The Practical Significance of Measurement Error in Pulmonary Function Testing Conducted in Research Settings

Richard B. Belzer and R. Jeffrey Lewis

Risk Analysis, 2019, vol. 39, issue 10, 2316-2328

Abstract: Conventional spirometry produces measurement error by using repeatability criteria (RC) to discard acceptable data and terminating tests early when RC are met. These practices also implicitly assume that there is no variation across maneuvers within each test. This has implications for air pollution regulations that rely on pulmonary function tests to determine adverse effects or set standards. We perform a Monte Carlo simulation of 20,902 tests of forced expiratory volume in 1 second (FEV1), each with eight maneuvers, for an individual with empirically obtained, plausibly normal pulmonary function. Default coefficients of variation for inter‐ and intratest variability (3% and 6%, respectively) are employed. Measurement error is defined as the difference between results from the conventional protocol and an unconstrained, eight‐maneuver alternative. In the default model, average measurement error is shown to be ∼5%. The minimum difference necessary for statistical significance at p

Date: 2019
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