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ERS Annual Congress Amsterdam
26–30 September 2015
EDUCATIONAL MATERIAL
Meet the expert 10
Paediatric lung function tests reference values
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• Th e ERS Handbook of Respiratory Medicine ISBN 978-1-84984-040-8 (print); 978-1-84984-041-5 (electronic)
• Th e ERS Handbook of Paediatric Respiratory Medicine ISBN 978-1-84984-038-5 (print); 978-1-84984-039-2 (online)
• Th e ERS Handbook of Respiratory Sleep Medicine ISBN 978-1-84984-023-1 (print); 978-1-84984-024-8 (online)
• Self-Assessment in Respiratory Medicine REVISED AND UPDATED ISBN 978-1-84984-077-4 (print); 978-1-84984-078-1 (online)
• Th e ERS Practical Handbook of Noninvasive Ventilation NEW! ISBN 978-1-84984-075-0 (print); 978-1-84984-076-7 (online)
To buy printed copies, visit the ERS Bookshop at the ERS International Congress 2015 (Hall 1, Stand 1.D_12).
AIMS: To review the key points regarding the use of appropriate reference values for lung function testing in children and their correct interpretation. The session will focus on both spirometry and the reference values for lung function techniques in preschool children. TARGET AUDIENCE: Caretakers who use lung function testing to manage paediatric patients, paediatric pulmonologists, paediatric nurses, and paediatric lung function technicians.
AIMS
Describe why reference equations are important and relevant to daily practice Describe the Global Lung Function Initiative and its advantages Discuss interpretation of lung function results in different ethnic groups Discuss different approaches to interpreting lung function test results Review several examples of paediatric lung function tests and how to interpret results
SUMMARY
Lung function results can help with establishing a diagnosis, with assessment of treatment effects and with making a prognosis. However, arbitrary differences in the way lung function is expressed and interpreted may result in mismanagement of patients as well as hindering our understanding of the global burden of lung disease. In this session I will summarise the Global Lung Function Initiative spirometry reference equations and dispel some common myths related to the use and interpretation of spirometry results. REFERENCES 1. Kirkby J, Aurora P, Spencer H, Rees S, Sonnappa S, and Stocks J, Stitching and switching: the impact
of discontinuous lung function reference equations. Eur Respir J, 2012. 39(5): p. 1256-7. 2. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MS,
Zheng J, Stocks J, 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: 40(6): 1324-1343.
3. Stanojevic, S., Qunajer, P., Miller, M.R., Stocks, J. The Global Lung Function Initiative: dispelling some myths of lung function test interpretation. Breathe: 2013: 9(6): 462-474
4. Quanjer PH, Pretto JJ, Brazzale DJ, Boros PW. Grading the severity of airways obstruction: new wine in new bottles. European Respiratory Journal 2014. 43(2):505-12
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5. Quanjer PH, Weiner DJ. Interpretative consequences of adopting the global lungs 2012 reference equations for spirometry for children and adolescents. Pediatr Pulmonol 2014: 49(2):118-25:
EVALUATION
1. If the pulmonary function test is done according to the ATS/ERS guidelines, does it not matter what reference equation is use.
a. No, it is only necessary to evaluate the absolute lung function results b. No, every reference equation produces the same percent predicted results c. Yes, reference equations should be representative of the study population, based on a large
representative sample of the study population and developed using appropriate methods to consider how the lungs grow and develop
d. Yes, you should always use reference equations derived at your centre, as long as there are more than 20 patients included in the sample
2. Before performing a lung function test, a patients height should be:
a. Measured at each visit b. Measured once at the first visit c. Measured in children, but adults can self-report their height d. Self-reported in children, but measured in adults
3. When can you start using the Global Lung Function Initiative Reference Equations a. As soon as I buy new equipment for my laborartory b. As soon as the GLI equations are available for all lung function tests (i.e. TLCO, lung volumes). c. As soon as I confirm the equations are in my equipment d. As soon as GLI equations are available for the ethnic group represented in my country
4. In addition to the appropriate reference equations, interpretation of a lung function test results should include (select all that apply):
a. A good effort, that meets current ATS/ERS standards b. An assessment of the patients clinical symptoms and other clinical findings c. Whether the lung function results is within the normal range d. The change in lung function from the previous visit
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Paediatric Lung Function Tests: Reference Values
Sanja Stanojevic PhD
Division of Respiratory MedicineHospital for Sick Children
Toronto, Canada66
Disclosures
• I have no conflicts to disclose
77
Reference Equations and Zzzzzzzz-Scores
88
Aims
• Describe why reference equations are important and relevant to daily practice
• Describe the Global Lung Function Initiative and its advantages
• Discuss interpretation of lung function results in different ethnic groups
• Discuss different approaches to interpreting lung function test results
• Review several examples of paediatric lung function tests and how to interpret results
99
How big should my lungs be?
Ethnicity
Age
Photos courtesy of www.london2012.com 1010
1111
Choice of 34 equations for spirometry in same commercial equipment!
1212
Switched and stitched into 14 different modules to cover various age ranges and
all possible outcomes
1313
Switched and stitched into 14 different modules to cover various age ranges and
all possible outcomes
1414
Why is this important?
1515
Lack of Universal Reference Equations and Limits of Normal hinders our
understanding of the global burden of lung disease
1616
Tracking of Individual Results
Kirkby et al ERJ 2012
% Predicted
1717
Kirkby et al ERJ 2012
Absolute Values
Tracking of Individual Results
1818
Spirometry from Cradle to the Grave
International GuidelinesLum et al AJRCCM 2005Beydon et al AJRCCM 2007Pellegrino et al. AJRCCM 2005 1919
Ideally Reference Ranges should span All-Ages
2020
The GLI-2012 equations based on collated results from ~74,000 healthy non-smokers aged 3-95 years to create the 1st multi-ethnic all-age lung growth charts