Avaliação da função respiratória: Comparação entre valores de referência percentuais fixos e o 5.o percentil para diagnóstico de obstrução das vias aéreas

Translated title of the contribution: Lung function evaluation: Comparing fixed percentual values and the 5th percentile for diagnosing airway obstruction

Luís Miguel Borrego, Mariana Couto, Isabel Almeida, Lara Pimenta, Sara Matos, Mário Morais-Almeida

Research output: Contribution to journalArticle

Abstract

Introduction: Fixed criteria have been classically used in the functional characterization of patients with respiratory diseases. International guidelines actually recommend the preferential use of the lower (LNN) or upper limit of normality (below or above the 5th percentile). Objective: To compare the results of lung function (LF) obtained in clinical practice for diagnosis of airway obstruction, using fixed percentage values versus the 5th percentile (the reference standard) as normality limits. Methods: Retrospective analysis of LF (spirometry and body plethysmography) performed in 2011 by the authors. It has been evaluated the concordance of both methods in the global sample, and divided by age groups. Those with criteria for airway obstruction considering the FEV1/VC (forced expiratory volume in one second / vital capacity) ratio < LLN were selected and among these, we analyzed FEV1, FVC (forced vital capacity), TLC (total lung capacity) and RV (residual volume) considering the 5th percentile and the fixed percentage values. Statistical analysis was performed with SPSS 20.0, using Cohen's Kappa test. Results: During 2011, 1358 subjects underwent LF; 8 were excluded due to incomplete data. Overall, the agreement between the two criteria was kappa = 0.655 ± 0.035. Among the 124 patients who had obstruction diagnosed by LLN, 32 (26%) had a normal test with the 0.70 cut -off, and would be wrongly underdiagnosed. This occurred only in younger age groups, while in older ones a high rate of overdiagnosis (51 subjects - 36%) was observed. Among patients with airway obstruction, the agreement of the 2 criteria for the remaining parameters was good, except for inflation diagnosed with TLC. Conclusion: Using fixed percentage criteria for the diagnosing airway obstruction leads to a high rate of underdiagnosis in younger and overdiagnosis in older ages.

Original languagePortuguese
Pages (from-to)197-205
Number of pages9
JournalRevista Portuguesa de Imunoalergologia
Volume21
Issue number3
Publication statusPublished - 1 Dec 2013

Keywords

  • Asthma
  • Bronchial obstruction
  • Diagnostic tests
  • Lung function
  • Reference standards

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