Aim of this study was to derive new lung function reference equations and compare the predicted values with those from three sets of existing reference equations: one derived from a Northern Italy population and the two others widely used in European (ECCS) and American (NHANES III) clinical practice.

Reference equations for flow-volume curve indexes and VC were derived on 497 normal subjects, aged 8–74, from the epidemiological survey in Pisa, Central Italy (1991–1993). By applying natural cubic splines, one single smooth and continuous equation for the entire age range was provided for each index, separately by gender.

Along with age and height, reference values also depended on BMI. Differences among the four reference equations for FEV₁, FVC, VC were quantified for average subjects. The magnitude largely varied over the age range in both genders, reaching up to half litre of air volume at specific ages. Age-gender-specific prevalence rates of airway obstruction, as defined by the ERS criterion, largely varied by applying the considered equations, the differences ranging from −3% to 28%.

The observed discrepancies confirm that reference equations should be derived from a population most similar to that for which the equations are to be used and based on measurements obtained by the same instrument and testing procedures, in order to minimize technical variability in lung function both for clinical and epidemiological purposes.