Reliability of Portable Spirometry Performed in the Korea National Health and Nutrition Examination Survey Compared to Conventional Spirometry

( Hye Jung Park ),( Chin Kook Rhee ),( Kwang Ha Yoo ),( Yong Bum Park ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.4

Background: The Korea National Health and Nutrition Examination Survey (KNHANES) is a well-designed survey to collect national data, which many researchers have used for their studies. In KNHANES, although portable spirometry was used, its reliability has not been verified. Methods: We prospectively enrolled 58 participants from four Korean institutions. The participants were classified into normal pattern, obstructive pattern, and restrictive pattern groups according to their previous spirometry results. Lung function was estimated by conventional spirometry and portable spirometry, and the results were compared. Results: The intraclass correlation coefficients of forced vital capacity (FVC) (coefficient, 9.993; 95% confidence interval [CI], 0.988-0.996), forced expiratory volume in 1 second (FEV₁) (coefficient, 0.997; 95% CI, 0.995-0.998), FEV₁/FVC ratio (coefficient, 0.995; 95% CI, 0.992-0.997), and forced expiratory flow at 25-75% (FEF25-75%; coefficient, 0.991; 95% CI, 0.984-0.994) were excellent (all p<0.001). In the subgroup analysis, the results of the three parameters were similar in all groups. In the overall and subgroup analyses, Pearson’s correlation of all the parameters was also excellent in the total (coefficient, 0.986-0.994; p<0.001) and subgroup analyses (coefficient, 0.915-0.995; p<0.001). In the paired t-test, FVC, FEV₁/FVC, and FEF25-75% estimated by the two instruments were statistically different. However, FEV₁ was not significantly different. Conclusion: Lung function estimated by portable spirometry was well-correlated with that estimated by conventional spirometry. Although the values had minimal differences between them, we suggest that the spirometry results from the KNHANES are reliable.

Influence of Age on Effort Required to Complete Spirometry in Children and Adolescents

Lee Eun,Song Jun Hyuk,Chung Eun Hee,Jung Sungsu,Rhee Eun Hee,Suh Dong In,양현종 대한천식알레르기학회 2022 Allergy, Asthma & Immunology Research Vol.14 No.6

Although effort required to complete spirometry is known to differ by age, no studies have addressed this issue. The present study aimed to identify the difference in the effort required to complete spirometry by age in children and adolescents. Data from 707 children (mean age, 10.2 years; range, 4–25 years) from 6 medical centers were analyzed. In addition to demographics, we obtained information on the time required for as well as the number of demonstrations and spirometry demonstrations and trials from the patients’ electronic medical records. A total of 398 (56.3%) male participants were included, and 300 (42.4%) participants had no prior experience receiving spirometry. The mean time required for spirometry demonstration was 2.7 minutes (standard deviation [SD], 2.1 minutes), whereas that for spirometry trial was 5.9 minutes (SD, 5.1 minutes). The total mean time required for spirometry was 8.6 minutes (SD, 6.5 minutes). Significant negative associations were observed between age and effort required to complete spirometry with respect to the time and number of demonstrations and trials. The results of the present study suggest that age may affect the degree of effort required to complete spirometry, with a pattern of increasing effort with decreasing age. This finding provides important evidence for the establishment of health care policies especially regarding lung diseases that can benefit from spirometry.

한국 성인을 대상으로 한 미국 및 유럽 폐활량 검사 재현성 기준의 유용성

박병훈 ( Byung Hoon Park ),박무석 ( Moo Suk Park ),정우영 ( Woo Young Jung ),변민광 ( Min Kwang Byun ),박선철 ( Seon Cheol Park ),신상윤 ( Sang Yun Shin ),전한호 ( Han Ho Jeon ),정경수 ( Kyung Soo Jung ),문지애 ( Ji Ae Moon ),김 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5

