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CLASS 1 Regent: Altamiro Pereira, MD PhD Adviser: Tiago Jacinto, MD

SPIROMETRY REFERENCE VALUES: - A SYSTEMATIC REVIEW OF PUBLISHED ARTICLES FROM 1998 TO 2008 -. CLASS 1 Regent: Altamiro Pereira, MD PhD Adviser: Tiago Jacinto, MD. INTRODUCTION TO MEDICINE 2009/2010. Research Questions. How many and how good are the studies published in the last decade?

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CLASS 1 Regent: Altamiro Pereira, MD PhD Adviser: Tiago Jacinto, MD

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  1. SPIROMETRY REFERENCE VALUES: - A SYSTEMATIC REVIEW OF PUBLISHED ARTICLES FROM 1998 TO 2008 - CLASS 1 Regent:Altamiro Pereira, MD PhD Adviser: Tiago Jacinto, MD INTRODUCTION TO MEDICINE 2009/2010

  2. Research Questions • How many and how good are the studies published in the last decade? • ii. Are they different in terms of methodological quality?

  3. 4Hughes, 2007 Reference values provide a point of reference to help to interpret and determine a patient’s condition: a test result is normal if it falls within the range predicted for the age, sex and height of the patient, based on large population studies 4 Introduction It is crucial to have adequate reference values when performing a test, in order to avoid misdiagnosis; Reference values are important statistical parameters to obtain medical relevant information

  4. Spirometry is an exam that allows to assess a patient’s pulmonary function using a spirometer:  The spirometer measures the volume and flow of the forced exhaled air during a period of time 2 Two reference values are commonly used: the FVC(total amount of exhaled air)and FEV1(exhaled air during the first second) 6,7 2Enright, n.d. 6Kuster, 2008 8Miller, 2007

  5. Different People have Different Values Pre-calculated values Inappropriate reference values can lead to bad diagnostics 1,3,5,6 SYSTEMATIC REVIEW AND QUALITY ASSESSMENT 1 Baur, 1999 3Garcia-Rio, 2004 5Ip, 2006 6Kuster, 2008

  6. 9STROBE statement Aims i.Summarize data published in the last decade; ii. Analyze and rate the obtained information using the STROBE checklist 9; iii. Propose the most suitable values for Portugal or suggesttheconduction of a study

  7. Methods

  8. Study design:Systematic review; General Methods Data Sources (online databases): Key words:Systematic review, Spirometry, Reference Values, Forced Expiratory Volume, Forced Vital Capacity • Procedure: • 1. Search for articles • 2. Selectandlayoutarticlesthatmeetthecriteria • 3. Rate usingthe STROBE checklist • 4. Conclusion 7Liberati, 2009

  9. Inclusion Criteria Exclusion Criteria • Articles that calculate new FEV1 and FVC spirometric reference values • Published from 1998 to 2008 • Articles whose full text can not be achieved for free; • Study subjects with occupational exposure to inhalable materials; • Articles about studies with missing data (reference equations, FEV1 or FVC values); • Study subjects with history of pulmonary disease, smoking or current disease; • Articles in languages other than Portuguese or English; • Studies conducted in animals; • Articles that don’t refer the equipment used; • Participants under 18 years old; • Not cross-sectional; Criteria

  10. QUERYAPPLICATION ON MARCH 5TH, 2010 ONLINE DATABASE QUERY USED: ARTICLES FOUND (N) ("1998"[Publication Date] : "2008"[Publication Date]) AND ("Spirometry"[tiab] AND ("Reference values"[mh] OR "Reference equations")) 218 814 (TITLE-ABS-KEY(spirometry) AND TITLE-ABS-KEY(“reference values” OR “reference equations” OR “normal values” OR “normative values”)) AND (LIMIT-TO(PUBYEAR, 2008) OR LIMIT-TO(PUBYEAR, 2007) OR LIMIT-TO(PUBYEAR, 2006) OR LIMIT-TO(PUBYEAR, 2005) OR LIMIT-TO(PUBYEAR, 2004) OR LIMIT-TO(PUBYEAR, 2003) OR LIMIT-TO(PUBYEAR, 2002) OR LIMIT-TO(PUBYEAR, 2001) OR LIMIT-TO(PUBYEAR, 2000) OR LIMIT-TO(PUBYEAR, 1999) OR LIMIT-TO(PUBYEAR, 1998)) 276

  11. Schematic representation of our work plan Research Method

  12. Procedure 1. Search for articles 2. Select and layout articles that meet the criteria

  13. Modified STROBE check-list

  14. Variable Extraction Table 2: Data extraction from the articles Number of participants total (female/male)

  15. Table 3: Equations and statistical data collected from equations, N.A. means Not Applicable Table 2: Data extraction from the articles Number of participants total (female/male)

  16. * Few recent studies with new reference equations; Expected Results * Heterogeneous concerning the methodological quality * Expose the necessity for these kind of studies

