Differences and agreement between two portable hand-held spirometers across diverse community-based populations in the Prospective Urban Rural Epidemiology (PURE) study

MyLinh Duong, Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Sumathy Rangarajan, Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Michele Zaman, Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Nafiza Mat Nasir, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
Pamela Seron, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.
Karen Yeates, Pamoja Tunaweza Research Centre, Moshi, Tanzania.
Afzalhussein M. Yusufali, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
Rasha Khatib, Advocate Aurora HealthFollow
Lap Ah Tse, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Chuangshi Wang, Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical, Beijing, China.
Andreas Wielgosz, University of Ottawa Department of Medicine, Ottawa, Ontario, Canada.
Koon Teo, Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Rajesh Kumar, State Health System Resource Center, Punjab, India.
Alvaro Avezum, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.Follow
Rosnah Ismail, Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Burcu Tumerdem Çalık, Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey.
Soumya Gopakumar, Health Action by People and Government Medical College, Thiruvananthapuram, Kerala, India.
Omar Rahman, University of Liberal Arts Bangladesh, Dhaka, Bangladesh.
Katarzyna Zatońska, Wroclaw Medical University Bujwida Wroclaw, Poland, EU.
Annika Rosengren, University of Gothenburg, Gothenburg, Sweden.
Johanna Otero, Instituto Masira, Universidad de Santander (UDES), Bucaramanga, Colombia.
Roya Kelishadi, Cardiovascular Research Institute, Chamran Hospital, Isfahan, Iran.
Rafael Diaz, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina.
Thandi Puoane, University of the Western Cape, School of Public Health, Cape Town, South Africa.
Salim Yusuf, Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Abstract

Introduction: Portable spirometers are commonly used in longitudinal epidemiological studies to measure and track the forced expiratory volume in first second (FEV1) and forced vital capacity (FVC). During the course of the study, it may be necessary to replace spirometers with a different model. This raise questions regarding the comparability of measurements from different devices. We examined the correlation, mean differences and agreement between two different spirometers, across diverse populations and different participant characteristics.

Methods: From June 2015 to Jan 2018, a total of 4,603 adults were enrolled from 628 communities in 18 countries and 7 regions of the world. Each participant performed concurrent measurements from the MicroGP and EasyOne spirometer. Measurements were compared by the intra-class correlation coefficient (ICC) and Bland-Altman method.

Results: Approximately 65% of the participants achieved clinically acceptable quality measurements. Overall correlations between paired FEV1 (ICC 0.88 [95% CI 0.87, 0.88]) and FVC (ICC 0.84 [0.83, 0.85]) were high. Mean differences between paired FEV1 (-0.038 L [-0.053, -0.023]) and FVC (0.033 L [0.012, 0.054]) were small. The 95% limits of agreement were wide but unbiased (FEV1 984, -1060; FVC 1460, -1394). Similar findings were observed across regions. The source of variation between spirometers was mainly at the participant level. Older age, higher body mass index, tobacco smoking and known COPD/asthma did not adversely impact on the inter-device variability. Furthermore, there were small and acceptable mean differences between paired FEV1 and FVC z-scores using the Global Lung Initiative normative values, suggesting minimal impact on lung function interpretation.

Conclusions: In this multicenter, diverse community-based cohort study, measurements from two portable spirometers provided good correlation, small and unbiased differences between measurements. These data support their interchangeable use across diverse populations to provide accurate trends in serial lung function measurements in epidemiological studies.

Document Type

Article

PubMed ID

36962310

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