연구배경: 본 연구를 통해 2005년도 ATS/ERS 폐활량검사 지침에서 제시한 재현성 기준을 한국 성인들에게 적용할 수 있는 지와, 한국 성인들의 폐활량 검사 시 재현성에 영향을 미치는 요인들을 알아보고자 하였다. 방 법: 국민건강영양조사, COPD 코호트, 지역사회 코호트로부터 얻은 성인 4,663명의 폐활량검사 결과를 이용하여 dFVC 및 dFEV1를 계산하여 분포를 알아보고, 1994년도 ATS 지침 및 2005년도 ATS/ERS 지침을 만족하는 검사의 비율을 비교하였다. 다중회귀분석을 통해 개인적 특성 및 재현성 기준의 변화가 재현성에 영향을 미치는가를 알아보았다. 결 과: 폐활량검사를 시행한 사람들 중 95% 이상이 150ml 이내의 재현성 기준을 만족시켰다. 1994년도 ATS 지침에 따라 검사를 시행한 경우 재현성을 만족하지 않는 경우가 증가하였다. 다중회귀분석 결과 재현성에 영향을 주는 요인들은 신장, 연령, 체중, 폐쇄성폐질환 여부, 재현성 기준의 변화 등이었으나 재현성에 영향을 미치는 정도는 매우 작았다(0.5∼3.0%). 결 론: 한국인에게도 2005년도 ATS/ERS에서 제시한 재현성 기준을 적용할 수 있을 것으로 생각하며, 이를 위해서는 변경된 재현성 기준에 대한 지속적인 홍보와 검사자 들에 대한 교육 및 정도 관리가 필요하다. Background: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. Methods: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spiro-metric variability. Results: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. Conclusion: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results. (Tuberc Respir Dis 2007;63:405-411)

Pharyngeal reperforation following incentive spirometry - A case report -

전소은,홍정민,권재영,황부영,윤기영 대한마취통증의학회 2018 Anesthesia and pain medicine Vol.13 No.4

Despite its widespread use, complication of incentive spirometry has been rarely reported. We report a case of pharyngeal reperforation following incentive spirometry. A 75-year-old female, had a history of long-term steroid use, entered the intensive care unit for maintenance of mechanical ventilation following surgical repair of a pharyngeal perforation. After ventilator weaning, incentive spirometry was implemented on postoperative day 4. Immediately after incentive spirometry use, patient’s neck began to swell, and subcutaneous emphysema was palpated. Pharyngeal reperforation was suspected on neck computed tomography, and emergency surgery was performed. Surgery revealed a 3-cm long rupture from the hypopharynx to the esophagus. The causes were thought to be delayed wound healing due to long-term steroid use and a sudden increase in pharyngeal pressure due to incentive spirometry. In conclusion, particular attention should be paid when using incentive spirometry after head and neck surgery in patients with a history of long-term steroid use.

Cut-off value of FEV₁/FEV₆ to determine airflow limitation using handheld spirometry in subjects with risk of chronic obstructive pulmonary disease

( Yong Il Hwang ),( Youlim Kim ),( Chin Kook Rhee ),( Deog Kyeom Kim ),( Yong Bum Park ),( Kwang Ha Yoo ),( Ki-suck Jung ),( Chang Youl Lee ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.3

