Clinical Reviews in Allergy & Immunology

, Volume 37, Issue 3, pp 137–152 | Cite as




Pulmonary function testing is useful for the diagnosis and management of a variety of pulmonary conditions, and the most commonly obtained component is spirometry. Spirometry is most useful in the evaluation of obstructive airway disorders but can be a helpful tool in the management of patients with chest restriction or mixed disease. The utility of spirometry depends on reproducibility, standardization, and quality of testing. Accurate interpretation of test results depends on the availability of reference equations applicable to the subject undergoing testing. This paper reviews basic concepts, testing procedures, and interpretation of a single set of spirometry results as well as results obtained over time and gives an overview of previously published reference equations.


Spirometry Lung FEV FVC PFT 


  1. 1.
    Morris AH, Kanner RE, Crapo RO, Gardner RM (eds) (1984) Clinical pulmonary function testing: a manual of uniform laboratory procedures, 2nd edn. Intermountain Thoracic Society, Salt Lake CityGoogle Scholar
  2. 2.
    Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Resp J 26:319–338CrossRefGoogle Scholar
  3. 3.
    Cotes JE, Dabbs JM, Hall AM, Heywood C, Laurence KM (1979) Sitting height, fat-free mass and body fat as reference variables for lung function in healthy British children: comparison with stature. Ann Hum Biol 6:307–314CrossRefPubMedGoogle Scholar
  4. 4.
    Hsi BP, Hsu KH, Jenkins DE (1983) Ventilatory functions of normal children and young adults: Mexican–American, white, and black. III. Sitting height as a predictor. J Pediatr 102:860–865CrossRefPubMedGoogle Scholar
  5. 5.
    Thompson JE, Sleigh AC, Passey ME, Barnes A, Streatfield RW (1992) Ventilatory standards for clinically well aboriginal adults. Med J Aust 156:566–569PubMedGoogle Scholar
  6. 6.
    Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159:179–187PubMedGoogle Scholar
  7. 7.
    Louw SJ, Goldin JG, Joubert G (1996) Spirometry of healthy adult South African men, Part I. Normative values. S Afr Med J 86:814–819PubMedGoogle Scholar
  8. 8.
    Crapo RO, Jensen RL, Oyunchimeg M, Tsh T, Schmidt CD (1999) Differences in spirometry reference values: a statistical comparison of a Mongolian and a Caucasian study. Eur Resp J 13:606–609CrossRefGoogle Scholar
  9. 9.
    Becklake M, Crapo RO, Buist S et al (1991) Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 144:1202–1218Google Scholar
  10. 10.
    Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, European community for steel and coal. Official statement of the European respiratory society. Eur Resp J Suppl 16:5–40Google Scholar
  11. 11.
    Woo J, Pang J (1988) Spirometry in healthy elderly Chinese. Thorax 43:617–620CrossRefPubMedGoogle Scholar
  12. 12.
    Ip MS, Ko FW, Lau AC et al (2006) Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest 129:384–392CrossRefPubMedGoogle Scholar
  13. 13.
    Townsend MC (1984) The effects of leaks in spirometers on measurements of pulmonary function. The implications for epidemiologic studies. J Occup Med 26:835–841CrossRefPubMedGoogle Scholar
  14. 14.
    Hepper NG, Black LF, Fowler WS (1965) Relationships of lung volume to height and arm span in normal subjects and in patients with spinal deformity. Am Rev Resp Dis 91:356–362PubMedGoogle Scholar
  15. 15.
    Golshan M, Crapo RO, Amra B, Jensen RL, Golshan R (2007) Arm span as an independent predictor of pulmonary function parameters: validation and reference values. Respirology 12:361–366CrossRefPubMedGoogle Scholar
  16. 16.
    Aggarwal AN, Gupta D, Jindal SK (1999) Interpreting spirometric data: impact of substitution of arm span for standing height in adults from North India. Chest 116:1837–1838CrossRefGoogle Scholar
  17. 17.
