of leg relative to trunk in Japanese children and adults from 1957 to 1977: comparison with British and with Japanese Americans. , 1982, Annals of human biology.

[122]  R M Gardner,et al.  Reference spirometric values using techniques and equipment that meet ATS recommendations. , 2015, The American review of respiratory disease.

[123]  K. P. Van de Woestijne,et al.  The influence of smoking habits and body weight on vital capacity and FEV1 in male Air Force personnel: a longitudinal and cross-sectional analysis. , 2015, The American review of respiratory disease.

[124]  P. Oldham Per cent of predicted as the limit of normal in pulmonary function testing: a statistically valid approach. , 1979, Thorax.

[125]  M. Chan-yeung,et al.  Racial differences in lung function: search for proportional relationships. , 1979, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[126]  B. J. Sobol,et al.  Per cent of predicted as the limit of normal in pulmonary function testing: a statistically valid approach. , 1979, Thorax.

[127]  A. Zapletal,et al.  [Significance of contemporary methods of lung function testing for the detection of airway obstruction in children and adolescents (author's transl)]. , 1977, Zeitschrift fur Erkrankungen der Atmungsorgane.

[128]  H Weill,et al.  Ethnic differences in lung function: evidence for proportional differences. , 1974, International journal of epidemiology.

[129]  G. Polgar,et al.  Pulmonary Function Testing in Children: Techniques and Standards , 1977 .

[130]  J. Cotes,et al.  Effects of inactivity, weight gain and antitubercular chemotherapy upon lung function in working coal-miners. , 1967, The Annals of occupational hygiene.

[131]  B. J. Sobol,et al.  Assessment of ventilatory abnormality in the asymptomatic subject: an exercise in futility1 , 2022 .