A study of the ability of the general United States (US) population to meet the American Thoracic Society (ATS) spirometry criteria was conducted. The cohort consisted of 6486 persons, 8 to 90 years old, selected from among the participants in the third round of the National Health and Nutrition Examination Survey (NHANES). Participants' spirograms were analyzed to determine if they met the ATS criteria which specified that the largest measured forced vital capacity (FVC) and 1 second forced expiratory volumes (FEV1s) come within 5% or 100 milliliters (ml) of the second largest values and that at least three acceptable flow volume curves be obtained. A total of 301 subjects had fewer than two acceptable curves and were not analyzed further. The percentage of subjects with FVCs or FEV1/FVC ratios falling below the ninth percentile or the lower limit of normality increased with increasing age. Both male and female subjects in the older age groups had more difficulty producing three acceptable flow volume curves than younger subjects. Overall, 9.2% of the males and 10.3% of the females had difficulty in meeting the ATS criteria, a nonstatistically significant difference. Hispanic and nonwhite subjects generally had more difficulty meeting the ATS criteria than white subjects. Failure to meet ATS criteria decreased with increasing height. The intrasubject variability of FVC and FEV1 expressed as the difference between the largest and second largest values was relatively uniform for all heights. When the previous ATS acceptability criterion of 200ml for the difference between the two largest FEV1 and FVC values was used, the number of subjects failing to meet the criteria did not vary significantly with age. The authors conclude that younger and older persons have difficulty meeting the ATS criteria. Failure to meet the criteria may be due to smaller heights and the resulting smaller lung volumes in younger subjects and smaller lung volumes in older subjects. Applying the ATS criteria rigidly may classify a large proportion of shorter subjects with small lung volumes as having nonreproducible lung function tests.
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