    Parker JM, Dillard TA, Phillips YY (1996) Arm span–height relationships in patients referred for spirometry. Am J Resp Crit Care Med 154:533–536PubMedGoogle Scholar
  18. 18.
    Zapletal A, Chalupová J (2003) Forced expiratory parameters in healthy preschool children (3–6 years of age). Pediatr Pulmonol 35:200–207CrossRefPubMedGoogle Scholar
  19. 19.
    Vilozni D, Barker M, Jellouschek H, Heimann G, Blau H (2001) An interactive computer-animated system (SpiroGame) facilitates spirometry in preschool children. Am J Resp Crit Care Med 164:2200–2205PubMedGoogle Scholar
  20. 20.
    Nystad W, Samiuelsen SO, Nafstad P, Edvardsen E, Stensrud T, Jaakkola JJK (2002) Feasibility of measuring lung function in preschool children. Thorax 57:1021–1027CrossRefPubMedGoogle Scholar
  21. 21.
    Piccioni P, Borraccino A, Forneris MP et al (2007) Reference values of forced expiratory volumes and pulmonary flows in 3–6 year children: a cross-sectional study. Resp Res 8:14CrossRefGoogle Scholar
  22. 22.
    Pesant C, Santschi M, Paurd JP, Geoffroy M, Niyonsenga T, Vlachos-Mayer H (2007) Spirometric pulmonary function in 3- to 5-year-old children. Pediatr Pulmonol 42:263–271CrossRefPubMedGoogle Scholar
  23. 23.
    Eigen H, Bieler H, Grant D et al (2001) Spirometric pulmonary function in healthy preschool children. Am J Resp Crit Care Med 163:619–623PubMedGoogle Scholar
  24. 24.
    Nathan SP, Lebowitz MD, Knudson RJ (1979) Spirometric testing. Number of tests required and selection of data. Chest 76:384–388CrossRefPubMedGoogle Scholar
  25. 25.
    Kerem E, Reisman J, Corey M, Canny GJ, Levison H (1992) Prediction of mortality in patients with cystic fibrosis. New Engl J Med 326:1187–1191PubMedCrossRefGoogle Scholar
  26. 26.
    Maurer JR, Frost AE, Glanville AR et al (1998) International guidelines for the selection of lung transplant candidates. Am J Resp Crit Care Med 158:335–339Google Scholar
  27. 27.
    Yankaskas JR, Mallory GB (1998) Lung transplantation in cystic fibrosis: consensus conference statement. Chest 113:217–226CrossRefPubMedGoogle Scholar
  28. 28.
    Liou TG, Adler FR, Fitzsimmons SC, Cahill BC, Hibbs JR, Marshall BC (2001) Predictive five year survivorship model of cystic fibrosis. Am J Epidemiol 153:345–352CrossRefPubMedGoogle Scholar
  29. 29.
    Kashima HK (1984) Documentation of upper airway obstruction in unilateral vocal cord paralysis: flow–volume loop studies in 43 subjects. Laryngoscope 94:923–937CrossRefPubMedGoogle Scholar
  30. 30.
    Glindmeyer HW, Diem JE, Jones RN, Weill H (1982) Noncomparability of longitudinally and cross-sectionally determined annual change in spirometry. Am Rev Resp Dis 125:544–548PubMedGoogle Scholar
  31. 31.
    Herpel LB, Kanner R, Lee SM et al (2006) Variability of spirometry in chronic obstructive pulmonary disease: results from two clinical trials. Am J Resp Crit Care Med 173:1106–1113CrossRefPubMedGoogle Scholar
  32. 32.
    Berglund E, Birath G, Bjure J et al (1963) Spirometric studies in normal subjects. I. Forced expirograms in subjects between 7 and 70 years of age. Acta Med Scand 173:185–192PubMedGoogle Scholar
  33. 33.
