The recent multi ‐ ethnic global lung initiative 2012 (GLI 2012 ) reference values don’t reflect contemporary Mediterranean spirometry Ben Saad H 1,2,

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The recent multi ‐ ethnic global lung initiative 2012 (GLI 2012 ) reference values don’t reflect contemporary Mediterranean spirometry Ben Saad H 1,2, Elattar Mn 1, Hadj Mabrouk K 1, Maatoug C 1, Rouatbi S 2 1 Functional Exploration Laboratory. Occupational Medicine Group. 2 Department of Physiology and Functional Explorations. Farhat HACHED Hospital. Sousse. Tunisia Methods Results Conclusion References Printed by 1.Quanjer PH et al. (2012) Multi-ethnic reference values for spirometry for the yr age range: the global lung function 2012 equations. Eur Respir J 40: Tabka Z et al. Spirometric reference values in a Tunisian population. Tunis Med. 1995;73: Objective Statistical analysis Chi-2 test: compare percentages.. Student t-test: compare anthropometric and spirometric data. Wilcoxon matched pairs test: compare %Ref. Construction of contingency tables: comparison of spirometry profiles (normal, LAOVD, SAOVD, TRVD, MVD). Z-score>0.5 is considered to be clinically significant and equated to a change in %Ref of approximately 6%. Z-score (ERS/GLI 2012 ): >0.5 is considered to be clinically significant and equated to a change in %Ref of approximately 6%. Design: cross-sectional study. Study population: Total sample: local workers aged Yrs and having a complete record with technically acceptable and reproducible spirometry maneuvers. (2) Healthy non-smokers group free from large airways obstructive ventilatory defect (LAOVD) or mixed ventilatory defect. (MVD) according local reference equations (2). Collected data: Medical questionnaire and smoking habits. Medical questionnaire and smoking habits. age (Yr), height (m), weight, (kg), body mass index. Anthropometric data: age (Yr), height (m), weight, (kg), body mass index. according ATS/ERS-2005 guidelines. Spirometry measurements according ATS/ERS-2005 guidelines. FVC (L), FEV 1 (L), FEV 1 /FVC, PEF (L/s), forced expiratory flow rate at the x% point of total volume to be exhaled (FEF x, L/s), maximal mid-expiratory flow (MMEF, L/s) and Z-score. Spirometric data: FVC (L), FEV 1 (L), FEV 1 /FVC, PEF (L/s), forced expiratory flow rate at the x% point of total volume to be exhaled (FEF x, L/s), maximal mid-expiratory flow (MMEF, L/s) and Z-score. Applied reference equations: Applied reference equations: ERS/GLI 2012 and Tunisia 1995 Data expression: Data expression: absolute values and percent of reference values (%Ref Tunisian 1995 and %Ref ERS/GLI 2012 ). Applied definitions: LAOVD: FEV 1 /FC < lower limit of normal (LLN). SAOVD (small airway obstructive ventilatory defect): FEV 1 /FVC ≥LLN and FVC ≥LLN and MMEF <LLN. TRVD (tendency through a restrictive ventilatory defect): FEV 1 <LLN and FVC < LLN and FEV 1 /FVC ≥ LLN. MVD: FEV 1 /FVC <LLN and FVC <LLN and FEV 1 <LLN. Rational To ascertain how well the recent ERS/GLI reference equations (1) fit contemporary Tunisian spirometric data. To ascertain how well the recent ERS/GLI reference equations (1) fit contemporary Tunisian spirometric data. The use of the ERS/GLI 2012 reference equations leads to misinterpretation of spirometry data in a significant proportion of subjects. Our results don’t support the use of the ERS/GLI 2012 reference equations to interpret spirometry in Tunisian population and probably in Mediterranean population. The applicability of the recent multi-ethnic reference equations derived by the ERS Global Lung Initiative (ERS/GLI) in interpreting spirometry data in Mediterranean population (eg.Tunisian subjects) has not been studied The applicability of the recent multi-ethnic reference equations derived by the ERS Global Lung Initiative (ERS/GLI) in interpreting spirometry data in Mediterranean population (eg.Tunisian subjects) has not been studied Comparison of measured spirometric data expressed as a reference percent from the 2 reference equations All measured spirometric data (except for FVC) expressed as %Ref ERS/GLI 2012 are significantly higher than those expressed as a %Ref Tunisia 1995 : mean±SD of FEV 1, FEV 1 /FVC, MMEF and FEF 75 are, respectively, 90±12 vs. 85±12%, 99±8 vs. 98±8%, 99±31 vs. 70±20% and 511±153 vs. 92±21%. How well did the recent ERS/GLI 2012 reference equations fit contemporary Tunisian spirometric data? Mean±SD Z-scores for the contemporary healthy group data (n=489) are -0.55±0.87 (FEV 1 ), -0.62±0.86 (FVC), 0.10±0.73 (FEV 1 /FVC), 4.43±0.69 (FEF 75 ) and 0.07±0.93 (MMEF). Mean Z-score differences equate to percent predicted differences of 6.95% (FEV 1 ), 7.73% (FVC), 400% (FEF 75 ), 4.37% (MMEF) and 0.59%.(FEV 1 /FVC).