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Moulinié J, Hayot M, Gouzi F. [The FEV 1/VC ratio to define bronchial obstruction: Should we use a fixed ratio or the lower limit of normal?]. Rev Mal Respir 2023; 40:564-571. [PMID: 37407298 DOI: 10.1016/j.rmr.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/07/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION While the screening of chronic obstructive lung diseases (COPD, asthma, etc.) constitutes a major public health issue in France and worldwide, simple spirometry appears currently as the key to meeting the challenge. Since description of the forced expiratory maneuver by Robert Tiffeneau in 1947, it has been admitted that the FEV1/VC ratio permits diagnosis obstructive pulmonary diseases. However, the diagnostic criteria for this ratio remain uncertain. The long-lasting debate between advocates of a 0.7 "fixed ratio" (FR) of 0.7 and advocates of the "lower limit of normal" (LLN) remains relevant. STATE OF THE ARTS In this general review, we describe the respective advantages of the FR and LLN criteria according to the most recently published studies, and characterize the conditions associated with discrepancies between these criteria. PERSPECTIVES AND CONCLUSIONS FR and LLN appear not to share similar diagnosis values and the use of both criteria facilitates proposal of an up-to-date interpretation and diagnosis strategy in the context of first-line spirometry, particularly for patients with FEV1/VC ratio in the "grey zone".
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Affiliation(s)
- J Moulinié
- Département de physiologie clinique, CHU de Montpellier, 34295 Montpellier, France; PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France.
| | - M Hayot
- PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France
| | - F Gouzi
- PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France
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Günther S, Gille T, Chenuel B, Aubourg F, Barnig C, Bayat S, Beydon N, Bonay M, Charloux A, Demoulin S, Hulo S, Ioana C, Rannou F, Gauthier R, Edmé JL, Plantier L. [Global Lung Initiative reference values are recommended for pulmonary function testing in France: A statement from the Lung Function Group of the French-Speaking Pulmonology Society]. Rev Mal Respir 2023; 40:198-201. [PMID: 36717334 DOI: 10.1016/j.rmr.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 01/30/2023]
Affiliation(s)
- S Günther
- Unité d'explorations fonctionnelles respiratoires et du sommeil, université de Paris Cité, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - T Gille
- Inserm U1272 « Hypoxie et Poumon », service physiologie et explorations fonctionnelles, UFR SMBH Léonard-de-Vinci, université Sorbonne Paris Nord, hôpitaux universitaires de Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - B Chenuel
- Exploration fonctionnelle respiratoire, centre universitaire de médecine du sport et activités physiques adaptées, DevAH, CHRU-Nancy, université de Lorraine, Nancy, France
| | - F Aubourg
- Service de physiologie, explorations fonctionnelles, université de Paris Cité, hôpital Cochin, AP-HP, Paris, France
| | - C Barnig
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France; Inserm, EFS BFC, LabEx LipSTIC, UMR1098, interactions hôte-greffon-tumeur/ingénierie cellulaire et génique, université de Bourgogne Franche-Comté, Besançon, France
| | - S Bayat
- STROBE Inserm UA07, laboratoire d'explorations fonctionnelles respiratoires, CHU de Grenoble-Alpes, université Grenoble-Alpes, Grenoble, France
| | - N Beydon
- Inserm U938, unité fonctionnelle de physiologie-explorations fonctionnelles respiratoires et du sommeil, centre de recherche Saint-Antoine, Sorbonne-université, hôpital Armand-Trousseau, hôpital Saint-Antoine, AP-HP, Paris, France
| | - M Bonay
- Service de physiologie - explorations fonctionnelles bi-sites Ambroise-Paré - Bicêtre, université Paris Saclay, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - A Charloux
- Faculté de médecine, maïeutique et sciences de la santé de Strasbourg, hôpitaux universitaires de Strasbourg, nouvel hôpital Civil, Strasbourg cedex, France
| | - S Demoulin
- Inserm, service d'explorations fonctionnelles respiratoires, CNRS, CHU Lille, université de Lille, U1019-UMR9017-CIIL-centre d'infection et d'immunité de Lille, institut Pasteur de Lille, Lille, France
| | - S Hulo
- CHU de Lille, université de Lille, ULR 4483 - IMPECS - IMPact de l'environnement chimique sur la santé humaine, institut Pasteur Lille, Lille, France
| | - C Ioana
- Service d'explorations fonctionnelles pédiatriques, CHRU de Nancy ; EA DevAH, université de Lorraine, hôpital d'Enfants, Nancy, France
| | - F Rannou
- Équipe ASMS-UNH, service de médecine du sport & explorations fonctionnelles, CHU de Clermont-Ferrand, CRNH Auvergne, Clermont-Ferrand, France
| | - R Gauthier
- Unité d'explorations fonctionnelles respiratoires pédiatriques, CHU de Amiens-Picardie, Amiens, France
| | - J-L Edmé
- CHU de Lille, université de Lille, ULR 4483 - IMPECS - IMPact de l'environnement chimique sur la santé humaine, institut Pasteur Lille, Lille, France
| | - L Plantier
- CEPR/Inserm UMR1100, service de pneumologie et explorations respiratoires, CHRU de Tours, université de Tours, Tours, France.