    Ferris BG, Anderson DO, Zickmantel R (1965) Prediction values for screening tests of pulmonary function. Am Rev Resp Dis 91:252–261PubMedGoogle Scholar
  34. 34.
    Harrison GA, Kuchemann CF, Moore MAS et al (1969) The effects of altitudinal variation in Ethiopian populations. Philos Trans R Soc Lond Ser B (Biol) 256:147–182CrossRefGoogle Scholar
  35. 35.
    Morris JF, Koski A, Johnson LC (1971) Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 103:57–67PubMedGoogle Scholar
  36. 36.
    Cherniack RM, Raber MB (1972) Normal standards for ventilatory function using an automated wedge spirometer. Am Rev Respir Dis 106:38–44PubMedGoogle Scholar
  37. 37.
    Knudson RJ, Slatin RC, Lebowitz MD, Burrows B (1976) The maximal expiratory flow–volume curve. Am Rev Respir Dis 113:587–600PubMedGoogle Scholar
  38. 38.
    Gibson J, Gallagher J, Johansen A, Webster I (1979) Lung function in an Australian population: 1. Spirometric standards for non-smoking adults. Med J Aust 7:292–295Google Scholar
  39. 39.
    Hsu KHK, Jenkins DE, Hsi BP et al (1979) Ventilatory functions of normal children and young adults—Mexican–American, white and black. I. Spirometry. J Pediatr 95:14–23CrossRefPubMedGoogle Scholar
  40. 40.
    Crapo RO, Morris AH, Gardner RM (1981) Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Resp Dis 123:659–664PubMedGoogle Scholar
  41. 41.
    Viljanen AA, Halttunen PK, Kreus KE, Viljanen BC (1982) Spirometric studies in non-smoking, healthy adults. Scand J Clin Lab Invest Suppl 159:5–20CrossRefPubMedGoogle Scholar
  42. 42.
    Burrows B, Cline MG, Knudson RJ, Taussig LM, Lebowitz MD (1983) A descriptive analysis of the growth and decline of the FVC and FEV1. Chest 83:717–724CrossRefPubMedGoogle Scholar
  43. 43.
    Megesha YA, Mekonnen Y (1985) Spirometric lung function tests in normal non-smoking Ethiopian men and women. Thorax 40:465–468CrossRefGoogle Scholar
  44. 44.
    Roca J, Sanchis J, Agusti-Vidal A et al (1986) Spirometric reference values from a Mediterranean population. Bull Europ Physiopath Resp 22:217–224Google Scholar
  45. 45.
    Castellsagué J, Burgos F, Sunyer J, Barberà JA, Roca J (1998) Prediction equations for forced spirometry from European origin populations. Barcelona Collaborative Group on Reference Values for Pulmonary Function Testing and the Spanish Group of the European Community Respiratory Health Survey. Resp Med 92:401–407CrossRefGoogle Scholar
  46. 46.
    Udwadia FE, Sunavala JD, Shetye VM, Jain PK (1986) The maximal expiratory flow volume curve in normal subjects in India. Chest 89:852–856CrossRefPubMedGoogle Scholar
  47. 47.
    Ayub M, Zaidi SH, Burki NK (1987) Spirometry and flow–volume curves in healthy, normal Pakistanis. Br J Dis Chest 81:35–44CrossRefPubMedGoogle Scholar
  48. 48.
    Chatterjee S, Saha D, Chatterjee BP (1988) Pulmonary function studies in healthy non-smoking men of Calcutta. Ann Hum Biol 15:365–374CrossRefPubMedGoogle Scholar
  49. 49.
    Neukirch F, Chansin R, Liard R, Levallois M, Leproux P (1988) Spirometry and maximal expiratory flow–volume curve reference standards for Polynesian, European, and Chinese teenagers. Chest 94:792–798CrossRefPubMedGoogle Scholar
  50. 50.
    Shamssain MH (1988) Forced expiratory indices in normal Libyan men. Thorax 43:923–925CrossRefPubMedGoogle Scholar
  51. 51.
