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The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide ( D  LCO ). Lower limit of normal (LLN),  i.e.  the 5th percentile, usually defines impaired  D  LCO . We examined if the GLI LLN for  D  LCO  differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.  Spirometry,  D  LCO , chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15 040 participants, aged 50–64 years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).  Both the median and LLN for  D  LCO  from SCAPIS were above the median and LLN from the GLI (p GLI LLN but  GLI LLN but  GLI LLN and &gt;SCAPIS LLN). No differences were found with regard to physician-diagnosed asthma.  The GLI LLN for  D  LCO  is lower than the estimated LLN in healthy, never-smoking, middle-aged Swedish adults. Individuals with  D  LCO  above the GLI LLN but below the SCAPIS LLN had, to a larger extent, an increased respiratory burden. This suggests clinical implications for choosing an adequate LLN for studied populations.

european respiratory journal/the european respiratory journal

Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary bioImage Study (SCAPIS)