Published ahead of print on July 2, 2009, doi:10.1164/rccm.200903-0323OC Am. J. Respir. Crit. Care Med., Volume 180, Number 6, September 2009, 547-552 A more recent version of this article appeared on September 15, 2009
Submitted on March 2, 2009 Spirometry Centile Charts for Young Caucasian Children: The Asthma UK Collaborative InitiativeSanja Stanojevic1*,1 Portex Unit: Respiratory Physiology and Medicine, University College London: Institute of Child Health, London, United Kingdom; Medical Research Council: Center of Epidemiology for Child Health, University College London: Institute of Child Health, London, United Kingdom, 2 Medical Research Council: Center of Epidemiology for Child Health, University College London: Institute of Child Health, London, United Kingdom, 3 Portex Unit: Respiratory Physiology and Medicine, University College London: Institute of Child Health, London, United Kingdom, 4 University of Manchester and National Institute of Health Research Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester, Manchester, United Kingdom, 5 Child Health, Institute for Lung Health, University of Leicester, Leicester, United Kingdom, 6 Respiratory Medicine, Princess Margaret Hospital and School of Paediatric and Child Health, University of Western Australia, Perth, Australia, 7 Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway, 8 Lung Function Laboratory, Hôpital Sainte Marguerite, Marseille, France, 9 Department of Pediatrics; North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States, 10 Academic Child Health, University of Aberdeen, Aberdeen, United Kingdom, 11 Pneumology, National Health Service, Turin, Italy, 12 Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel Aviv, Israel, 13 Section of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Minnesota, United States, 14 Division of Respiratory Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke - Hôpital Fleurimont, University of Sherbrooke, Sherbrooke, Canada, 15 State Key Lab of Respiratory Disease, 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, 16 Department Physiopathology of Respiratory System, Insitute for TBC and Lung Diseaes, Rabka, Poland, 17 Division of Pediatric Pulmonary, Hospital São Lucas Pontifícia Universidade Católica do RGS, Porto Alegre, Brazil, 18 Hankinson Consulting Inc, Valdosta, Georgia, United States * To whom correspondence should be addressed. E-mail: s.stanojevic{at}ich.ucl.ac.uk.
Rationale: Advances in spirometry measurement techniques have made it possible to obtain measurements in children as young as 3 years of age; however, in practice, application remains limited by the lack of appropriate reference data for young children, which are often based on limited population-specific samples. Objectives: We aimed to build on previous models by collating existing reference data in young children (aged 3-7 years), to produce updated prediction equations that span the preschool years and that are also linked to established reference equations for older children and adults. Methods: The Asthma UK Collaborative initiative was established to collate lung function data from healthy young children aged 3-7 years. Collaborators included researchers with access to pulmonary function test data in healthy preschool children. Spirometry centiles were created using the LMS (Lambda-Mu-Sigma) method and extend previously published equations down to 3 years of age. Main Results: The Asthma UK centiles charts for spirometry are based on the largest sample of healthy young Caucasian children aged 3-7 years (n=3777) from 15 centers across 11 countries and provide a continuous reference with a smooth transition into adolescence and adulthood. These equations improve existing pediatric equations by considering the between-subject variability to define a more appropriate age-dependent lower limit of normal. The collated dataset reflects a variety of equipment, measurement protocols and population characteristics and may be generalizable across different populations. Conclusions: We present prediction equations for spirometry for preschool children and provide a foundation which will facilitate continued updating. Key words: spirometry • pulmonary function tests • reference values • preschool
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