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

Philip H. Quanjer, Sanja Stanojevic, Tim J. Cole, Xaver Baur, Graham L. Hall, Bruce H. Culver, Paul L. Enright, John L. Hankinson, Mary S.M. Ip, Jinping Zheng, Janet Stocks, the ERS Global Lung Function Initiative
European Respiratory Journal 2012 40: 1324-1343; DOI: 10.1183/09031936.00080312
Philip H. Quanjer
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  • For correspondence: pquanjer@xs4all.nl
Sanja Stanojevic
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Tim J. Cole
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Xaver Baur
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Graham L. Hall
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Bruce H. Culver
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Paul L. Enright
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John L. Hankinson
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Mary S.M. Ip
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Jinping Zheng
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Janet Stocks
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Abstract

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.

  • Lower limit of normal
  • predicted values
  • spirometry
  • statistical modelling
  • z-score

Footnotes

  • This article has supplementary material available from www.erj.ersjournals.com

  • Support Statement

    This report has been endorsed by the European Respiratory Society (ERS), American Thoracic Society (ATS), Australian and New Zealand Society of Respiratory Science (ANZSRS), Asian Pacific Society for Respirology (APSR), Thoracic Society of Australia and New Zealand (TSANZ) and the American College of Chest Physicians (ACCP). This study includes data from the MESA study, Funded by National Institutes of Health R01-HL077612, N01-HC095159-165, N01-HC095169.

  • Statement of Interest

    None declared.

  • Received May 22, 2012.
  • Accepted June 6, 2012.
  • ©ERS 2012
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Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations
Philip H. Quanjer, Sanja Stanojevic, Tim J. Cole, Xaver Baur, Graham L. Hall, Bruce H. Culver, Paul L. Enright, John L. Hankinson, Mary S.M. Ip, Jinping Zheng, Janet Stocks, the ERS Global Lung Function Initiative
European Respiratory Journal Dec 2012, 40 (6) 1324-1343; DOI: 10.1183/09031936.00080312

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Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations
Philip H. Quanjer, Sanja Stanojevic, Tim J. Cole, Xaver Baur, Graham L. Hall, Bruce H. Culver, Paul L. Enright, John L. Hankinson, Mary S.M. Ip, Jinping Zheng, Janet Stocks, the ERS Global Lung Function Initiative
European Respiratory Journal Dec 2012, 40 (6) 1324-1343; DOI: 10.1183/09031936.00080312
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