ABSTRACT
BACKGROUND: The GLI2012 (Global Lung Initiative 2012) has provided the largest data set to date for multi-ethnic spirometry reference equations; however, data on African populations are limited. In pulmonary function testing, diagnosis of lung disorder is based on comparing the individual's lung function to a reference appropriate for sex and ethnicity.METHODS: We conducted a systematic review of studies reporting spirometry results in healthy children and adults in Africa. Data from these studies were collated for Z-scores of forced expiratory volume in 1 sec (zFEV1), forced vital capacity (zFVC) and zFEV1/FVC compared to GLI reference equations.RESULTS: Nine studies, covering a total of 4750 individuals from North, South, East, West and Central Africa (52% were female), were reviewed. Marked differences were noted between individuals from North Africa and sub-Saharan Africa. The Southern zFEV1 (-0.12 ± 0.98), zFVC (-0.15 ± 0.98) and zFEV1/FVC (0.05 ± 0.89), Central zFEV1 (-0.16 ± 0.79), zFVC (-0.09 ± 0.83) and zFEV1/FVC (-0.17 ± 0.71) and East African zFEV1 (0.10 ± 0.88), zFVC (0.16 ± 0.85) and zFEV1/FVC (-0.10 ± 0.95) cohorts had an excellent fit with the GLI-African American. The West African showed a poor fit to all reference equations. The North African group showed the best fit for the GLI Caucasian zFEV1 (-0.12 ± 1.37), zFVC (-0.26 ± 1.36) and zFEV1/FVC (0.25 ± 1.11). The zFEV1/FVC ratios were stable across all the populations.CONCLUSION: Current evidence seems to support the use of GLI2012 reference values in North African and sub-Saharan African populations after taking into account ethnic correction factors.
Subject(s)
Black People , Lung Diseases/diagnosis , Spirometry/methods , Adult , Africa , Child , Female , Forced Expiratory Volume/physiology , Humans , Lung Diseases/physiopathology , Male , Reference Values , Respiratory Function Tests/methods , Vital Capacity/physiologyABSTRACT
INTRODUCTION: The validity of the published plethysmographic reference equations specific to adults living in Eastern Algeria (RE-EA) in the interpretation of spirometric results in adult natives of Northern Algeria has not been assessed. AIM: To test the application of the RE-EA (Constantine, mean altitude=694m) to a population of healthy adults living in Algiers (mean altitude=153m). METHODS: The plethysmographic parameters of 453 healthy adults living in Algiers (234 women; age: 45±15 years, height: 1.66±0.10m, weight: 73±14kg) were determined and were compared with those predicted from the RE-EA. In addition, the percentages of adults with an obstructive ventilatory defect (OVD), a restrictive ventilatory defect (RVD) and/or lung hyperinflation were noted. The RE-EA are considered inapplicable to healthy adults living in Algiers if, firstly, the differences between the determined and predicted plethysmographic parameters are statistically significant and, secondly, more than 5% of healthy adults have OVD and/or RVD and/or lung hyperinflation. RESULTS: The RE-EA significantly overestimated the following parameters: FEV1 by 0.27±0.39L, MMEF by 0.52±0.75L/s, FEF25% by 0.75±0.56L/s, FEF50% by 0.85±1.02L/s, FEF75% by 0.28±1.25L/s, VC by 0.21±0.50L, TLC by 0.31±0.62L, ERV by 0.06±0.48L, IC by 0.27±0.48L, FEV1/VC by 0.03±0.05, and FEV1/FVC by 0.03±0.05. They significantly underestimated the RV/TLC by 0.01±0.05. Moreover, 14.35 %, 8.83 % and 5.74 % of healthy adults had OVD, RVD and lung hyperinflation, respectively. CONCLUSION: The RE-EA are not applicable in adult natives of Northern Algeria.