PT  - JOURNAL ARTICLE
AU  - Müller-Brandes, Christine
AU  - Krämer, Ursula
AU  - Gappa, Monika
AU  - Seitner-Sorge, Gabriele
AU  - Hüls, Anke
AU  - von Berg, Andrea
AU  - Hoffmann, Barbara
AU  - Schuster, Antje
AU  - Illi, Sabina
AU  - Wisbauer, Matthias
AU  - Berdel, Dietrich
TI  - LUNOKID: can numerical American Thoracic Society/European Respiratory Society quality criteria replace visual inspection of spirometry?
AID  - 10.1183/09031936.00058813
DP  - 2014 May 01
TA  - European Respiratory Journal
PG  - 1347--1356
VI  - 43
IP  - 5
4099  - http://erj.ersjournals.com/content/43/5/1347.short
4100  - http://erj.ersjournals.com/content/43/5/1347.full
SO  - Eur Respir J2014 May 01; 43
AB  - The gold standard for assessing quality of forced expiratory manoeuvres is visual inspection by an expert. American Thoracic Society/European Respiratory Society numerical quality criteria (NQC) include back-extrapolated volume (BEV), repeatability and forced expiratory time (FET). Equipment currently available provides feedback tempting the investigator to use NQC as pass–fail criterion. To investigate whether using NQC instead of visual acceptability is a valid option, we analysed data from a multicentre national reference study in Germany of children aged 4–18 years. Spirometry was performed under field conditions. Receiver operating characteristic analysis was used to assess performance of BEV, repeatability, FET and a combination thereof in relation to visual acceptability. We included data from 3133 healthy Caucasians in the analyses; 72% delivered at least two visually acceptable manoeuvres. Of these, 59% would have been rejected based on combined NQC, mainly because the FET criterion was not feasible. Specificity of the NQC was generally low (BEV 10%, repeatability 30% and FET 50%). Receiver operating characteristic analysis showed that a combination of the three measures could reach at best a sensitivity of 90% and specificity of 56%. We conclude that visual control is mandatory and NQC may help obtain the best possible results, but a fixed cut-off for FET should be abandoned. Visual control of spirometry is mandatory: quality criteria may help to get best results, but we should abandon FET http://ow.ly/uje5B