Abstract
Background Multiple breath washout is a lung function test based on tidal breathing that assesses lung volume and ventilation distribution. The aim of this analysis was to use the Global Lung Function Initiative methodology to develop all-age reference equations for the multiple breath washout indices lung clearance index (LCI) and functional residual capacity (FRC).
Methods Multiple breath washout data from healthy individuals were collated from sites. Data were re-analysed using the latest software versions. Reference equations were derived using the lambda-mu-sigma (LMS) method using the generalised additive models of location shape and scale programme in R. The impact of equipment type, inert tracer gas, and equipment dead space volume on the derived reference ranges were investigated.
Results Data from 23 sites (n=3647 test occasions) were submitted. Reference equations were derived from 1581 unique observations from participants between the ages of 2 and 81 years. Equipment type, inert tracer gas, and equipment dead space volume did not significantly affect the prediction equations for either LCI or FRC. Reference equations for LCI include age as the only predictor, whereas sex-specific reference equations for FRC included height and age.
Conclusions Global Lung Function Initiative reference equations for multiple breath washout variables provide a standard for reporting and interpretation of LCI and FRC.
Footnotes
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Conflict of interest: K. A. Ramsey reports support for the present study from ERS.
Conflict of interest: S. Stanojevic grants from ATS, consultancy fees from Chiesi Farmaceutricals, payment or honoraria for lectures, presentations, manuscript writing or educational events from Vyaire Medical, participation on a data safety monitoring board or advisory board with Ndd technologiest, leadership role with ATS (Pulmonary Function Testing Committee) and ERS (Global Lung Function Initiative), and the following financial (or non-financial) interests: Statistical Editor at Thorax, Editorial Board Member at European Respiratory Journal, and Junior Associate Editor at Canadian Journal of Respiratory, Critical Care and Sleep Medicine.
Conflict of interest: L. Chavez has nothing to disclose.
Conflict of interest: N. Johnson has nothing to disclose.
Conflict of interest: C. Bowerman reports grants from Canadian Lung Association, support for attending meetings from Canadian Thoracic Society, and leadership role with Global Lung Function Initiative (Jr. Executive).
Conflict of interest: G. L. Hall reports support for the present study from ERS, as co-chair of the Global Lung Function Initiative.
Conflict of interest: P. Latzin reports grants from Vertex, and OM Pharma, payment or honoraria for lectures, presentations, manuscript writing or educational events from Vertex, Vifor, and OM Pharma and participation on a data safety monitoring board or advisory board with Polyphor, Santhera (DMC), Vertex, OM Pharma, Vifor, Allecra, and Sanofi Aventis.
Conflict of interest: K. O'Neill has nothing to disclose.
Conflict of interest: P. D. Robinson has nothing to disclose.
Conflict of interest: M. Stahl reports support for the present study from German Research Foundation (Deutsche Forschungsgemeinschaft, DFG), grants from Vertex Pharmaceuticals, payment or honoraria for lectures, presentations, manuscript writing or educational events from Vertex Pharmaceuticals, participation on a data safety monitoring board or advisory board with Vertex Pharmaceuticals, and leadership role with FGM (Chairman), ERS (Secretary Group CF), and GPP (Treasurer).
Conflict of interest: D. J. Weiner reports consultancy fees from Cystic Fibrosis Foundation.
Conflict of interest: A. M. Zwitserloot reports grants from Vertex Pharmaceuticals, and consultancy fees from Sanofi.
Conflict of interest: A. Horsley reports support for the present study from ERS, grants from NIHR Manchester Biomedical Research Centre, consultancy fees from Vertex Pharmaceuticals, payment or honoraria for lectures, presentations, manuscript writing or educational events from Vertex Pharmaceuticals, leadership role with NIHR Respiratory Translational Research Collaboration (Chair), receipt of equipment, materials, drugs, medical writing, gifts or other services from Vertex Pharmaceuticals, and the following financial (or non-financial) interests: technical support provided to Innocor ApS.
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- Received March 15, 2024.
- Accepted July 11, 2024.
- Copyright ©The authors 2024. For reproduction rights and permissions contact permissions{at}ersnet.org
