Class 1 Regent: Prof. Dr. Altamiro Pereira Professor: Dr. Tiago Jacinto

1. Spirometry reference values: - a systematic review of studies in the last decade - Class 1 Regent: Prof. Dr. Altamiro Pereira Professor: Dr. Tiago Jacinto INTRODUCTION TO MEDICINE 2009/2010

2. 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?

3. 4Hughes, 2007 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 It is crucial to have adequate reference values when performing a test, in order to avoid misdiagnosis;  Reference values are important statistical parameters to obtain medical relevant information

4. Spirometry is an exam that allows to assess a patient’s pulmonary function using a spirometer:  The spirometer measures the volume and flow of the forced exhaled airduring a period of time2 Two reference values are commonly used: the FVC (total amount of exhaled air) and FEV1 (exhaled air during the first second) 6,7 2Enright, n.d. 6Kuster, 2008 8Miller, 2007

5. At the time of diagnosis, there aren’t previous personal values. The spirometric data is compared to those calculated from population studies (reference values); Spirometricreferencevaluesvarywith individual characteristics. Theyshouldbetailored to each individual; Healthcare professionals may be using inappropriate reference values for their target-populations, resulting in compromised diagnosis. 1,3,5,6 Systematic review and quality assessment 1 Baur, 1999 3Garcia-Rio, 2004 5Ip, 2006 6Kuster, 2008

6. 9STROBE statement Summarize the wide range of data that has been published in the last decade; Aims Analyze and rate the obtained information using the STROBE checklist 9;  Propose, from all studies, the most suitable for Portugal or suggesttheconduction of a study in our country.

8. “A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria to answer a specific research question.” 7 Study design:Systematic review; Methods Data Sources (online databases):  Key words: Reference Values Spirometry FEV1; FVC 7Liberati, 2009

9. PUBMED ("1998"[Publication Date] : "2008"[Publication Date]) AND ("Spirometry"[tiab] AND ("Reference values"[mh] OR "Reference equations")) Query:

10. Query: ISI WEB OF KNOWLEDGE

11. Query: SCOPUS (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))

12. Inclusion Criteria Exclusion Criteria Criteria • 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 • Articles whose full text can not be achieved for free; • Values referring to diseased individuals; • Articles about studies with insufficient or inconclusive data; • Study subjects with history of pulmonary disease

13. Research Method

14. 7Liberati, 2009

15. Procedure 2. Select and layout the studies that meet the criteria 1. Search for studies 3. Rate using the STROBE checklist 4. Conclusion

16. Find at least one study that can be applied to Portugal; Expectedresults • Gather a set of adequate spirometry reference values for our country; • Expose the necessity for these kind of studies

17. Informationsources 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.org 3. 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.pdf 5. 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=326 9. 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

18. 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