Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Applicability of American and European Spirometry Repeatability Criteria to Korean Adults

한국 성인을 대상으로 한 미국 및 유럽 폐활량 검사 재현성 기준의 유용성

  • Park, Byung Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jung, Woo Young (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Byun, Min Kwang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Seon Cheol (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Shin, Sang Yun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jeon, Han Ho (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jung, Kyung Soo (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Moon, Ji Ae (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chang, Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Sung Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Ahn, Song Vogue (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Oh, Yeon-Mok (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Do (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine)
  • 박병훈 (연세대학교 의과대학 내과학교실) ;
  • 박무석 (연세대학교 의과대학 내과학교실) ;
  • 정우영 (연세대학교 의과대학 내과학교실) ;
  • 변민광 (연세대학교 의과대학 내과학교실) ;
  • 박선철 (연세대학교 의과대학 내과학교실) ;
  • 신상윤 (연세대학교 의과대학 내과학교실) ;
  • 전한호 (연세대학교 의과대학 내과학교실) ;
  • 정경수 (연세대학교 의과대학 내과학교실) ;
  • 문지애 (연세대학교 의과대학 내과학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • 김성규 (연세대학교 의과대학 내과학교실) ;
  • 안성복 (연세대학교 의과대학 예방의학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김영삼 (연세대학교 의과대학 내과학교실)
  • Received : 2007.09.21
  • Accepted : 2007.10.29
  • Published : 2007.11.30
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Abstract

Background: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. Methods: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and $FEV_1$ ($dFEV_1$) from prebronchodilator spirometry. Analyses included the distribution of dFVC and $dFEV_1$, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spiro-metric variability. Results: About 95% of subjects were able to reproduce FVC and $FEV_1$ within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. Conclusion: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results.

연구배경: 본 연구를 통해 2005년도 ATS/ERS 폐활량검사 지침에서 제시한 재현성 기준을 한국 성인들에게 적용할 수 있는 지와, 한국 성인들의 폐활량 검사 시 재현성에 영향을 미치는 요인들을 알아보고자 하였다. 방 법: 국민건강영양조사, COPD 코호트, 지역사회 코호트로부터 얻은 성인 4,663명의 폐활량검사 결과를 이용하여 dFVC 및 $dFEV_1$를 계산하여 분포를 알아보고, 1994년도 ATS 지침 및 2005년도 ATS/ERS 지침을 만족하는 검사의 비율을 비교하였다. 다중회귀분석을 통해 개인적 특성 및 재현성 기준의 변화가 재현성에 영향을 미치는가를 알아보았다. 결 과: 폐활량검사를 시행한 사람들 중 95% 이상이 150ml 이내의 재현성 기준을 만족시켰다. 1994년도 ATS 지침에 따라 검사를 시행한 경우 재현성을 만족하지 않는 경우가 증가하였다. 다중회귀분석 결과 재현성에 영향을 주는 요인들은 신장, 연령, 체중, 폐쇄성폐질환 여부, 재현성 기준의 변화 등이었으나 재현성에 영향을 미치는 정도는 매우 작았다(0.5~3.0%). 결 론: 한국인에게도 2005년도 ATS/ERS에서 제시한 재현성 기준을 적용할 수 있을 것으로 생각하며, 이를 위해서는 변경된 재현성 기준에 대한 지속적인 홍보와 검사자 들에 대한 교육 및 정도 관리가 필요하다.

Keywords

References

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