Background/Aims: Postbronchodilator forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) less than 0.7 using spirometry is the golden standard to diagnose airf low limitation of chronic obstructive pulmonary disease (COPD). Recently, measuring FEV₆ has been suggested as an alternative to measure FVC. Studies about the cut-off value for FEV₁/FEV₆ to diagnose airflow limitation have shown variable results, with values between 0.7 and 0.8. The purpose of this study was to determine the best cut-off value of FEV₁/FEV₆ to detect airflow limitation using handheld spirometry. Methods: We recruited subjects over 40 years of age with smoking history over 10 pack-years. Participants underwent measurements with both handheld spirometry and conventional spirometry. We calculated the sensitivity and specificity of the value of FEV₁/FEV₆ using receiver-operating characteristic (ROC) curve analysis to obtain the diagnostic accuracy of handheld spirometry to detect airflow limitation. Results: A total of 290 subjects were enrolled. Their mean age and smoking amount were 63.1 years and 31.6 pack-years, respectively. According to our ROC curve analysis, when FEV₁/FEV₆ ratio was 73%, sensitivity and specificity were the maximum and the area under the ROC curve was 0.93, showing an excellent diagnostic accuracy. Sensitivity, specificity, positive predictive value, and negative predictive value were 86.7%, 89.7%, 88.0%, and 88.5%, respectively. Participants with FEV₁/FEV₆ ≤ 73% had lower FEV1 predicted value compared to those with FEV₁/FEV₆ > 73% (65.4% vs. 86.5%, p < 0.001). Conclusions: In summary, we demonstrate that the value of 73% in FEV₁/FEV₆ using handheld spirometry has the best sensitivity and specificity to detect airflow limitation in subjects with risk of COPD.

소아의 기도 폐쇄 평가에서 impulse oscillometry system과 폐활량 측정법의 비교

허혜영,곽지희,김형윤,정다운,신윤호,한만용 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.8

Purpose:Measurement of forced expiratory volume in 1 second (FEV1) is usually difficult to obtain in children under six years of age because it requires active cooperation. This study evaluates the sensitivity of impulse oscillometry system (IOS) parameters for detecting airway obstruction in comparison with FEV1. Methods:We studied 174 children who performed the lung function and methacholine challenge tests to diagnose asthma by IOS and spirometry. Children were divided into two subgroups according to their PC20, which is a parameter for bronchial sensitivity. We compared IOS parameters with FEV1 at the baseline, post-methacholine challenge, and evaluated their correlation. Results:At the baseline, reactance at 5 Hz (X5) and resistance at 5 Hz (R5) significantly differed between the PC20 positive (PC20≤16 mg/mL) group and PC20 negative (PC20 >16 mg/mL) group; however, FEV1, FEV1 % predicted, FEV1_Zs (Z score) did not differ. FEV1 is correlated with X5 (r=0.45, P<0.01) and R5 (r=―0.69, P<0.01). FEV1_Zs is also correlated with X5_Zs (r=―0.26, P<0.01) and R5_Zs (r=―0.31, P<0.01). After the methacholine challenge test, dose-response slopes in FEV1 and X5 significantly differed between the two subgroups (P<0.05). Conclusion:IOS parameters were more discriminative than FEV1 for detecting decreased baseline lung function between two subgroups and have a good correlation with FEV1. (Korean J Pediatr 2008;51:842-847) Purpose:Measurement of forced expiratory volume in 1 second (FEV1) is usually difficult to obtain in children under six years of age because it requires active cooperation. This study evaluates the sensitivity of impulse oscillometry system (IOS) parameters for detecting airway obstruction in comparison with FEV1. Methods:We studied 174 children who performed the lung function and methacholine challenge tests to diagnose asthma by IOS and spirometry. Children were divided into two subgroups according to their PC20, which is a parameter for bronchial sensitivity. We compared IOS parameters with FEV1 at the baseline, post-methacholine challenge, and evaluated their correlation. Results:At the baseline, reactance at 5 Hz (X5) and resistance at 5 Hz (R5) significantly differed between the PC20 positive (PC20≤16 mg/mL) group and PC20 negative (PC20 >16 mg/mL) group; however, FEV1, FEV1 % predicted, FEV1_Zs (Z score) did not differ. FEV1 is correlated with X5 (r=0.45, P<0.01) and R5 (r=―0.69, P<0.01). FEV1_Zs is also correlated with X5_Zs (r=―0.26, P<0.01) and R5_Zs (r=―0.31, P<0.01). After the methacholine challenge test, dose-response slopes in FEV1 and X5 significantly differed between the two subgroups (P<0.05). Conclusion:IOS parameters were more discriminative than FEV1 for detecting decreased baseline lung function between two subgroups and have a good correlation with FEV1. (Korean J Pediatr 2008;51:842-847)