    Wu HD, Yang SC (1990) Maximal expiratory flow and volume in Chinese aged 60 years and over. J Formos Med Assoc 89:749–755PubMedGoogle Scholar
  52. 52.
    Olanrewaju DM (1991) Spirometric standards for healthy Nigerian children and adolescents. East Afr Med J 68:812–819PubMedGoogle Scholar
  53. 53.
    Roberts CM, MacRae KD, Winning AJ, Adams L, Seed WA (1991) Reference values and prediction equations for normal lung function in a non-smoking white urban population. Thorax 46:643–650CrossRefPubMedGoogle Scholar
  54. 54.
    Shamssain MH (1991) Forced expiratory indices in normal black southern African children aged 6–19 years. Thorax 46:175–179CrossRefPubMedGoogle Scholar
  55. 55.
    Smolej-Narancic N, Pavlovic M, Rudan P (1991) Ventilatory parameters in healthy nonsmoking adults of Adriatic islands (Yugoslavia). Eur Resp J 4:955–964Google Scholar
  56. 56.
    Rao NM, Mavlankar MG, Kulkarni PK, Kashyap SK (1992) Pulmonary function studies in Gujarati subjects. Indian J Physiol Pharmacol 36:55–59PubMedGoogle Scholar
  57. 57.
    Singh R, Singh HJ, Sirisinghe RG (1992) Forced vital capacity in Malaysian females. Jpn J Physiol 42:407–414CrossRefPubMedGoogle Scholar
  58. 58.
    Singh R, Singh HJ, Sirisinghe RG (1993) Spirometric studies in Malaysians between 13 and 69 years of age. Med J Malaysia 48:175–184PubMedGoogle Scholar
  59. 59.
    Chia SE, Wang YT, Chan OY, Poh SC (1993) Pulmonary function in healthy Chinese, Malay and Indian adults in Singapore. Ann Acad Med Singapore 22:878–884PubMedGoogle Scholar
  60. 60.
    Shamssain MH (1994) Pulmonary function in normal non-smoking black southern African adults. Resp Med 88:287–291CrossRefGoogle Scholar
  61. 61.
    Chowgule RV, Shetye VM, Parmar JR (1995) Lung function tests in normal Indian children. Indian Pediatr 32:185–191PubMedGoogle Scholar
  62. 62.
    Gore CJ, Crockett AJ, Pedersen DG, Booth ML, Bauman A, Owen N (1995) Spirometric standards for healthy adult lifetime nonsmokers in Australia. Eur Resp J 8:773–782Google Scholar
  63. 63.
    Udupihille M (1995) Spirometric and flow standards for healthy adult non-smoking Sri Lankans belonging to the Sinhalese ethnic group. Ann Hum Biol 22:321–336CrossRefPubMedGoogle Scholar
  64. 64.
    Brändli O, Schindler C, Künzli N, Keller R, Perruchoud AP (1996) Lung function in healthy never smoking adults: reference values and lower limits of normal of a Swiss population. Thorax 51:277–283CrossRefPubMedGoogle Scholar
  65. 65.
    Huang MS, Lai CS, Chong IW et al (1996) Spirometry in lifelong non-smoking, healthy Chinese women in Taiwan. Resp Med 90:343–348CrossRefGoogle Scholar
  66. 66.
    Quintero C, Bodin L, Andersson K (1996) Reference spirometric values in healthy Nicaraguan male workers. Am J Ind Med 29:41–48CrossRefPubMedGoogle Scholar
  67. 67.
    Chin NK, Ng TP, Hui KP, Tan WC (1997) Population based standards for pulmonary function in non-smoking adults in Singapore. Respirology 2:143–149CrossRefPubMedGoogle Scholar
  68. 68.
    Pan WH, Chen JY, Haung SL et al (1997) Reference spirometric values in healthy Chinese never smokers in two townships of Taiwan. Chin J Physiol 40:165–174PubMedGoogle Scholar
  69. 69.
