Spirometry reference values: a systematic review
Turma 1
Docente: Dr. Tiago António Queirós JacintoRegente: Prof. Dr. Altamiro Pereira
INTRODUCTION TO MEDICINE 2009/2010
ARE THE SPIROMETRY REFERENCE VALUES USED IN PORTUGAL ADEQUATE?
Have the values changed in the last ten years?
Were the reference values obtained correctly?
Problem/Research Question
Introduction
Reference values are important statistical values to obtain medical
relevant information;
They vary with the age, gender,
and other characteristics determining
whether he/she is healthy or not;
It is crucial to have adequate, current and correct reference values
when performing an exam, in order to avoid misdiagnoses.
Spirometry is one of the most important medical exams
to assess the function of a person’s pulmonary capacity.
This test consists in measuring
the volume of air and flow that
has been exhaled into a
spirometer.
Two reference values are commonly used:
Both values are
standardized (reference values for
healthy lung function) allowing the detection of
pulmonary problems by
comparison with the obtained values.
Forced Vital Capacity or FVC
Forced Expiratory Value during the first second or FEV1
Likely hypothesis: inadequate reference values are being applied in the Portuguese population
Variability of the different sets of reference values
Strong influence over the diagnostics
SYSTEMATIC REVIEW
Aims
Summarize the wide range of data that has been published in
the last decade;
Analyze and rate the obtained information using the STROBE
checklist;
Select a new set of up to date reference values and
suggest its use in Portugal.
Methods
Methods Study design: systematic review;
Data Sources (online databases):
Key words:
SPIROMETRY
FVCFEV
Reference values
QUERY (PUBMED)ARTICLES
(NO LIMITS)
ARTICLES (ENGLISH OR
PORTUGUESE)
("SPIROMETRY"[TIAB] OR "SPIROMETRY"[MESH]) AND (("REFERENCE VALUES“ AND ("FEV1” OR "FVC”)) OR ("FORCED VITAL CAPACITY” AND "FORCED
EXPIRATORY VALUE” ) OR "REFERENCE EQUATIONS” OR "NORMAL VALUES” OR "NORMATIVE VALUES”)
464 372
(“SPIROMETRY” [MESH] OR "SPIROMETRY" [TIAB]) AND "REFERENCE VALUES" 710 561
("SPIROMETRY” [TIAB] OR "SPIROMETRY" [MESH]) AND (“REFERENCE VALUES” OR “REFERENCE EQUATIONS” OR “NORMAL VALUES” OR “NORMATIVE VALUES”) 837 659
(“SPIROMETRY” [MESH] OR "SPIROMETRY" [TIAB]) AND ("REFERENCE VALUES" OR "FEV1" OR "FVC") 4031 3503
(“SPIROMETRY” [TIAB] OR "SPIROMETRY" [MESH]) AND (“REFERENCE VALUES” OR “FEV1” OR “FVC” OR “FORCED VITAL CAPACITY” OR “FORCED EXPIRATORY
VALUE” OR “REFERENCE EQUATIONS” OR “NORMAL VALUES” OR “NORMATIVE VALUES”)
4506 3934
(“SPIROMETRY” [MESH] OR “SPIROMETRY” [TIAB]) 19679 14775
Criteria
Inclusion Criteria Exclusion Criteria
Articles written in Portuguese
or English;
Articles referring to studies performed in humans;
Articles which refer the equipment used;
Published from 1998 to 2008.
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.
Research MethodStart
Search
Read Title And Abstract
Is It written in Portuguese or English?
No Yes
Exclude Select and Save for further analysis
Remove Repeated Articles
Remove all not related articles
Select and Save for further analysis
Read Abstract
Apply Inclusion/Exclusion Criteria
Read Full Text By Two Reviewers
Both Decide To Include
Both Decide To Exclude
Both Do Not Agree
Include
Exclude
Read By A Third Reviewer Who Decides
To Include Or Not
Expected results
• Conclude that some reference values are outdated and
inadequate;
• Realize that inaccurate reference values lead to a wrong diagnosis of pulmonary diseases;
• Reunite a list of adequate spirometry reference values to our country.
• Improve the accuracy and reliability of pulmonary diseases diagnosis
Turma 12009/2010