The Prevalence of Chronic Obstructive Pulmonary Disease and the Determinants of Underdiagnosis in Women Exposed to Biomass Fuel in India- a Cross Section Study

Vinay KalagoudaMahishale,Naveen Angadi,Vjayanand metgudmath,Mitchelle Lolly,Ajith Eti,Sujeer Khan 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.2

Background and Objectives: Tobacco smoking has been established as a major risk factorfor chronic obstructive pulmonary disease (COPD) in women of developing countries,but emerging evidence suggests that biomass fuel is an important risk factor aswell. The primary objective of the study was to find the true prevalence of COPD inIndian women exposed to biomass fuel using spirometry. We also aimed to find the determinantsof underdiagnosis of COPD in these participants. Methods: Women with a history of exposure to biomass fuel for >10 years were screenedfor COPD using spirometry following all standard protocols as per GOLD/ATS/ERSdefinitions. Results: Of the 2868 women screened, a total of 529 (18.4%) women were confirmedto have COPD in which 123 (4.2%) were “Women with known COPD” and 406 (14.2%)“Women with new COPD”. The mean age at the time of Diagnosis was 61±5.2 and 47±3.6respectively. The duration of exposure to biomass fuel had a great impact on the riskof COPD with OR 1.2, 95% CI (1.1-1.9) for patients with 10-15 years exposure and OR2.9, 95% CI (2.5-3.1) for exposure >25 years, p<0.001. Conclusion: The prevalence of COPD among women exposed to biomass fuel is veryhigh. A strong correlation was found between the risk of COPD and the duration of exposurealong with the age at which the exposure to biomass fuel begins. Underdiagnosisof COPD was frequent in women due to the lack of the availability of spirometry, lackknowledge of hazards of biomass fuel, a low level of education and the ignorance of thehealth care provider being the important determinants of underdiagnosis.

Relation of Pulmonary Function Impairment and Coronary Artery Calcification by Multi-detector Computed Tomography in Group Exposed to Inorganic Dusts

Lee, Won-Jeong,Shin, Jae Hoon,Park, So Young The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.74 No.2

Background: The purpose of this study was to evaluate the relationship of pulmonary function impairment (PFI) and coronary artery calcification (CAC) by multi-detector computed tomography (MDCT), and the effect of pneumoconiosis on CAC or PFI. Methods: Seventy-six subjects exposed to inorganic dusts underwent coronary artery calcium scoring by MDCT, spirometry, laboratory tests, and a standardized questionnaire. CAC was quantified using a commercial software (Rapidia ver. 2.8), and all the subjects were divided into two categories according to total calcium scores (TCSs), either the non-calcified (<1) or the calcified (${\geq}1$) group. Obstructive pulmonary function impairment (OPFI) was defined as forced expiratory volume in one second/forced vital capacity ($FEV_1$/FVC, %)<70, and as $FEV_1$/FVC (%){\geq}70 and FVC<80 for restrictive pulmonary function impairment (RPFI) by spirometry. All subjects were classified as either the case (profusion${\geq}1/0$) or the control (profusion${\leq}0/1$) group by pneumoconiosis findings on simple digital radiograph. Results: Of the 76 subjects, 35 subjects (46.1%) had a CAC. Age and hypertension were different significantly between the non-calcified and the calcified group (p<0.05). Subjects with pneumoconiosis were more frequent in the calcified group than those in the non-calcified group (p=0.099). $FEV_1$/FVC (%) was significantly correlated with TCSs (r=-0.316, p=0.005). Subjects with OPFI tended to increase significantly with increasing of TCS (4.82, p=0.028), but not significantly in RPFI (2.18, p=0.140). Subjects with OPFI were significantly increased in the case group compared to those in the control group. Conclusion: CAC is significantly correlated with OPFI, and CAC and OPFI may be affected by pneumoconiosis findings.

