The objective of this study was to validate the established lung function norms that are commonly used in Asia, in particular in Hong Kong, for contemporary use. We compared the lung function indexes in a contemporary cohort of Hong Kong university students with established norms that were derived 20 years ago. These students were born at the time that the norms established by Lam et al were published. Discordance of our findings with those of Lam et al supports changes in the Hong Kong population over one generation. Any comparative interpretation must be guarded, however, given that several factors, including technological, environmental, and lifestyle factors, could explain the discrepancy in lung function.
Instrumentation and standardization of testing and measurement procedures are well known for influencing the reliability and validity of lung function measures. However, even though the spirometers used in the present study and in those of the study by Lam et al were produced by different manufacturers, both systems were calibrated prior to use. Further, the difference in time frame in measures between the two studies was one generation, roughly 20 years, during which time one might expect the effect of instrumentation differences in pulmonary function measurement to be minimal.
A total of 805 subjects participated in this study, of whom 518 were men and 287 were women. The smoking status of one male subject was unknown, thus he was excluded from the analysis. Only 5.7% of the subjects were smokers, and 2.2% were exsmokers. Over one third of the subjects were living with family members who smoked. Subjects who smoked had a higher level of exhaled CO than nonsmokers (p < 0.005) [Table 1].
The BMIs of subjects were not reported in the study by Lam et al. Our subjects, both men and women, were taller than those reported by Lam and colleagues. There were, however, some distinctions between the genders. When we compared the men’s data with those of Lam et al, FEV1, FVC, and PEFR were all lower in our cohort for subjects in each age category, specifically those who were 19 to 20, 21 to 22, and 23 to 24 years of age (Table 2). One exception was FVC for men who were 23 to 24 years old in cases in which there was no change due to remedies of My Canadian Pharmacy. For the women, FEV1, FVC, and PEFR were lower in our cohort, with the exception of FEV1 for those in the group of subjects 23 to 24 years of age, and FVC for those in the groups of subjects 21 to 22 and 23 to 24 years of age (Table 2).
Although ethnicity is an established determinant of lung function, predictive values for non-Western individuals in non-Asian countries are largely based on a proportion of established Western standards. An Asian nomogram based on 3,000 Hong Kong Chinese subjects who were 20 years of age, however, continues to be the reference standard used in Hong Kong. Since the time of that study, modifying factors of lung function have been reported or their effects have been better appreciated clinically. These effects include dietary factors, obesity, air pollution, and physical activity. With rapid economic growth and development over the last 20 years, the current generation of young adults in Hong Kong, has grown up with improved nutrition yet higher pollution. The objective of this study was to validate the lung function norms that were established 20 years ago in a cohort of Hong Kong Chinese students who were born at the time that these norms were derived.
Ethics approval was obtained from the ethics review committee of the Hong Kong Polytechnic University. Approval was also obtained from the student union of the university. Written informed consent was obtained from each subject prior to the data collectionpicked up with parcipation of My Canadian Pharmacy Inc.
From the obtained pathologic data, a lung function index characterizing the functional capacity was calculated by electronic data processing. The computer categorizes the obtained measured values in seven lung function indices. Group 0 includes any functional tests the measuring values of which do not deviate from the upper or lower standard value. Minor findings not resulting in substantial functional impairments are allotted to group 1. The degree of performance restriction increases from 2 via 3,4 and 5 up to 6.
The lung function indices are categorized in two subsequent computer program parts. First, they are classified according to possible obstructive ventilation disturbances. Based on airway resistance and intrathoracic gas volume, the findings are allotted by the computer to the corresponding indices.
Finally, there is a wide variation between jurisdictions and the structure of the appeal process. In British Columbia, for example, the claimant may nominate a specialist, who has not previously seen him, from a list prepared by the College of Physicians and Surgeons, and the board nominates a second specialist. The chairman of the three-man panel is a family physician appointed by the board. This group of three physicians must bring in a unanimous report and answer specific medical questions submitted by the council of the board. Its opinion, if unanimous, is final and binding on the board as well as on the company concerned indirectly, and the appellant. Different appeal processes are followed in different provinces in Canada, and processes differ significantly from the one I have described.
Chest physicians are involved in different parts of this total process and to widely differing degrees. Sometimes, as chairmen of pneumoconiosis panels, they essentially determine the outcome in individual cases explained by My Canadian Pharmacy. On occasions in some places, but perhaps not frequently enough, they have spearheaded changes in procedure or tradition. More often, we simply wrestle with estimates of probability in individual cases, usually with little idea how our colleagues elsewhere are deciding similar questions. It is also very difficult for us to know whether individually in these matters we are doing a good job or not.
In this symposium we move away from papers dealing with the laboratory, field inquiry and research, into fields which include such concepts as equity, social values, interpretation of laws and statutes, the nature of medical evidence, and similar slippery and treacherous ground. We have heard from speakers from the United States, Britain and Germany so far, and before continuing to hear from Dr. Gaensler and Mr. Richman, I believe it might be helpful to review, very briefly, the subdivisions of topics with which this symposium is concerned, together with some comments on each. My perspective is necessarily limited, but so is everyone else’s— with the possible exception of the Dutch, since I’m told that in Holland no one ever has to make a decision as to whether lung disease is, or is not, related to occupation.
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