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Comparison of predicted values for spirometry

Reference values for spirometry in children and adolescents

Paediatricians in the Netherlands rely almost exclusively on predicted values from Zapletal [1]. These are based on a quite limited number of children (111 boys and girls), and the regression equations only take height into account, not age (6-17 year). In other countries predicted values from Polgar [2], Knudson [3], Quanjer [4], Rosenthal [5], Wang [6] and Hankinson [7] are frequently used. Predicted values according to Stanojevic [8] fit a population of healthy children well, unlike those from Zapletal, Polgar, Wang, Rosenthal, Knudson (fig. 1).

Comparison of predicted values for spirometry in children and adolescentsFig. 1 - Comparison of predicted FEV1 and FVC in healthy boys and girls according to GLI-2012, Zapletal, Stanojevic, Polgar, Quanjer, Hankinson, Knudson, Rosenthal and Wang.

Reference values for spirometry in adults

In adults (fig. 2) the FEV1/FVC ratios according to ECCS/ERS [9] and NHANES [7] differ from those of GLI-2012 [10]. This is mainly due to the fact that the GLI-2012 equations take into account that the ratio is inversely related to standing height, whereas the two other equations only take age into account.

Predcted values for FEV1/FVC according to ECSC, GLI-2012 and HankinsonFig. 2 - Comparison of predicted FEV1/FVC ratio in adults according to Quanjer GLI-2012, Hankinson and ECCS/ERS.

Predicted values for FEV1 and FVC according to NHANES agree well with those from GLI-2012, the ECSC/ERS predicted values are definitely too low (fig. 3). Consequently, the ECSC/ERS predicted values, which are widely used in Europe, need to be abandoned.


Predicted values for FEV1 and FVC in adults according to Quanjer GLI-2012, ECSC and HankinsonFig. 3 - Comparison of predicted FEV1 and FVC in healthy adults according to Quanjer GLI-2012 [10], ECSC/ERS [9] and NHANES [7].


  1. Zapletal A, Paul T, Samanek N. Die Bedeutung heutiger Methoden der Lungenfunktionsdiagnostik zur Feststellung einer Obstruktion der Atemwege bei Kindern und Jugendlichen. Z Erkrank Atm-Org 1977; 149: 343-371.
  2. Polgar, G, Promadhat V. Pulmonary function testing in children: techniques and standards. Philadelphia, WB Saunders C, 1971.
  3. Knudson RJ, Lebowitz MD, Holberg CJ, et al. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis 1983; 127: 725–734. PubMed
  4. Quanjer PH, Borsboom GJ, Brunekreef B, Zach M, Forche G, Cotes JE, Sanchis J, Paoletti P. Spirometric reference values for white European children and adolescents: Polgar revisited. Pediatr Pulmonol 1995;19: 135-142. PubMed
  5. Rosenthal M, Bain SH, Cramer D, et al. Lung function in white children aged 4–19 years: I – Spirometry. Thorax 1993; 48: 794–802. Manuscript
  6. Wang X, Dockery DW, Wypij D, et al. Pulmonary function between 6 and 18 years of age. Pediatr Pulmonol 1993; 15: 75–88. PubMed
  7. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 1995; 152: 179–187. Manuscript
  8. Stanojevic S, Wade A, Stocks J, et al. Reference ranges for spirometry across all ages. A new approach. Am J Respir Crit Care Med 2008; 177: 253–260. Manuscript
  9. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault J-C. Lung volume and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993; 6: Suppl. 16, 5–40. Erratum Eur Respir J 1995; 8: 1629.
  10. Quanjer PH, Stanojevic S, Cole TJ, et al. and the ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometry for the 3-95 years age range: the Global Lung Function 2012 equations. Eur Respir J 2012; 40: 1324-1343. PubMed

Acknowledgement: Illustrations modified and reproduced with permission of the European Respiratory Society. Eur Respir J July 2012 40:190-197; published ahead of print December 19, 2011, doi:10.1183/09031936.00161011

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