Although spirometry results can be interpreted differently depending on the reference equation used, there are no established criteria for selecting reference equations as part of the special health examinations for Korean workers. Thus, it is essential to examine the current use of reference equations in Korea, quantify their impact on result interpretation, and propose reference equations suitable for Korean workers, while also considering the environmental conditions of special health examination facilities.

The 213,640 results from the special health examination database were analyzed to identify changes in the ratio of measured values to reference values of lung capacity in Korean workers with changes in age or height, and changes in the agreement of interpretations with the reference equation used. Data from 238 organizations that participated in the 2018–2019 quality control assessment by the Korea Occupational Safety and Health Agency were used to identify the spirometer model and reference equations used in each special health examination facility.

Korean special health examination facilities used six reference equations, and the rate of normal or abnormal ventilatory diagnoses varied with the reference equation used. The prediction curve of the Global Lung Function Initiative 2012-Northeast Asian (GLI2012) equation most resembled that of the normal group, but the spirometry model most commonly used by examination facilities was not compliant with the GLI2012 equation. With a scaling factor of 0.95 applied to the Dr. Choi equation, the agreement with the GLI2012 equation was > 0.81 for men and women.

We propose the GLI2012 equation as reference equation for spirometry in Korean workers. The GLI2012 equation exhibited the most suitable prediction curve against the normal lung function group. For devices that cannot use the GLI2012 equation, we recommend applying a scaling factor of 0.95 to the Dr. Choi equation.

Asian migrant workers in Korea have various ethnicities. The purpose of this study was to evaluate the difference in spirometric interpretation made using the set of third National Health and Nutrition Examination Survey (NHANES III) reference equations and the relevant ethnicity-specific reference sets.

Spirometry was performed on 166 migrant and 498 Korean male workers between March and November 2012. We analyzed the spirometric data of healthy never-smokers. Spirometric patterns were evaluated using the NHANES III reference set and some relevant ethnicity-specific equations (Eom’s equation for Koreans, Ip’s equation for East Asians, Crapo’s equation for Central Asians, Memon’s equation for South Asians, and Gnanou’s equation for Southeast Asian people).

In all migrant groups except the Central Asian group, the forced expiratory volume in 1 second percentage (FEV₁%) and forced vital capacity percentage (FVC%) calculated using each of the ethnicity-specific reference equations considered were significantly higher than those calculated using the NHANES III reference set. This study showed that in the evaluation of the spirometric result of subjects from Southeast Asia or South Asia, the percentage of cases with an abnormal FEV₁ or FVC increased when the NHANES III set of equations was used as compared to when the ethnicity-specific equations were used.

We found that the spirometric results of all ethnic groups were higher and the composition of the abnormal spirometric result was lower when the ethnicity-specific reference equations were used instead of the NHANES III reference set.

Korean regression models for spirometric reference values are different from those of other ethnic groups. The purpose of this study was to evaluate discordance in spirometric interpretations based on using Korean reference equations versus non-Korean reference equations.

Spirometry was performed on 825 Korean male workers from April 2009 to November 2011. The spirometric patterns and disease severity were evaluated using two Korean equations (Choi's and Lee's) and three equations for Caucasians (NHANES III, Morris's, and Knudson's), and the results of Choi's equation were compared with the non-Korean equations. The spirometric patterns were defined as normal, restrictive, and mild and moderate obstructive.

The mean differences in the FEV₁% and FVC% between the two Korean equations were 2.0 ± 1.3% and 3.5 ± 2.2%, respectively. Morris's equation had the greatest difference in the FEV₁% from Choi's equation: 32.9 ± 8.5%. Knudson's equation had the greatest difference in the FVC% from Choi's equation: 10.5 ± 6.5%.

The two Korean equations shared similar characteristics of spirometric interpretation. The spirometric interpretations of Choi's equation were significantly different from those of Morris's equation and Knudson's equation.