    McDonnell WF, Enright PL, Abbey DE et al (1998) Spirometric reference equations for older adults. Resp Med 92:914–921CrossRefGoogle Scholar
  70. 70.
    Baltopoulos G, Fildisis G, Karatzas S, Georgiakodis F, Myrianthefs P (2000) Reference values and prediction equations for FVC and FEV(1) in the Greek elderly. Lung 178:201–212PubMedGoogle Scholar
  71. 71.
    Dejsomritrutai W, Nana A, Maranetra KN et al (2000) Reference spirometric values for healthy lifetime nonsmokers in Thailand. J Med Assoc Thai 83:457–466PubMedGoogle Scholar
  72. 72.
    Hnizdo E, Churchyard G, Dowdeswel R (2000) Lung function prediction equations derived from healthy South African gold miners. Occup Environ Med 57:698–705CrossRefPubMedGoogle Scholar
  73. 73.
    Ip MS, Karlberg EM, Karlberg JP, Luk KD, Leong JC (2000) Lung function reference values in Chinese children and adolescents in Hong Kong. I. Spirometric values and comparison with other populations. Am J Resp Crit Care Med 162:424–429PubMedGoogle Scholar
  74. 74.
    Vijayan VK, Reetha AM, Kuppurao KV, Venkatesan P, Thilakavathy S (2000) Pulmonary function in normal south Indian children aged 7 to 19 years. Indian J Chest Dis Allied Sci 42:147–156PubMedGoogle Scholar
  75. 75.
    Kivastik J, Kingisepp PH (2001) Spirometric reference values in Estonian schoolchildren. Clin Physiol 21:490–497CrossRefPubMedGoogle Scholar
  76. 76.
    Langhammer A, Johnsen R, Gulsvik A, Holmen TL, Bjermer L (2001) Forced spirometry reference values for Norwegian adults: the Bronchial Obstruction in Nord-Trondelag Study. Eur Resp J 18:770–779CrossRefGoogle Scholar
  77. 77.
    Manzke H, Stadlober E, Schellauf H-P (2001) Combined body plethysmographic, spirometric and flow volume reference values for male and female children aged 6 to 16 years obtained from “hospital normals”. Eur J Pediatr 160:300–306CrossRefPubMedGoogle Scholar
  78. 78.
    Marion MS, Leonardson GR, Rhoades ER, Welty TK, Enright PL (2001) Spirometry reference values for American Indian adults: results from the Strong Heart Study. Chest 120:489–495CrossRefPubMedGoogle Scholar
  79. 79.
    Milivojevic-Poleksic L, Wells AU, Moody A, Fergusson W, Tukuitonga C, Kolbe J (2001) Spirometric lung volumes in the adult Pacific Islander population: comparison with predicted values in a European population. Respirology 6:247–253CrossRefPubMedGoogle Scholar
  80. 80.
    Virani N, Shah B, Celly A (2001) Pulmonary function studies in healthy non-smoking adults in Sri Aurobindo Ashram, Pondicherry. Indian J Med Res 114:177–184PubMedGoogle Scholar
  81. 81.
    Zverev Y, Gondwe M (2001) Ventilatory capacity indices in Malawian children. East Afr Med J 78:14–18PubMedGoogle Scholar
  82. 82.
    Boskady MH, Keshmiri M, Banihashemi B, Anvary K (2002) Lung function values in healthy non-smoking urban adults in Iran. Respiration 69:320–326CrossRefGoogle Scholar
  83. 83.
    Mohamed EI, Maiolo C, Iacopino L, Pepe M, Di Daniele N, De Lorenzo A (2002) The impact of body-weight components on forced spirometry in healthy Italians. Lung 180:149–159CrossRefPubMedGoogle Scholar
  84. 84.
