An urgent need for African spirometry reference equations: the Paediatric and Adult African Spirometry study

R Masekela; G L Hall; S Stanojevic; B Sartorius; R MacGinty; H Benn Saad; Y Trabelsi; F Messan; M Arigliani; A Ketfi; D Gray

doi:10.5588/ijtld.18.0442

An urgent need for African spirometry reference equations: the Paediatric and Adult African Spirometry study

Int J Tuberc Lung Dis. 2019 Aug 1;23(8):952-958. doi: 10.5588/ijtld.18.0442.

Authors

R Masekela¹, G L Hall², S Stanojevic³, B Sartorius⁴, R MacGinty⁵, H Benn Saad⁶, Y Trabelsi⁷, F Messan⁸, M Arigliani⁹, A Ketfi¹⁰, D Gray⁵

Affiliations

¹ Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
² Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University and Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
³ Division of Respiratory Medicine, Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Division of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
⁵ Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
⁶ Université de Sousse, Faculté de Médicine de Sousse, Laboratoire de Recherche Insuffisance Cardiaque (LR12AP09), Hôpital Farhat Hached, Sousse.
⁷ Department of Physiology and Lung Function Testing (UR12 ES06), Faculty of Medicine of Sousse, University of Sousse, Tunisia.
⁸ Laboratoire APS et Motricité, Institut National de la Jeunesse de l'Education Physique et du Sport, Université d'Abomey-Calavi, Porto-Novo, Benin.
⁹ Department of Medical, University Hospital of Udine, Udine, Italy.
¹⁰ Department of Pneumology, Phtthisiology and Allergology, Rouiba Hospital, University of Algiers, Algiers.

PMID: 31533886
DOI: 10.5588/ijtld.18.0442

Abstract

BACKGROUND: The GLI₂₀₁₂ (Global Lung Initiative 2012) has provided the largest data set to date for multi-ethnic spirometry reference equations; however, data on African populations are limited. In pulmonary function testing, diagnosis of lung disorder is based on comparing the individual's lung function to a reference appropriate for sex and ethnicity.METHODS: We conducted a systematic review of studies reporting spirometry results in healthy children and adults in Africa. Data from these studies were collated for Z-scores of forced expiratory volume in 1 sec (zFEV₁), forced vital capacity (zFVC) and zFEV₁/FVC compared to GLI reference equations.RESULTS: Nine studies, covering a total of 4750 individuals from North, South, East, West and Central Africa (52% were female), were reviewed. Marked differences were noted between individuals from North Africa and sub-Saharan Africa. The Southern zFEV₁ (-0.12 ± 0.98), zFVC (-0.15 ± 0.98) and zFEV₁/FVC (0.05 ± 0.89), Central zFEV₁ (-0.16 ± 0.79), zFVC (-0.09 ± 0.83) and zFEV₁/FVC (-0.17 ± 0.71) and East African zFEV₁ (0.10 ± 0.88), zFVC (0.16 ± 0.85) and zFEV₁/FVC (-0.10 ± 0.95) cohorts had an excellent fit with the GLI-African American. The West African showed a poor fit to all reference equations. The North African group showed the best fit for the GLI Caucasian zFEV₁ (-0.12 ± 1.37), zFVC (-0.26 ± 1.36) and zFEV₁/FVC (0.25 ± 1.11). The zFEV₁/FVC ratios were stable across all the populations.CONCLUSION: Current evidence seems to support the use of GLI₂₀₁₂ reference values in North African and sub-Saharan African populations after taking into account ethnic correction factors.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Africa
Black People*
Black or African American
Child
Female
Forced Expiratory Volume / physiology
Humans
Lung Diseases / diagnosis*
Lung Diseases / physiopathology
Male
Reference Values
Respiratory Function Tests / methods
Spirometry / methods*
Vital Capacity / physiology