  17. Statistical Results

  18. Statistical Results Median=52%

  19. Statistical Results

  20. Statistical Results Average=0,73; Range 0,6-0,93

  21. DetailedScore

  22. Smolej, N. et al, New reference equations for forced spirometry in elderly persons 2008 0,93 Croatia Yes Jager’s Pneumoscreen, Wurtzburg, Germany 261 (154/1079 65-86 M. Susan Marion et al. Spirometry Reference Values for American Indian Adults: Results From the Strong Heart Study 2001 0,88 United States of America Yes Mijnhart S&M Instruments 3167 (1972/1195) 45-74 A. Langhammer et al. Forced spirometry reference values for Norwegian adults: the Bronchial Obstructi 2001 0,75 Norway Yes MasterScope spirometer, version 4.15, Erich Jaeger GmbH, 908 (546/362) 20-80 M.H. Boskabadya et al. Lung Function Values in Healthy Non-Smoking Urban Adults in 2002 0,72 Iran Yes Model ST90, Fukuda Sangyo 572 (246/326) 18-65 Gutierrez, Carlos et al. Reference values of pulmonary function tests for Canadian caucasians 2004 0,69 Canada Yes Morgan Model USA System; Med Science wedge spirometer model 570, PK Morgan Rolling seal spirometer, Stead wells spirometer 627 (327/300) 20-80 Marsh, S. et al. Complete reference ranges for pulmonary function tests from a single population 2006 0,69 New Zealand Yes Jaegar Master Screen Body 266 (156/110) 18-70 Results Roca, J. et al. References values for forced spirometry 1998 0,67 England No Sensor Medics 2130; Jaeger Pneumolab Vitalograph; Morgan Spirograph DS12; Sensor Medics Pne 12050; Spirotech S500; Hewlett Packard 12898 (6419/6479) 20-44 Falaschetti, E. et al. Prediction equations for normal and low lung function from the Health Survey for 2004 0,6 England Yes Vitalograph Escort Spirometer 3053 (556/2497) 16-75 Muhammad Asif Memon et al. Spirometric reference values in healthy, non-smoking, urban Pakistani population 2007 0,6 Pakistan Yes Micromedical, Microloop and Microrint (airway resistant) in Conjunction with spida 5 PC software 504 (183/321) 15-65 Table 2: Data extraction from the articles Number of participants total (female/male)

  23. A. Langhammer et al.0,75 Smolej, N. et al. 0,93 M. Susan Marion et al. 0,88 Conclusion 20 Years Old 45 Years Old 65 Years Old 74 Years Old 80 Years Old 18 Years Old 86 Years Old

  24. * The best scored article (93%) refers to a population with a very limited age * The second best scored article has a larger range of age but is still limited Discussion * The third best scored article, in spite of having a much lower score than the others has a larger age range * There is a limited number of studies of this type published each year

  25. * All but one study follow ATS/ERS criteria showing an effort for the standardization of this studies *There is the need for a study with a good sample size that covered a wide range of ages *We don’t have enough data to affirm that there are equations that can be applied in Portugal: a study should be conducted Discussion *The average score for methods (73%) and results (59%) were the lowest. Suggesting that most studies are frail in the most important topics of the check-list.

  26. Web site Plan

  27. Information Sources 1. Baur, X., S. Isringhausen-Bley, et al. (1999). "Comparison of lung-function reference values." International Archives of Occupational and Environmental Health 72(2): 69-83. 2. Enright P. Testing your lungs: spirometry [Internet]. European Lung Foundation. Available from: http://www.european-lung-foundation.org 3. Garcia-Rio, F., J. M. Pino, et al. (2004). "Spirometric reference equations for European females and males aged 65-85 yrs." Eur Respir J 24(3): 397-405. 4. Hughes, J.M.B.,Interpreting pulmonary function tests [Internet] ERS Education –Your best online source of CME in respiratory medicine [2007] European Respitatory Society. Available from: http://www.ers-education.org/media/2009/pdf/103639.pdf 5. Ip, M. S.-m., F. W.-s. Ko, et al. (2006). "Updated Spirometric Reference Values for Adult Chinese in Hong Kong and Implications on Clinical Utilization" Chest 129(2): 384-392. 6. Kuster, S. P., D. Kuster, et al. (2008). "Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years." Eur Respir J 31(4): 860-868. 7. Liberati, A., D. G. Altman, et al. (2009). "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration." Journal of Clinical Epidemiology 62(10): e1-e34. 8. Miller, Martin R. Interactive Course on Spirometry Training [Internet] ERS Education –Your best online source of CME in respiratory medicine [2007] European Respitatory Society. Available from: http://www.ers-education.org/pages/default.aspx?id=326 9. Unknown. STROBE Statement - checklist of items that should be included in reports of observational study [Internet] Strobe Statement: Strengthening the reporting of observational studies in epidemiology. [2009] ISPM - University of Bern. Available from: http://www.strobe-statement.org

  28. LEITE, Ana; PEIXOTO, Cláudia; MOURA, Diana; MARTINS, Diana; FERNANDES, Luís; ALMEIDA, Maria; BRITO, Nuno; ALMEIDA, Pedro; DIOGO, Pedro; MONTEIRO, Sara; PIMENTA, Sofia Class 1; turma1intromed@gmail.com 2009/2010

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