Relation of Pulmonary Function Impairment and Coronary Artery Calcification by Multi-detector Computed Tomography in Group Exposed to Inorganic Dusts

( Won Jeong Lee ),( Jae Hoon Shin ),( So Young Park ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.2

Background: The purpose of this study was to evaluate the relationship of pulmonary function impairment (PFI) and coronary artery calcification (CAC) by multi-detector computed tomography (MDCT), and the effect of pneumoconiosis on CAC or PFI. Methods: Seventy-six subjects exposed to inorganic dusts underwent coronary artery calcium scoring by MDCT, spirometry, laboratory tests, and a standardized questionnaire. CAC was quantified using a commercial software (Rapidia ver. 2.8), and all the subjects were divided into two categories according to total calcium scores (TCSs), either the non-calcified (<1) or the calcified (≥1) group. Obstructive pulmonary function impairment (OPFI) was defined as forced expiratory volume in one second/forced vital capacity (FEV1/FVC, %)<70, and as FEV1/FVC (%)≥70 and FVC<80 for restrictive pulmonary function impairment (RPFI) by spirometry. All subjects were classified as either the case (profusion≥1/0) or the control (profusion≤0/1) group by pneumoconiosis findings on simple digital radiograph. Results: Of the 76 subjects, 35 subjects (46.1%) had a CAC. Age and hypertension were different significantly between the non-calcified and the calcified group (p<0.05). Subjects with pneumoconiosis were more frequent in the calcified group than those in the non-calcified group (p=0.099). FEV1/FVC (%) was significantly correlated with TCSs (r=-0.316, p=0.005). Subjects with OPFI tended to increase significantly with increasing of TCS (4.82, p=0.028), but not significantly in RPFI (2.18, p=0.140). Subjects with OPFI were significantly increased in the case group compared to those in the control group. Conclusion: CAC is significantly correlated with OPFI, and CAC and OPFI may be affected by pneumoconiosis findings.

Relation of Pulmonary Function Impairment and Coronary Artery Calcification by Multi-detector Computed Tomography in Group Exposed to Inorganic Dusts

이원정,신재훈,So Young Park 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.2

Background: The purpose of this study was to evaluate the relationship of pulmonary function impairment (PFI) and coronary artery calcification (CAC) by multi-detector computed tomography (MDCT), and the effect of pneumoconiosis on CAC or PFI. Methods: Seventy-six subjects exposed to inorganic dusts underwent coronary artery calcium scoring by MDCT, spirometry, laboratory tests, and a standardized questionnaire. CAC was quantified using a commercial software (Rapidia ver. 2.8), and all the subjects were divided into two categories according to total calcium scores (TCSs), either the non-calcified (<1) or the calcified (≥1) group. Obstructive pulmonary function impairment (OPFI) was defined as forced expiratory volume in one second/forced vital capacity (FEV1/FVC, %)<70, and as FEV1/FVC (%)≥70 and FVC<80 for restrictive pulmonary function impairment (RPFI) by spirometry. All subjects were classified as either the case (profusion≥1/0) or the control (profusion≤0/1) group by pneumoconiosis findings on simple digital radiograph. Results: Of the 76 subjects, 35 subjects (46.1%) had a CAC. Age and hypertension were different significantly between the non-calcified and the calcified group (p<0.05). Subjects with pneumoconiosis were more frequent in the calcified group than those in the non-calcified group (p=0.099). FEV1/FVC (%) was significantly correlated with TCSs (r=−0.316, p=0.005). Subjects with OPFI tended to increase significantly with increasing of TCS (4.82, p=0.028), but not significantly in RPFI (2.18, p=0.140). Subjects with OPFI were significantly increased in the case group compared to those in the control group. Conclusion: CAC is significantly correlated with OPFI, and CAC and OPFI may be affected by pneumoconiosis findings.