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Expert in Spirometry

The Global Lung Function Initiative

Spirometric tests play a pivotal role in diagnosing airway obstruction, severity of respiratory impairment, in monitoring health, and in pre-operative assessment of subjects. For most biochemical indices the normal range is independent of sex, age and ethnic group, because the concentration of that index is maintained within narrow limits by a feedback control system. Conversely, the interpretation of spirometric test results is hampered by the fact that "normal values" vary with age, height, sex and ethnic group. In addition the normal range is age dependent.

Until recently it was not possible to satisfactorily describe the age-related growth and decline of lung function with age. As a result a piece-meal approach was adopted, which entailed deriving prediction equations for a limited age range. Inevitably they connected poorly at the transition from one to the next age. Also the modelling usually left something to be desired because skewness and age-related scatter were not properly addressed. The pioneering work of Stanojevic et al. [1] changed all this and gave rise to the Global Lung Function Initiative, a Task Force of the European Respiratory Society. The Task Force produced a report [2] that was endorsed by the European Respiratory Society, American Thoracic Society, Australian and New Zealand Society of Respiratory Science, Asian Pacific Society for Respirology, the Thoracic Society of Australia and New Zealand, and
the American College of Chest Physicians. We present an overview of the work done in the next pages.

Lung growth and aging

Philip H. Quanjer - Sanja Stanojevic - Janet Stocks - Tim J. Cole


  1. 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
  2. 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
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