Implications of the 2022 lung function update and GLI global reference equations among patients with interstitial lung disease

Andrew Li, Alan Teoh, Lauren Troy, Ian Glaspole, Margaret L. Wilsher, Sally de Boer, Jeremy Wrobel, Yuben P. Moodley, Francis Thien, Henry Gallagher, Michelle Galbraith, Daniel C. Chambers, John Mackintosh, Nicole Goh, Yet Hong Khor, Adrienne Edwards, Karen Royals, Christopher Grainge, Benjamin Kwan, Gregory J. KeirChong Ong, Paul N. Reynolds, Elizabeth Veitch, Gin Tsen Chai, Ziqin Ng, Geak Poh Tan, Dan Jackson, Tamera Corte, Helen Jo

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    Abstract

    Background: Lung function testing remains a cornerstone in the assessment and management of interstitial lung disease (ILD) patients. The clinical implications of the Global Lung function Initiative (GLI) reference equations and the updated interpretation strategies remain uncertain. Methods: Adult patients with ILD with baseline forced vital capacity (FVC) were included from the Australasian ILD registry and the National Healthcare Group ILD registry, Singapore. The European Coal and Steel Community and Miller reference equations were compared with the GLI reference equations to assess (a) differences in lung function percent predicted values; (b) ILD risk prediction models and (c) eligibility for ILD clinical trial enrolment. Results: Among 2219 patients with ILD, 1712 (77.2%) were white individuals. Idiopathic pulmonary fibrosis (IPF), connective tissue disease-associated ILD and unclassifiable ILD predominated. Median FVC was 2.60 (2.01-3.36)L, forced expiratory volume in 1 s was 2.09 (1.67-2.66)L and diffusing capacity of the lungs for carbon monoxide (DLCO) was 13.60 (10.16-17.60)mL/min/mm Hg. When applying the GLI reference equations, the mean FVC percentage predicted was 8.8% lower (87.7% vs 78.9%, p<0.01) while the mean DLCO percentage predicted was 4.9% higher (58.5% vs 63.4%, p<0.01). There was a decrease in 19 IPF and 119 non-IPF patients who qualified for the nintedanib clinical trials when the GLI reference equations were applied. Risk prediction models performed similarly in predicting mortality using both reference equations. Conclusion: Applying the GLI reference equations in patients with ILD leads to higher DLCO percentage predicted values and smaller lung volume percentage predicted values. While applying the GLI reference equations did not impact on prognostication, fewer patients met the clinical trial criteria for antifibrotic agents.
    Original languageEnglish
    Pages (from-to)1024-1032
    Number of pages9
    JournalThorax
    Volume79
    Issue number10
    Early online dateSept 2024
    DOIs
    Publication statusPublished - Oct 2024

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