Effects of adopting the Global Lung Function Initiative 2017 reference equations on the interpretation of carbon monoxide transfer factor

The recently published Global Lung Function Initiative (GLI) carbon monoxide transfer factor ( T LCO ) reference equations provide an opportunity to adopt a current, all-age, widely applicable reference set. The aim of this study was to document the effect of changing to GLI from commonly utilised reference equations on the interpretation of T LCO results. 33 863 T LCO results (48% female, 88% Caucasian, n=930 aged <18 years) from clinical pulmonary function laboratories within three Australian teaching hospitals were analysed. The lower limit of normal (LLN) and proportion of patients with a T LCO below this value were calculated using GLI and other commonly used reference equations. The average T LCO LLN for GLI was similar or lower than the other equations, with the largest difference seen for C rapo equations (median: −1.25, IQR: −1.64, −0.86 mmol·min −1 ·kPa −1 ). These differences resulted in altered rates of reduced T LCO for GLI particularly for adults (+1.9% versus M iller to −27.6% versus C rapo ), more so than for children (−0.8% versus K im to −14.2% versus C otes ). For adults, the highest raw agreement for GLI was with M iller equations (94.7%), while for children it was with K im equations (98.1%). Results were reclassified from abnormal to normal more frequently for younger adults, and for adult females, particularly when moving from R oca to GLI equations (30% of females versus 16% of males). The adoption of GLI T LCO reference equations in adults will result in altered interpretation depending on the equations previously used and to a greater extent in adult females. The effect on interpretation in children is less significant.