Age Dependency of GLI Reference Values Compared with Paediatric Lung Function Data in Two German Studies (GINIplus and LUNOKID)

PLoS One. 2016 Jul 20;11(7):e0159678. doi: 10.1371/journal.pone.0159678. eCollection 2016.

Abstract

A hallmark of the newly published GLI (Global Lungs Initiative) spirometric reference values is their "all-age" (3-95yr) predictive power, accomplished by incorporating non-linear age dependencies into modelling parameters. This modelling strategy is especially promising for the age range of puberty; however, the performance of GLI-values for adolescents is currently unknown. We calculated GLI-based z-scores for children/adolescents without apparent respiratory diseases from two different German studies, LUNOKID (N = 1943, 4-19 years) and GINIplus (N = 1042, 15 years) and determined the goodness of fit for specific age groups. We defined fit sufficient if the absolute mean of z-scores was <0.5. For children (<10yr) the mean GLI-based z-scores for FEV1 and FVC reached a good fit with mean z-scores for FEV1 between -0.11 and 0.01 and mean z-scores for FVC between 0.01 and 0.16, but larger deviations were observed in adolescents, especially boys (mean z-score -0.58 for FEV1 and -0.57 for FVC in GINIplus). The fit for FEV1/FVC was sufficient. GLI reference values provided reasonable estimates for the individuals enrolled in our studies, which span the age range of lung growth and development. However, we found that GLI-predictions overestimated lung volumes, especially those for German adolescent boys, which may, left unrecognised, lead to erroneous diagnosis of lung disease. Caution should be taken when applying these reference values to epidemiologic studies.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Child, Preschool
  • Female
  • Forced Expiratory Volume / physiology*
  • Germany / epidemiology
  • Humans
  • Infant
  • Lung / physiopathology*
  • Lung Diseases / epidemiology
  • Lung Diseases / physiopathology*
  • Male
  • Puberty / physiology
  • Reference Values
  • Spirometry / methods*
  • White People
  • Young Adult

Grants and funding

LUNOKID was supported by GlaxoSmithKline GmbH & Co. KG, Munich, Germany; Aerocrine AB, Solna, Sweden; MSD Sharp & Dohme GmbH, Haar, Germany; AstraZeneca GmbH, Wedel, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Astellas Pharma GmbH, Munich, Germany, Deutsche Atemwegsliga; Ndd Medizintechnik AG, Zürich, Switzerland, Lions Club Wesel. The GINIplus study was mainly supported for the first 3 years by the Federal Ministry for Education, Science, Research and Technology (interventional arm) and Helmholtz Zentrum Munich (former GSF) (observational arm). The 4-year, 6-year and 10-year follow-up examinations of the GINIplus study were covered from the respective budgets of the 5 study centres (Helmholtz Zentrum Munich (former GSF), Marien-Hospital Wesel, LMU Munich, TU Munich and from 6 years onward also from IUF - Leibniz Research-Institute for Environmental Medicine) and a grant from the Federal Ministry for Environment (IUF, FKZ 20462296). The 15-year follow-up examination of the GINIplus study was supported by the Commission of the European Communities, the 7th Framework Program (MeDALL project) and the Mead Johnson and Nestlé companies. The publication of this article was funded by the Open Access fund of the Leibniz Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.