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The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children

João Gaspar Marques1,2,3; P Carreiro Martins1,2,3; Joana Belo1; Sara Serranho1; Isabel Peralta1, Nuno Neuparth1,2,3; Paula Leiria Pinto1,2

1 - Serviço de Imunoalergologia, Departamento de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
2 - CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisboa
3 - Departamento de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa

- Comunicação oral no 4th Pediatric Allergy and Asthma Meeting, European Academy Allergy and Clinical Immunology, Berlim, Outubro de 2015; Travel Grant Award

Introduction: Spirometry is the mainstay of lung function assessment, comparing test results with expected values. In 2012, The Global Lung Function Initiative (GLI) introduced the first global multi-ethnic reference equations for spirometry that span all-ages. These equations are being progressively adopted although the impact in daily clinical practice needs further research. The objective of our study is to compare the application of GLI 2012 equations with commonly used prediction equations in asthmatic children.
Methods: A retrospective analysis of the children (6-18 years-old) with a medical diagnosis of asthma that performed spirometry during 2014 in our lung function laboratory was made. GLI and Zapletal equations agreement was compared in three different obstruction criteria: FEV1<80% predicted, FEV1<LLN (lower limit of normal) and FEV1/FVC<LLN. All the agreement analysis were performed using Cohen’s kappa test.
Results: 391 children were evaluated (61% boys) with a mean age of 12.4 years (standard-deviation ± 3.1 years). Considering Zapletal equations the percentages of children classified as obstructed according to the different analyzed parameters were: 7.7% for FEV1<80% predicted, 8.7% for FEV1<LLN and 26.3% for FEV1/FVC<LLN. Assuming GLI 2012 equations the correspondent percentages were 12.0% for FEV1<80% predicted, 11.8% for FEV1<LLN and 29.2% for FEV1/FVC<LLN. Using the FEV1/FVC<0.70 ratio criteria 10.2% of the patients were classified as obstructed. Cohen´s kappa coefficients for agreement between Zapletal and GLI 2012 equations to the analyzed parameters were: 0.67 for FEV1<80% predicted, 0.64 for FEV1<LLN and 0.85 for FEV1/FVC<LLN.
Conclusions: In our study there was a good agreement between the commonly used prediction equations (Zapletal equations) and GLI 2012 equations. GLI 2012 equations adoption is a reasonable option in asthmatic children lung function evaluation, although maybe the changes in nowadays clinical practice will not be considerable.

Palavras Chave: asma; função pulmonar; idade pediátrica