Stanojevic, S.; (2009) Development and use of international reference centiles for lung function in early childhood. Doctoral thesis , UCL (University College London).

Abstract

Traditionally, in older children and adults, spirometry has been an integral part of the clinical assessment of respiratory diseases; however these tests are relatively novel for preschool children. Like most medical observations, reliable interpretation of spirometry testing in very young children are accompanied by a relative dearth of suitable reference data. To address the lack of appropriate spirometry reference data for young children, this thesis aims to collate available spirometry data from healthy children to develop updated reference centiles for this age group. The Asthma UK collaborative group contributed >10 000 spirometry measurements in healthy children between 2-10 years. These data were used to develop more spirometry centiles using the LMS method with the GAMLSS technique. To address the discontinous paediatric and adult equations, the highly flexible modelling techniques were also applied to develop the first continuous and smoothly changing spirometry centiles between 4-80 years. In this case, the American NHANES Ill dataset was extended with paediatric data and re-modelled. The resulting centiles improved the interpretation of spirometry during childhood and early adolescence. Application of these centiles in clinical practice should facilitate more accurate detection and quantification of lung disease in both children and adults. Furthermore, this thesis provides a foundation from which future international studies can be established to maintain an up-to-date database of reference data for lung function.

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