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      ARTP statement on pulmonary function testing 2020

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          Abstract

          The Association for Respiratory Technology & Physiology (ARTP) last produced a statement on the performance of lung function testing in 1994. At that time the focus was on a practical statement for people working in lung function laboratories. Since that time there have been many technological advances and alterations to best practice in the measurement and interpretation of lung function assessments. In light of these advances an update was warranted. ARTP, therefore, have provided within this document, where available, the most up-to-date and evidence-based recommendations for the most common lung function assessments performed in laboratories across the UK. These recommendations set out the requirements and considerations that need to be made in terms of environmental and patient factors that may influence both the performance and interpretation of lung function tests. They also incorporate procedures to ensure quality assured diagnostic investigations that include those associated with equipment, the healthcare professional conducting the assessments and the results achieved by the subject. Each section aims to outline the common parameters provided for each investigation, a brief principle behind the measurements (where applicable), and suggested acceptability and reproducibility criteria.

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          Most cited references141

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          Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians.

          There are numerous reference equations available for the single-breath transfer factor of the lung for carbon monoxide (T LCO); however, it is not always clear which reference set should be used in clinical practice. The aim of the study was to develop the Global Lung Function Initiative (GLI) all-age reference values for T LCOData from 19 centres in 14 countries were collected to define T LCO reference values. Similar to the GLI spirometry project, reference values were derived using the LMS (lambda, mu, sigma) method and the GAMLSS (generalised additive models for location, scale and shape) programme in R.12 660 T LCO measurements from asymptomatic, lifetime nonsmokers were submitted; 85% of the submitted data were from Caucasians. All data were uncorrected for haemoglobin concentration. Following adjustments for elevation above sea level, gas concentration and assumptions used for calculating the anatomic dead space volume, there was a high degree of overlap between the datasets. Reference values for Caucasians aged 5-85 years were derived for T LCO, transfer coefficient of the lung for carbon monoxide and alveolar volume.This is the largest collection of normative T LCO data, and the first global reference values available for T LCO.
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            Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation

            The strength of the respiratory muscles can be evaluated from static measurements (maximal inspiratory and expiratory pressures, MIP and MEP) or inferred from dynamic maneuvers (maximal voluntary ventilation, MVV). Although these data could be suitable for a number of clinical and research applications, no previous studies have provided reference values for such tests using a healthy, randomly selected sample of the adult Brazilian population. With this main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females), 20 to 80 years old, selected from more than 8,000 individuals. Gender-specific linear prediction equations for MIP, MEP and MVV were developed by multiple regression analysis: age and, secondarily, anthropometric measurements explained up to 56% of the variability of the dependent variables. The most cited previous studies using either Caucasian or non-Caucasian samples systematically underestimated the observed values of MIP (P<0.05). Interestingly, the self-reported level of regular physical activity and maximum aerobic power correlates strongly with both respiratory and peripheral muscular strength (knee extensor peak torque) (P<0.01). Our results, therefore, provide a new frame of reference to evaluate the normalcy of some useful indexes of respiratory muscle strength in Brazilian males and females aged 20 to 80.
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              Predicted normal values for maximal respiratory pressures in caucasian adults and children.

              Maximal respiratory pressures at the mouth (PEmax and PImax) have been measured in 370 normal caucasian children and adults. Age, height, and weight were recorded for all subjects and incorporated in a stepwise multiple regression analysis to determine prediction equations for the maximal respiratory pressures in the children and adults for both sexes. In men PImax and PEmax were significantly correlated only with age (p less than 0.001 and less than 0.035 respectively), whereas in women they were correlated with height (p less than 0.035 and less than 0.03). In both boys and girls PImax was related to weight (p less than 0.0001 and less than 0.01 respectively) and PEmax to age (p less than 0.001 for both). The values for PImax and PEmax in adults were lower than in previously reported series, but in children the values obtained were similar to those reported for several smaller series.
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                Author and article information

                Journal
                BMJ Open Respir Res
                BMJ Open Respir Res
                bmjresp
                bmjopenrespres
                BMJ Open Respiratory Research
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2052-4439
                2020
                5 July 2020
                : 7
                : 1
                : e000575
                Affiliations
                [1 ]departmentRespiratory Physiology , Royal Papworth Hospital NHS Foundation Trust , Cambridge, UK
                [2 ]departmentLung Function Unit , Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
                [3 ]departmentThe North West Lung Function Laboratory , Manchester University NHS Foundation Trust , Manchester, Greater Manchester, UK
                [4 ]departmentRespiratory Physiology , University Hospitals of North Midlands NHS Trust , Stoke-on-Trent, Staffordshire, UK
                [5 ]departmentLung Function Unit , University Hospitals Bristol NHS Foundation Trust , Bristol, UK
                [6 ]departmentRespiratory Function Lab , Sheffield Children's NHS Foundation Trust , Sheffield, Sheffield, UK
                [7 ]departmentApplied Health Research , University of Birmingham , Birmingham, Birmingham, UK
                [8 ]departmentRespiratory Physiology Department , Sandwell and West Birmingham Hospitals NHS Trust , Birmingham, Birmingham, UK
                [9 ]departmentChild Health , King's College London School of Medicine , London, UK
                [10 ]departmentDepartment of Respiratory Physiology , University Hospitals Coventry and Warwickshire NHS Trust , Coventry, Coventry, UK
                [11 ]departmentPOLARIS, Academic Radiology , The University of Sheffield, Sheffield , Sheffield, Sheffield, UK
                [12 ]West Midlands Strategic Health Authority , Birmingham, Birmingham, UK
                [13 ]departmentClinical Physiology , St George's University , London, UK
                [14 ]departmentDepartment of Respiratory Medicine , Dorset County Hospital NHS Foundation Trust , Dorchester, Dorset, UK
                Author notes
                [Correspondence to ] Dr Karl Peter Sylvester; karl.sylvester@ 123456nhs.net
                Author information
                http://orcid.org/0000-0002-5769-423X
                Article
                bmjresp-2020-000575
                10.1136/bmjresp-2020-000575
                7337892
                32631927
                de8062ad-28a2-4300-864b-8ddb981e9ac9
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 06 February 2020
                : 11 February 2020
                : 14 February 2020
                Categories
                Guidelines
                1506
                Custom metadata
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                lung physiology,respiratory measurement,respiratory muscles

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