class 1 regent: prof. dr. altamiro pereira professor: dr. tiago jacinto
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Class 1
Regent: Prof. Dr. Altamiro PereiraProfessor: Dr. Tiago Jacinto
INTRODUCTION TO MEDICINE 2009/2010
Spirometry reference values:
- a systematic review of studies in the last decade -
Research Questions
How good are the studies published in the last decade?
Is there any study that can be applied to Portugal? If so, which one is the best?
Introduction
Reference values provide a point of reference to help to interpret and
determine a patient’s condition: a test result is normal if it falls within the range
predicted for the age, sex and height of the patient, based on large population
studies 4
Reference values are important statistical parameters to obtain
medical relevant information
It is crucial to have adequate reference values when performing a test,
in order to avoid misdiagnosis;
4 Hughes, 2007
Spirometry is an exam that allows to assess a patient’s pulmonary function using a spirometer:
Two reference values are commonly used: the FVC (total amount of exhaled air) and FEV1 (exhaled air during the first second) 6,7
The spirometer measures the volume and flow of the forced exhaled air during a period of time 2
2 Enright, n.d.
6 Kuster, 2008
8 Miller, 2007
Spirometric reference values vary with individual
characteristics.
They should be tailored to each individual;
At the time of diagnosis, there aren’t previous personal values.
The spirometric data is compared to those calculated from population
studies (reference values);
Healthcare professionals may be using inappropriate reference values for their target-populations, resulting in compromised diagnosis. 1,3,5,6
Systematic review and quality assessment1 Baur, 1999
3Garcia-Rio, 2004
5 Ip, 2006
6 Kuster, 2008
Aims
Summarize the wide range of data that has been published in the last decade;
Propose, from all studies, the most suitable for Portugal or suggest the conduction of a study in our country.
Analyze and rate the obtained information using the STROBE checklist 9;
9 STROBE statement
Methods
Methods
Key words:
“A systematic review attempts to collate all
empirical evidence that fits pre-specified eligibility
criteria to answer a specific research question.” 7
Spirometry Reference Values
FEV1; FVC
Study design: Systematic review;
Data Sources (online databases):
7Liberati, 2009
Query:
("1998"[Publication Date] : "2008"[Publication Date]) AND("Spirometry"[tiab] AND ("Reference values"[mh] OR "Reference
equations"))
PUBMED
Query: ISI WEB OF KNOWLEDGE
(TITLE-ABS-KEY(spirometry) AND TITLE-ABS-KEY(“reference values” OR “reference equations” OR “normal values” OR “normative values”)) AND (LIMIT-TO(PUBYEAR, 2008) OR LIMIT-TO(PUBYEAR,
2007) OR LIMIT-TO(PUBYEAR, 2006) OR LIMIT-TO(PUBYEAR, 2005) OR LIMIT-TO(PUBYEAR, 2004) OR LIMIT-TO(PUBYEAR, 2003) OR LIMIT-TO(PUBYEAR, 2002) OR LIMIT-TO(PUBYEAR, 2001) OR LIMIT-
TO(PUBYEAR, 2000) OR LIMIT-TO(PUBYEAR, 1999) OR LIMIT-TO(PUBYEAR, 1998))
Query: SCOPUS
Criteria
Inclusion Criteria Exclusion Criteria
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;
o Study subjects with history of pulmonary disease
Articles written in Portuguese or English;
Articles referring to studies performed in humans;
Articles which refer the equipment used;
Articles published from 1998 to 2008.
Study subjects over 18 years old
Cross-sectional studies only
Research Method
1. Search for studies2. Select and layout the studies that meet the
criteria
3. Rate using the STROBE checklist 4. Conclusion
Procedure
Expected results
Find at least one study that can be applied to Portugal;
Gather a set of adequate spirometry reference values for our country;
Expose the necessity for these kind of studies
1. Baur, X., S. Isringhausen-Bley, et al. (1999). "Comparison of lung-function reference values." International Archives of Occupational and Environmental Health 72(2): 69-83.2. Enright P. Testing your lungs: spirometry [Internet]. European Lung Foundation. Available from: http://www.european-lung-foundation.org3. Garcia-Rio, F., J. M. Pino, et al. (2004). "Spirometric reference equations for European females and males aged 65-85 yrs." Eur Respir J 24(3): 397-405.4. Hughes, J.M.B.,Interpreting pulmonary function tests [Internet] ERS Education –Your best online source of CME in respiratory medicine [2007] European Respitatory Society. Available from: http://www.ers-education.org/media/2009/pdf/103639.pdf5. Ip, M. S.-m., F. W.-s. Ko, et al. (2006). "Updated Spirometric Reference Values for Adult Chinese in Hong Kong and Implications on Clinical Utilization" Chest 129(2): 384-392.6. Kuster, S. P., D. Kuster, et al. (2008). "Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years." Eur Respir J 31(4): 860-868.7. Liberati, A., D. G. Altman, et al. (2009). "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration." Journal of Clinical Epidemiology 62(10): e1-e34.8. Miller, Martin R. Interactive Course on Spirometry Training [Internet] ERS Education –Your best online source of CME in respiratory medicine [2007] European Respitatory Society. Available from: http://www.ers-education.org/pages/default.aspx?id=3269. Unknown. STROBE Statement - checklist of items that should be included in reports of observational study [Internet] Strobe Statement: Strengthening the reporting of observational studies in epidemiology. [2009] ISPM - University of Bern. Available from: http://www.strobe-statement.org
Information sources
LEITE, Ana; PEIXOTO, Cláudia; MOURA, Diana; MARTINS, Diana; FERNANDES, Luís; ALMEIDA, Maria; BRITO, Nuno; ALMEIDA, Pedro; DIOGO, Pedro;
MONTEIRO, Sara; PIMENTA, Sofia
Class 1; turma1intromed@gmail.com 2009/2010
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