Reference Equations for Pulmonary Function Tests

  • Bruce H. Culver
  • Sanja StanojevicEmail author
Part of the Respiratory Medicine book series (RM)


Lung function parameters vary with age, sex, ethnicity, and body size, such that interpretation of pulmonary function test results requires comparison to an individualized predicted value that is calculated from reference equations derived from healthy individuals. Over the years, these reference data have evolved from small regional samples described by simple linear equations to very large collated, often international, samples described by more complex statistical methods. The interpretive comparison of a test result to the predicted value and the normal range has also evolved from oversimplified “rules of thumb” to the use of a properly individualized lower limit of normal, generally taken to be the 5th percentile of the healthy population. Rapid changes in lung function and variability in growth rates add a challenge to the interpretation of lung function during childhood and adolescence. Newer reference equations allowing continuous tracking of individuals throughout growth and aging are particularly helpful for pediatric laboratories. Due to the slow progression of many chronic lung diseases, the values associated with early disease will inevitably overlap with low normal values, requiring an understanding of the clinical uncertainty around values near the limits of normal, especially among older persons. Better data on the outcomes of individuals with low normal or borderline function in relation to identifiable risk factors would help the clinician in estimating the likelihood of progression to impactful disease.


Reference equations Lower limit of normal Interpretation of lung function Spirometry Diffusing capacity Lung volumes 

Selected References

Guidelines and Statements

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Spirometry Reference Equation Sources


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pulmonary, Critical Care and Sleep MedicineUniversity of Washington School of MedicineSeattleUSA
  2. 2.Translational Medicine, The Hospital for Sick ChildrenTorontoCanada

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