Methodologic issues in the analysis of lung function data.

The forced expiratory volume in one second (FEV1) is routinely used in epidemiologic studies of lung function to assess the presence and severity of obstructive airways disease. Normative prediction equations developed using data from healthy, asymptomatic individuals may then be used both in a clinical setting and to adjust comparisons among risk subgroups for known demographic differences. Unfortunately no concensus has yet developed as to how best to model lung function data. This paper addresses this issue in a systematic manner using data derived from two cohorts followed over a period of 9-11 years. We compare a variety of cross-sectional and longitudinal models for FEV1, show how they may be expressed as members of a larger class of general linear models, and discuss goodness-of-fit procedures for comparing them. We found little objective evidence for discriminating among these models; only those fit to FEV1/ht3 performed poorly. We argue on subjective grounds for the use of models based on FEV1 as a function of age, height and their interactions.

[Reference values for lung function. A summary of reference values used in the GDR (analysis September 1978) (author's transl)]. / Eine Zusammenstellung der in der DDR entwickelten methodenspezifischen Referenz-werte (Auswertungsstand September 1978).

The reference values of several original papers were summarized for the assessment of ventilation, flow-volume, blood gases, bodyplethysmography, single breath test, bronchial reactivity. The standards were showed for adults and children.

The timing of the forced vital capacity.

Based on analysis of more than 2,500 forced vital capacity (FVC) maneuvers, we examined 2 aspects of the standards for spirometry recommended by the 1977 Snowbird Workshop concerning the timing of the FVC maneuver. We compared the forced expiratory volume in one sec (FEV1) when timing was initiated by the back extrapolation method with FEV1 when timing was initiated by flow or volume threshold to determine whether the latter offered a reliable equivalent. Although the mean differences appear to be relatively small, because of variability in initiating expiratory effort, neither alternative is likely to offer a uniformly accurate numeric equivalent to backward extrapolation. We also measured the volume expired before the initiation of the timing as a per cent of FVC to determine whether 10 per cent was a reasonable limit to apply for acceptability of a test. Although 2 SD from the mean of 4.35 per cent were well within this limit, it appears that the technician's judgment of acceptability is sufficient in most cases.