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. 2018 May 31;18(1):95.
doi: 10.1186/s12890-018-0658-9.

Global Lung Function Initiative 2012 Reference Values for Spirometry in Asian Americans

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Free PMC article

Global Lung Function Initiative 2012 Reference Values for Spirometry in Asian Americans

Jingzhou Zhang et al. BMC Pulm Med. .
Free PMC article

Abstract

Background: Spirometry reference values specifically designed for Asian Americans are currently unavailable. The performance of Global Lung Function Initiative 2012 (GLI-2012) equations on assessing spirometry in Asian Americans has not been evaluated. This study aimed to assess the fitness of relevant GLI-2012 equations for spirometry in Asian Americans.

Methods: Asian subjects who never smoked and had qualified spirometry data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Z-scores of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were separately constructed with GLI-2012 equations for North East (NE) Asians, South East (SE) Asians, and individuals of mixed ethnic origin (Mixed). In addition, Proportions of subjects with observed spirometry data below the lower limit of normal (LLN) were also evaluated on each GLI-2012 equation of interest.

Results: This study included 567 subjects (250 men and 317 women) aged 6-79 years. Spirometry z-scores (z-FEV1, z-FVC, and z-FEV1/FVC) based on GLI-2012 Mixed equations had mean values close to zero (- 0.278 to - 0.057) and standard deviations close to one (1.001 to 1.128); additionally, 6.0% (95% confidence interval (CI) 3.1-8.9%) and 6.4% (95% CI 3.7-9.1%) of subjects were with observed data below LLN for FEV1/FVC in men and women, respectively. In contrast, for NE Asian equations, all mean values of z-FEV1 and z-FVC were smaller than - 0.5; for SE Asian equations, mean values of z-FEV1/FVC were significantly smaller than zero in men (- 0.333) and women (- 0.440).

Conclusions: GLI-2012 equations for individuals of mixed ethnic origin adequately fitted spirometry data in this sample of Asian Americans. Future studies with larger sample sizes are needed to confirm these findings.

Keywords: Asian Americans; LLN; Lung function; Spirometry; Z-score.

Conflict of interest statement

Ethics approval and consent to participate

The NHANES protocols were reviewed and approved by the Research Ethics Review Board of National Center for Health Statistics. Written informed consents were obtained from all NHANES participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study sample selection
Fig. 2
Fig. 2
Age distribution of study subjects by gender
Fig. 3
Fig. 3
Distributions of z-scores of FEV1, FVC, and FEV1/FVC based on GLI-2012 equations for North East Asians, South East Asians, and individuals of mixed ethnic origin. Panels A and B showed z-score distributions based on GLI-2012 equations for North East Asians in women and men, respectively; panels C and D showed z-score distributions based on GLI-2012 equations for South East Asians in women and men, respectively; and panels E and F showed z-score distributions based on GLI-2012 equations for individuals of mixed ethnic origin in women and men, respectively. In this graph, red dot denotes 5th and 95th percentiles of observed spirometry data; blue diamond denotes median of observed values; solid line represents a z-score of zero; and dotted line represents z-scores of ±1.96. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GLI: Global Lung Function Initiative
Fig. 4
Fig. 4
Bland-Altman plots of spirometry predictions using NHANES III Caucasian values with a correction factor of 0.88 for FEV1 and FVC against those with GLI-2012 equations for individuals of mixed ethnic origin (difference = NHANES III prediction – GLI-2012 prediction). In this graph, dashed line represents the mean difference; dotted line represents 95% confidence interval of the mean difference; solid line represents the value of zero. NHANES III: The Third National Health and Nutrition Examination Survey; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GLI: Global Lung Function Initiative

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