Lung Function in Growth and Aging
Founding of working group PDF Print E-mail
 

Summary of Meeting of the ERS working group on

"New lung function reference equations”

European Respiratory Society, Berlin, October 6th, 5:00 - 7:00 p.m.


Following a series of emails earlier in 2008, a group of interested participants met at the congress of the European Respiratory Society (ERS) in Berlin to discuss the possibility of joining forces to develop improved lung function reference ranges.   
Prof Xaver Baur (Hamburg) led the introductions and summarised the scope of the problem, including the well recognised limitations of continuing to use the ECCS reference equations and the necessity of developing continuous reference equations from childhood to old age. Brief discussions followed including agreement that this initiative should represent a global initiative and not simply be confined to European countries.   
 
Brief presentations followed including those by
  1. Janet Stocks: Limitations of current reference values; no reliable reference equations for children, elderly and many ethnic groups. As a result of improved computing facilities and more sophisticated statistical modelling, it is now possible to develop equations across all ages. Discussed experience gained from recent international collation of current  datasets which focussed on young children and proposed various options for future action etc. (see  www.growinglungs.org.uk)   
  2. Mascha Rochat: Presentation of the equations of the Swiss LuftiBus study (8,684 never-smokers, aged 18-80 years); many elderly subjects studied; mostly self reported height and weight; predominantly Caucasians of white European descent, other ethnics about 1-2 %.    
  3. Waldemar Tomalak: “Comparison between LuftiBus and HSE”; LuftiBus equations are a little bit higher and show  more pronounced decrease of FEV1/FVC in elderly.
  4. Graham Hall: Presentation of an Australian multi-centre study for the collation of spirometric measurements from healthy subjects.
 
 General discussions covered issues such as:
  • Influence of different devices, selection bias, failure to record/report essential core details or specific lung function parameters which are needed if  trying to collate data retrospectively.
  • Some participants proposed that a new prospective multi-centre study of high quality should be planned. However, this would need considerable funding and would take many years to achieve.
  • Whether or not a prospective multi-centre study really was necessary, especially with respect to spirometry, for which many high quality studies have already been performed was then debated, with reference to the feasibility of collating such data as recently demonstrated by the  ‘NHANES revisited initiative’ (Stanojevic et al. AJRCCM 2008)
  • It was agreed that if new studies were to be designed, they need to be conducted to a clear protocol and focus on areas where there is currently a dearth of information (ethnic groups other than those of white European (Caucasian) descent, the very young and the very old, etc.
  • Issues regarding what the inclusion and exclusion criteria for such studies should be with respect to quality control, date and methods of data collection, population characteristics, etc. were also discussed  

Conclusions
  • It was agreed that the aims of this group are the development of improved all-age (3-90+ yr) international lung function reference equations based on collation of original data available in well-designed and executed studies.
  • The initial focus of the work would be baseline spirometric lung function parameters, although it is recognised that there is an urgent need too for prediction equations for other key lung function parameters (lung volumes, diffusing capacity, etc.). 
  • A steering committee will be established  to coordinate further steps, which will include  Xaver Baur, Janet Stocks, Graham Hall and Bruce Culver (ATS).
  • Future Action will include:
    • Establishment of a formal ERS/ATS task force.
    • Establishment of a web site to facilitate communication between participants.
    • Collation and cleaning of the raw data from existing studies. Philip Quanjer already has a vast collection of such data and may be able to help in this respect.
    • Development of a study design / statistical methods for an integrative approach.
    • Development and validation of updated reference equations.
    • Recommendations re criteria for future normative data collection.
    • Dissemination of results.
    • Development of a long-term strategy for database management and update of equations.
Last Updated on Friday, 13 March 2009 08:16