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Wardyn PM, de Broucker V, Chenivesse C, Sobaszek A, Van Bulck R, Perez T, Edmé JL, Hulo S. Assessing the applicability of the new Global Lung Function Initiative reference values for the diffusing capacity of the lung for carbon monoxide in a large population set. PLoS One 2021; 16:e0245434. [PMID: 33445178 PMCID: PMC7808798 DOI: 10.1371/journal.pone.0245434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The single-breath diffusing capacity of the lung for carbon monoxide (DLCO) interpretation needs the comparison of measured values to reference values. In 2017, the Global Lung Function Initiative published new reference values (GLI-2017) for DLCO, alveolar volume (VA) and transfer coefficient of the lung for carbon monoxide (KCO). We aimed to assess the applicability of GLI-2017 reference values for DLCO on a large population by comparing them to the European Community of Steel and Coal equations of 1993 (ECSC-93) widely used. METHODS In this retrospective study, spirometric indices, total lung capacity, DLCO, VA and KCO were measured in adults classified in 5 groups (controls, asthma, chronic bronchitis, cystic fibrosis, and interstitial lung diseases (ILD)). Statistical analysis comparing the 2 equations sets were stratified by sex. RESULTS 4180 tests were included. GLI-2017 z-scores of the 3 DLCO indices of the controls (n = 150) are nearer to 0 (expected value in a normal population) than ECSC-93 z-scores. All groups combined, in both genders, DLCO GLI-2017 z-scores and %predicted are significantly higher than ECSC z-scores and %predicted. In the ILD group, differences between the 2 equation sets depend on the DLCO impairment severity: GLI-2017 z-scores are higher than ECSC z-scores in patients with no or "mild" decrease in DLCO, but are lower in "moderate" or "severe" decrease. CONCLUSION GLI-2017 reference values for DLCO are more suitable to our population and influence the diagnostic criteria and severity definition of several lung diseases.
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Affiliation(s)
- Pierre-Marie Wardyn
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
| | - Virginie de Broucker
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
- EA 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé humaine, Univ. Lille, Lille, France
| | - Cécile Chenivesse
- Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, CHU Lille, Lille, France
- INSERM U1019—CNRS UMR 8204, Institut Pasteur de Lille—CIIL—Center for Infection and Immunity of Lille, Lille, France
- Univ. Lille, Lille, France
| | - Annie Sobaszek
- EA 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé humaine, Univ. Lille, Lille, France
- Service de Médecine du Travail, CHU Lille, Lille, France
| | - Richard Van Bulck
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
| | - Thierry Perez
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
- INSERM U1019—CNRS UMR 8204, Institut Pasteur de Lille—CIIL—Center for Infection and Immunity of Lille, Lille, France
| | - Jean-Louis Edmé
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
- EA 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé humaine, Univ. Lille, Lille, France
| | - Sébastien Hulo
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
- EA 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé humaine, Univ. Lille, Lille, France
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