Reference values for spirometry,including vital capacity,in Japanese adults calculated with the LMS method and compared with previous values

BackgroundReference values for lung function tests should be periodically updated because of birth cohort effects and improved technology. This study updates the spirometric reference values, including vital capacity (VC), for Japanese adults and compares the new reference values with previous Japanese reference values.MethodsSpirometric data from healthy non-smokers (20,341 individuals aged 17–95 years, 67% females) were collected from 12 centers across Japan, and reference equations were derived using the LMS method. This method incorporates modeling skewness (lambda: L), mean (mu: M), and coefficient of variation (sigma: S), which are functions of sex, age, and height. In addition, the age-specific lower limits of normal (LLN) were calculated.ResultsSpirometric reference values for the 17–95-year age range and the age-dependent LLN for Japanese adults were derived. The new reference values for FEV₁ in males are smaller, while those for VC and FVC in middle age and elderly males and those for FEV₁, VC, and FVC in females are larger than the previous values. The LLN of the FEV₁/FVC for females is larger than previous values. The FVC is significantly smaller than the VC in the elderly.ConclusionsThe new reference values faithfully reflect spirometric indices and provide an age-specific LLN for the 17–95-year age range, enabling improved diagnostic accuracy. Compared with previous prediction equations, they more accurately reflect the transition in pulmonary function during young adulthood. In elderly subjects, the FVC reference values are not interchangeable with the VC values.     

Telemedicine and cystic fibrosis: Do we still need face-to-face clinics?

There has been growing interest in telemedicine for cystic fibrosis over recent years based largely on convenience for patients and/or increasing the frequency of surveillance and early detection which, it is assumed, could improve treatment outcomes. During 2020, the covid-19 pandemic catalysed the pace of development of this field, as CF patients were presumed to be at high risk of infection. Most clinics adapted to digital platforms with provision of lung function monitoring and sample collection systems. Here, we present the views of multidisciplinary team members at a large paediatric CF centre on what has worked well and what requires further optimisation in the future. In response to the question posed, ‘Do we still need face to face clinics?’ our answer is ‘Yes, but not every time, and not for everyone’.     

Accesibilidad y utilización de la espirometría en los centros de atención primaria de Cataluña

ObjectiveExamine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia.DesignCross-sectional study using a survey.ParticipantsThree hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010.MeasurementsSurvey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants.Main resultsResponse rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals. > 50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record. > 50% recognized a high priority strategies for improving the quality.ConclusionDespite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.     

What can we learn from pulmonary function testing in heart failure?

Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital‐based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.     

Inter-Regional Changes in the Performance and Interpretation of Spirometry in Spain: 3E Study

ObjectivesThis report shows the results of a nation-wide survey on spirometry to assess regional differences.MethodsObservational cross-sectional study conducted by means of a telephone survey in 805 primary care (PC) and specialized centers (SC) in all regions. The survey was carried out among technicians in charge of spirometry and consisted of 36 questions related to the test.ResultsThe results showed major differences between regions. Most centers had 1–2 spirometers. The number of spirometry tests per week ranged from 2 to 8.9 in PC and between 34.3 and 98.3 in SC. Some training had been given in most centers (63.6%–100% in PC and 60.0%–100% in SC) but not on a regular basis. Most centers used several short-acting bronchodilators for the bronchodilation test, but with insufficient inhalations (2.0–3.8 in PC and 2.0–3.3 in SC) and frequently incorrect waiting time (29.4%–83.3% in PC and 33.3%–87.5% in SC). Daily calibration was not performed in all centers (0%–100% in PC and 66.7%–100% in SC). Significant inter-regional differences in spirometry quality criteria were observed, with 6 or more criteria met in 9.1%–84.6% of PC centers and 37.5%–100% in SC.ConclusionsOur results show the current situation of spirometry in primary and specialized care in Spain, highlighting considerable variability and areas for improvement. This information should be considered by health officials to improve the quality and accessibility of such tests.     

Statement from the Japanese Respiratory Society: Working diagnosis and initial management of COPD during the COVID-19 pandemic

The Japanese Respiratory Society (JRS) has recommended spirometry for the diagnosis of respiratory diseases. It is indispensable for the confirmation of airflow obstruction by spirometry in chronic obstructive pulmonary disease (COPD) diagnosis. However, the coronavirus disease 2019 (COVID-19) pandemic has made it difficult for many clinics to perform spirometry as it may lead to possible aerosol infections. Thus, the diagnosis of COPD, especially in the early stage, has become difficult. To overcome this situation, JRS issued a “Flowchart of Working Diagnosis and Management of COPD during the COVID-19 Pandemic”. This flowchart may help physicians provisionally diagnose COPD patients without performing spirometry, offering them appropriate intervention even in epidemic and pandemic situations.