Class 1

Regent: Prof. Dr. Altamiro PereiraProfessor: Dr. Tiago Jacinto

INTRODUCTION TO MEDICINE 2009/2010

Spirometry reference values:

- a systematic review of studies in the last decade -

Research Questions

How good are the studies published in the last decade?

Is there any study that can be applied to Portugal? If so, which one is the best?

Introduction

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

Reference values are important statistical parameters to obtain

medical relevant information

It is crucial to have adequate reference values when performing a test,

in order to avoid misdiagnosis;

4 Hughes, 2007

Spirometry is an exam that allows to assess a patient’s pulmonary function using a spirometer:

Two reference values are commonly used: the FVC (total amount of exhaled air) and FEV1 (exhaled air during the first second) 6,7

The spirometer measures the volume and flow of the forced exhaled air during a period of time 2

2 Enright, n.d.

6 Kuster, 2008

8 Miller, 2007

Spirometric reference values vary with individual

characteristics.

They should be tailored to each individual;

At the time of diagnosis, there aren’t previous personal values.

The spirometric data is compared to those calculated from population

studies (reference values);

Healthcare professionals may be using inappropriate reference values for their target-populations, resulting in compromised diagnosis. 1,3,5,6

Systematic review and quality assessment1 Baur, 1999

3Garcia-Rio, 2004

5 Ip, 2006

6 Kuster, 2008

Aims

Summarize the wide range of data that has been published in the last decade;

Propose, from all studies, the most suitable for Portugal or suggest the conduction of a study in our country.

Analyze and rate the obtained information using the STROBE checklist 9;

9 STROBE statement

Methods

Methods

Key words:

“A systematic review attempts to collate all

empirical evidence that fits pre-specified eligibility

criteria to answer a specific research question.” 7

Spirometry Reference Values

FEV1; FVC

Study design: Systematic review;

Data Sources (online databases):

7Liberati, 2009

Query:

("1998"[Publication Date] : "2008"[Publication Date]) AND("Spirometry"[tiab] AND ("Reference values"[mh] OR "Reference

equations"))

PUBMED

Query: ISI WEB OF KNOWLEDGE

(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))

Query: SCOPUS

Criteria

Inclusion Criteria Exclusion Criteria

 o Articles whose full text can not

be achieved for free;

o Values referring to diseased individuals;

o Articles about studies with insufficient or inconclusive data;

o Study subjects with history of pulmonary disease

Articles written in Portuguese or English;

Articles referring to studies performed in humans;

Articles which refer the equipment used;

Articles published from 1998 to 2008.

Study subjects over 18 years old

Cross-sectional studies only

Research Method

7Liberati, 2009

1. Search for studies2. Select and layout the studies that meet the

criteria

3. Rate using the STROBE checklist 4. Conclusion

Procedure

Expected results

Find at least one study that can be applied to Portugal;

Gather a set of adequate spirometry reference values for our country;

Expose the necessity for these kind of studies

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.org3. 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.pdf5. 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=3269. 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

Information sources

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