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Determinants of lung disease in children
S33 Validation of the GLI-2012 Multi-Ethnic Spirometry Reference Equations in London School Children
  1. S Lum1,
  2. R Bonner1,
  3. J Kirkby1,2,
  4. S Sonnappa1,2,
  5. J Stocks1
  1. 1Portex Respiratory Unit, UCL Institute of Child Health, London, UK
  2. 2Great Ormond Streeet Hospital for Children NHS Foundation Trust, London, UK


The Global Lung Function Initiative (GLI) recently published the first global all-age (3–95 years) multi-ethnic reference equations for spirometry (Quanjer 2012 ERJ).

Aim To assess the agreement of the GLI reference range to contemporary lung function data from children living in Britain to verify its appropriateness for clinical use in this population.

Methods Anthropometry and spirometry were undertaken within a mobile laboratory in primary school children recruited to the Size and Lung function In Children study during one school year (2011–2012). Spirometry Z-scores were calculated using the GLI-2012 reference range, using the ‘Black equation’ for South Asian children, for whom a specific equation has yet to be developed.

Results Spirometry data from 728 (47% boys; 35% White; 28% Black; 26% South Asian; 11% other/mixed race) healthy children aged 5–11 years from eight London schools were eligible for inclusion. Mean (SD) age of 8 (1.6) years was similar across the 4 ethnic groups. After adjustment for age and sex, Black children were significantly heavier and taller compared to other groups, while South Asians were significantly lighter. When compared with White children, after adjusting for age, sex and standing height, FEV1 was significantly lower by a mean(95%CI) of 14% (11%; 16%) in Black; 11% (9%; 14%) in South Asian and 4% (1%; 8%) in the “other”/mixed race children. Similar patterns were seen for FVC but FEV1/FVC was similar across all groups. When expressed according to ethnic-specific reference equations the mean (SD) for FVC, FEV1 and FEV1/FVC for the White, Black and other groups approximated 0(1) suggesting that the GLI equations are appropriate for use in this population (Figure). Mean (95%CI) FVC and FEV1 were however 3% (–0.1%; 6.1%, p=0.07) higher in South Asian than Black children.

Conclusions This study shows that the GLI-2012 equations are appropriate for use in children across a wide range of ethnicities. Of the currently available equations, the ‘Black equation’ provides the best fit for South Asian children, although it results in slight over-estimation of lung function, emphasising the need to develop specific coefficients for this group.

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