• Marije Koopman, Pieter Zanen, Cas L J J Kruitwagen, Cornelis K van der Ent, and Hubertus G M Arets.
• Department of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Huispostnr KH 01.419.0, P.O. Box 85090, 3508 GA Utrecht, The Netherlands. M.Koopman-5@umcutrecht.nl
• Respir Med. 2011 Jan 1;105(1):15-23.

BackgroundSince populations evolve, measurement protocols and equipment improve and analysis techniques progress, there is an ongoing need to reassess reference data for pulmonary function tests. Furthermore, reference values for total lung capacity and carbon monoxide diffusion capacity are scarcely available in children. We aimed to provide updated reference equations for most commonly used pulmonary function indices in Caucasian children.MethodsIn the 'Utrecht Pulmonary Function Reference Data Study' we collected data in Caucasian children aged 2-18 years. We analyzed them using the 'Generalized Additive Models for Location Scale and Shape' (GAMLSS) statistical method.ResultsMeasurements of interrupter resistance (R(int)) (n = 877), spirometry (n = 1042), body plethysmography (n = 723) and carbon monoxide diffusion/helium dilution (n = 543) were obtained in healthy children. Height (or the natural logarithm of height) and age (or the natural logarithm of age) were both significantly related to most outcome measures. Also sex was a significant determinant, except for RV, RV/TLC, FRC(pleth), Raw(0,5), Raw(tot), R(int) and FEF values. The application of previously published reference equations on the study population resulted in misinterpretation of pulmonary function.ConclusionThese new paediatric reference equations provide accurate estimates of the range of normality for most commonly used pulmonary function indices, resulting in less underdiagnosis and overdiagnosis of pulmonary diseases.Copyright © 2010 Elsevier Ltd. All rights reserved.

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