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. 2019 Feb 21;9:2487. doi: 10.1038/s41598-018-37887-8

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Distribution of spirometry variable Global Lung Function Initiative (GLI) z-scores. The X-axis displays the spirometry variables and the Y-axis demonstrates the z-score values. The box portion of the boxplot represents the 25^th and 75^th percentile with the solid mid-line representing the median and the whisker portion representing the 2.5^th to the 97.5^th percentile. Each dot represents a participant measurement. Median z-score values were well below zero [FEV1 = −2.05 (IQR −2.64, −1.41); FVC = −1.61 (IQR −2.30, −0.99); FEV1/FVC = −0.78 (IQR −1.40, −0.23); FEF25–75 = −1.53 (IQR −2.41, −0.86)]. Notably the median value for FEV1 z-score was less than −1.64, the GLI-defined lower limit of normal, and FVC and FEF25–75 approached this value.