Upton M N, Ferrell C, Bidwell C, McConnachie A, Goodfellow J, Davey Smith G, Watt G C
Department of General Practice, University of Glasgow, Glasgow, UK.
Public Health. 2000 Sep;114(5):353-60.
Population studies in Britain and elsewhere report deficiencies in quality of pulmonary function measurements. Methods were tested to improve the standardisation of spirometry in an epidemiological study. The spirometer provided visual feedback about acceptability and reproducibility to American Thoracic Society (ATS) standards. After 14 weeks technicians (research nurses) were given feedback and further training. Measurements were repeated in a 5% sample. Participant characteristics and technical factors (technician and technician feedback) predicted unacceptable forced expiratory volume in 1 second (FEV1) and excessively variable FEV1 and forced vital capacity (FVC). Only participant characteristics predicted unacceptable FVC. Feedback to technicians reduced test failure for FEV1 by half and excessive within-session variability by one-third. In the reproducibility study, coefficients of variation for FEV1 and FVC were 3%. Epidemiological studies can achieve standards of between-session reproducibility for spirometry comparable to levels reported by pulmonary function laboratories. Performance feedback to technicians improves the level of minimally acceptable spirometry, and within-session reproducibility.
英国及其他地区的人口研究报告了肺功能测量质量存在缺陷。在一项流行病学研究中对提高肺活量测定标准化的方法进行了测试。肺活量计提供了关于符合美国胸科学会（ATS）标准的可接受性和可重复性的视觉反馈。14周后，向技术人员（研究护士）提供了反馈并进行了进一步培训。在5%的样本中重复进行测量。参与者特征和技术因素（技术人员及技术人员反馈）可预测1秒用力呼气量（FEV1）不可接受以及FEV1和用力肺活量（FVC）过度变异。只有参与者特征可预测不可接受的FVC。向技术人员提供反馈使FEV1的测试失败率减半，且使会话内过度变异减少了三分之一。在可重复性研究中FEV1和FVC的变异系数为3%。流行病学研究能够实现肺活量测定的会话间可重复性标准，与肺功能实验室报告的水平相当。向技术人员提供性能反馈可提高最低可接受肺活量测定水平以及会话内可重复性。
