Area under the expiratory flow-volume curve: normative values in the National Health and Nutrition Survey (NHANES) study

• Type of Material: Article
• Authors: Octavian Ioachimescu, Emory University; Kevin McCarthy, Cleveland Clinic; James K Stoller, Cleveland Clinic
• Language: English
• Date: 2022-02-20
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © American Federation for Medical Research 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/jim-2021-002057
• Title of Journal or Parent Work: JOURNAL OF INVESTIGATIVE MEDICINE
• Volume: 70
• Issue: 5
• Start Page: 1247
• End Page: 1257
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: lung diseases; Medicine, Research & Experimental; General & Internal Medicine; Science & Technology; AGE; respiratory physiological phenomena; Research & Experimental Medicine; SPIROMETRY; Life Sciences & Biomedicine; respiratory system; respiration disorders; Medicine, General & Internal
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The area under the expiratory flow-volume (AEX-FV) loop has been evaluated before as a spirometric tool for assessing respiratory functional impairment. We computed the AEX-FV curves in spirometry tests performed on 20,313 participants in the National Health and Nutrition Examination Survey (NHANES) study. We analyzed 108,939 spirometry tests performed between 2007 and 2012 (5964 children; 14,349 adults). In these tests, we computed the three areas from existing NHANES raw data on instantaneous expiratory flows measured at 0.01 s intervals. Mean best-trial measurements for AEX-FV were 3.4 in boys, 2.8 in girls, 11.8 in men and 7.7 L2/s in women. We characterized indices of central tendency and dispersion of the measurements (eg, means and fifth percentiles—lower limits of normal) by age group (children vs adults), gender, race or ethnicity group and effort grading. Simple regression equations using logarithmic transformations of the above areas and using age, gender and height as inputs provided good predictive ability for the variable AEX-FV. Regular, digital spirometry could and should make available to clinicians and researchers the area under the curves for flow versus volume graph, providing additional tools in our armamentarium to evaluate ventilatory impairments and patterns, and possibly respiratory disability.