    Golshan M, Menatbakhsh M, Amra B, Crapo RO (2003) Spirometric reference values in a large Middle Eastern population. Eur Resp J 22:529–534CrossRefGoogle Scholar
  85. 85.
    Havryk AP, Gilbert M, Burgess KR (2002) Spirometry valued in Himalayan high altitude residents (Sherpas). Respir Physiol Neurobiol 132:223–232CrossRefPubMedGoogle Scholar
  86. 86.
    Mustajbegovic J, Kern J, Schachter EN, Zuskin E, Pavicic F, Teufel N (2003) Ventilatory functions in Croatian population in comparison with European reference values. Croat Med J 44:614–617PubMedGoogle Scholar
  87. 87.
    Pérez-Padilla R, Regalado-Pineda J, Rojas M et al (2003) Spirometric function in children of Mexico City compared to Mexican–American children. Pediatr Pulmonol 35:177–183CrossRefPubMedGoogle Scholar
  88. 88.
    Al-Riyami BM, Al-Rawas OA, Hassan MO (2004) Normal spirometric reference values for Omani children and adolescents. Respirology 9:387–391CrossRefPubMedGoogle Scholar
  89. 89.
    Boskabady MH, Tashakory A, Mazloom R, Ghamami G (2004) Prediction equations for pulmonary function values in healthy young Iranians aged 8–18 years. Respirology 9:535–542CrossRefPubMedGoogle Scholar
  90. 90.
    Falaschetti E, Laiho J, Primatesta P, Purdon S (2004) Prediction equations for normal and low lung function from the Health Survey for England. Eur Resp J 23:456–463CrossRefGoogle Scholar
  91. 91.
    Fulambarker A, Copur AS, Javeri A, Jere S, Cohen ME (2004) Reference values for pulmonary function in Asian Indians living in the United States. Chest 126:1225–1233CrossRefPubMedGoogle Scholar
  92. 92.
    García-Río F, Pino JM, Dorgham A, Alonso A, Villamor J (2004) Spirometric reference equations for European females and males aged 65–85. Eur Resp J 24:397–405CrossRefGoogle Scholar
  93. 93.
    Kotaniemi J, Kataja M (2004) Spirometry values in adults in northern Finland. Int J Circumpolar Health 63:12139Google Scholar
  94. 94.
    Trabelsi Y, Ben Saad H, Tabka Z et al (2004) Spirometric reference values in Tunisian children. Respiration 71:511–518CrossRefPubMedGoogle Scholar
  95. 95.
    Ostrowski S, Grzywa-Celinska A, Mieczkowska J, Rychlik M, Lachowska-Kotowska P, Lopatynski J (2005) Pulmonary function between 40 and 80 years of age. J Physiol Pharmacol 56(Supplement 4):127–133PubMedGoogle Scholar
  96. 96.
    Zhang QL, Aheng JP, Yuan BT et al (2005) Feasibility and predicted equations spirometry in Shenzhen preschool children. Zhonghua Er Ke Za Zhi 43:843–848PubMedGoogle Scholar
  97. 97.
    Johannessen A, Lehmann S, Omenaas ER, Eide GE, Bakke PS, Gulsvik A (2006) Post-bronchodilator spirometry reference values in adults and implications for disease management. Am J Resp Crit Care Med 173:1316–1325CrossRefPubMedGoogle Scholar
  98. 98.
    Nku CO, Peters EJ, Eshiet AI, Bisong SA, Osim EE (2006) Prediction formulae for lung function parameters in females of south eastern Nigeria. Niger J Physiol Sci 21:43–47PubMedGoogle Scholar
  99. 99.
    Quanjer PH (1983) Standardized lung function testing: report of the working party. Bull Eur Physiopath Resp 19(Suppl 5):1–95Google Scholar
  100. 100.
    Pellegrino R, Viegi G, Brusasco V et al (2005) Interpretative strategies for lung function tests. Eur Resp J 26:948–968CrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  1. 1.Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUSA
  2. 2.Salt Lake CityUSA

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