TY - JOUR T1 - LUNOKID: can numerical American Thoracic Society/European Respiratory Society quality criteria replace visual inspection of spirometry? JF - European Respiratory Journal JO - Eur Respir J SP - 1347 LP - 1356 DO - 10.1183/09031936.00058813 VL - 43 IS - 5 AU - Christine Müller-Brandes AU - Ursula Krämer AU - Monika Gappa AU - Gabriele Seitner-Sorge AU - Anke Hüls AU - Andrea von Berg AU - Barbara Hoffmann AU - Antje Schuster AU - Sabina Illi AU - Matthias Wisbauer AU - Dietrich Berdel Y1 - 2014/05/01 UR - http://erj.ersjournals.com/content/43/5/1347.abstract N2 - 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 ER -