Applicability of American and European Spirometry Repeatability Criteria to Korean Adults

Byung Hoon Park; Moo Suk Park; Woo Young Jung; Min Kwang Byun; Seon Cheol Park; Sang Yun Shin; Han Ho Jeon; Kyung Soo Jung; Ji Ae Moon; Se Kyu Kim; Joon Chang; Sung Kyu Kim; Song Vogue Ahn; Yeon-Mok Oh; Sang Do Lee; Young Sam Kim

doi:10.4046/trd.2007.63.5.405

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Park, Park, Jung, Byun, Park, Shin, Jeon, Jung, Moon, Kim, Chang, Kim, Ahn, Oh, Lee, and Kim: Applicability of American and European Spirometry Repeatability Criteria to Korean Adults

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(5): 405-411.

Published online: 30 November 2007

DOI: https://doi.org/10.4046/trd.2007.63.5.405

Applicability of American and European Spirometry Repeatability Criteria to Korean Adults

Byung Hoon Park, M.D.¹, Moo Suk Park, M.D.^1,³, Woo Young Jung, M.D.¹, Min Kwang Byun, M.D.¹, Seon Cheol Park, M.D.¹, Sang Yun Shin, M.D.¹, Han Ho Jeon, M.D.¹, Kyung Soo Jung, M.D.¹, Ji Ae Moon, M.D.¹, Se Kyu Kim, M.D.^1,^3,⁵, Joon Chang, M.D.^1,³, Sung Kyu Kim, M.D.^1,³, Song Vogue Ahn, M.D.², Yeon-Mok Oh, M.D.^4,⁵, Sang Do Lee, M.D.^4,⁵, Young Sam Kim, M.D.^1,^3,⁵

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

²Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

³The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁵Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Young Sam Kim, M.D. Department of Internal Medicine, Yonsei University College of Medicine, 134, Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Phone: 82-2-2228-1965, Fax: 82-2-393-6884, ysamkim@yuhs.ac

Received 21 September 2007 Accepted 29 October 2007

Abstract

Background

The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults.

Methods

We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV₁ (dFEV₁) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV₁, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spirometric variability.

Results

About 95% of subjects were able to reproduce FVC and FEV₁ within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%.

Conclusion

We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results.

Keywords: Spirometry, Repeatability, Quality control

Figures and Tables

Table 1

Characteristics of subjects between groups (I)

dFVC: the difference between the highest and second-highest FVC; dFEV₁: the difference between the highest and second-highest FEV₁; dFVC (%): dFVC / the highest FVC; dFEV₁ (%): dFEV₁ / the highest dFEV₁; n: number.

^*Korean National Health and Nutritional Examination Survey, ^†A Community-based Cohort Study VI-Fishing village/Islands, ^‡Chronic Obstructive Pulmonary Disease Cohort.

Table 2

Characteristics of subjects between groups (II)

^*Korean National Health and Nutritional Examination Survey, ^†A Community-based Cohort Study VI-Fishing village/Islands, ^‡Chronic Obstructive Pulmonary Disease Cohort.

Table 3

Spirometry repeatability (2001 KNHANES)

Table 4

Spirometry repeatability (Community and COPD Cohort)

Table 5

Numbers of subjects meeting different repeatability criteria

dFVC: the difference between the highest and second-highest FVC.

^*Korean National Health and Nutritional Examination Survey, ^†A Community-based Cohort Study VI-Fishing village/Islands, ^‡Chronic Obstructive Pulmonary Disease Cohort.

Table 6

Numbers of subjects meeting different repeatability criteria

dFEV₁: the difference between the highest and second-highest FEV₁.

^*Korean National Health and Nutritional Examination Survey, ^†Chronic Obstructive Pulmonary Disease Cohort.

Table 7

Linear regression models predicting higher spirometry variability

^*1 cm increase in height, ^†1 year increase in age, ^‡1 kg increase in weight, ^§10 years≤educational period≤12 years, ^∥educational period≥13 years, ^¶the total variance explained by the model.

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