What’s normal about the GLI DLCO reference values?

The Global Lung Initiative (GLI) has been working for several years to develop a universal reference equation for DLCO. Although this endeavor is not necessarily complete, an article describing the GLI DLCO reference equation for Caucasians was published in the September issue of the European Respiratory Journal as an open access article and can be downloaded by anyone. The Global Lung Initiative in general and the authors of the article more particularly are to be commended for this monumental work and for the insight it brings to understanding the normal distribution of DLCO.

The data used to develop the GLI reference equations was originally derived from 19 studies the GLI identified to have been performed on lifetime nonsmoking populations. 85% of the results came from Caucasian populations and the remaining from two Asian sources. The authors felt that there weren’t a sufficient number of non-Caucasians to accurately describe any ethnicity-based differences in DLCO and for this reason only the Caucasian data was used.

From this data some results were excluded because of:

  • FEV1 > 5 Z-scores or < 5 Z scores
  • Height (children only, >5 or <5 Z scores)
  • VA less than VC
  • Elevated BMI (>30 kg/m2 in adults, >85% centile in children)
  • Missing demographic information

After these exclusions 9710 results remained of which 4859 were male and 4851 were female. DLCO values were corrected for altitude and FiO2 and uncorrected for hemoglobin. Reference equations were derived using the LMS (Lambda, Mu, Sigma) method.

Note: The study population consisted of individuals from 4.5 to 91 years of age and GLI reference equations are valid across this entire span. The majority of the existing DLCO reference equations available to me are for an adult population and for this reason this discussion of the GLI DLCO reference equations will be limited to this portion of the age range. The GLI article also includes reference values for KCO and VA but these subjects will also be saved for a separate discussion.

Not surprisingly, DLCO is highest in tall and young individuals, and lower in short and elderly ones.

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