title: Spirometry reference values in Indigenous Australians: a systematic review.
abstract: OBJECTIVE
  To evaluate published spirometry data for Australian Aboriginal and Torres Strait Islander (Indigenous) peoples to determine (i) whether their ethnicity influenced spirometry results; and (ii) if any reliable spirometry reference values exist for Indigenous Australians.
  
  
  METHODS
  Systematic review of published and grey literature.
  
  
  METHODS
  PubMed and Cochrane Library databases, references of included articles and appropriate grey literature. Last searches were conducted in April 2016.
  
  
  METHODS
  We included any study that performed spirometry on healthy Indigenous Australians and compared their results with those from people of European ancestry. Two authors independently screened titles and abstracts and then reviewed potentially relevant full-text articles for possible inclusion. We used PRISMA systematic review reporting methods to collate data.
  
  
  RESULTS
  Of a possible 125 studies, 18 full-text articles were reviewed, but only nine fulfilled the inclusion criteria. None specified Torres Strait Islander inclusion. All studies reported lower spirometry values (as much as 30% lower) for Aboriginal people compared with non-Indigenous people. Five studies developed spirometry reference values for Indigenous Australians; however, none adhered to all participant inclusion and exclusion criteria outlined by the American Thoracic Society and European Respiratory Society. Hence, reported results and subsequent reference values may not be a true representation of spirometry values in healthy Indigenous people.
  
  
  CONCLUSIONS
  The lower spirometry values reported for Indigenous Australians may be due to study limitations. Furthermore, there are currently no reliable spirometry reference values for Indigenous Australians that adhere to current guidelines. Developing a set of Indigenous Australian reference values will improve the accuracy of test interpretation and aid in the diagnosis of respiratory disease in this population.
authors.affiliation: Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD tamara.blake@health.qld.gov.au.
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Blake
authors.affiliation: Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, QLD.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Petsky
authors.affiliation: Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, QLD.
authors.forename: Leanne T
authors.initials: LT
authors.lastname: Rodwell
authors.affiliation: Thoracic Medicine Department, Royal Brisbane and Women's Hospital, Brisbane, QLD.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Brown
authors.affiliation: Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, QLD.
authors.forename: Debra C
authors.initials: DC
authors.lastname: Hill
authors.affiliation: Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC.
authors.forename: Bruce
authors.initials: B
authors.lastname: Thompson
authors.affiliation: Indigenous Respiratory Outreach Care Program, Prince Charles Hospital, Brisbane, QLD.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: McElrea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D012016:Reference Values; D013147:Spirometry / Q000592:standards*; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples