1. Spirometry reference values: a systematic review Turma 1 Docente: Dr. Tiago António Queirós Jacinto Regente: Prof. Dr. Altamiro Pereira INTRODUCTION TO MEDICINE 2009/2010

2. 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

3. 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.

4. 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.

5. 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

6. 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

7. 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.

9. Methods  Study design : systematic review ;  Data Sources (online databases):  Key words: SPIROMETRY FVC FEV Reference values

10. 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”) 464372 (“SPIROMETRY” [MESH] OR "SPIROMETRY" [TIAB]) AND "REFERENCE VALUES" 710561 ("SPIROMETRY” [TIAB] OR "SPIROMETRY" [MESH]) AND (“REFERENCE VALUES” OR “REFERENCE EQUATIONS” OR “NORMAL VALUES” OR “NORMATIVE VALUES”) 837659 (“SPIROMETRY” [MESH] OR "SPIROMETRY" [TIAB]) AND ("REFERENCE VALUES" OR "FEV1" OR "FVC") 40313503 (“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”) 45063934 (“SPIROMETRY” [MESH] OR “SPIROMETRY” [TIAB]) 1967914775

11. 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.

12. Research Method Start 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

13. 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

14. 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

15. Turma 1 2009/2010