Reference equations for maximal respiratory pressures in healthy Spanish children and adolescents

Barral-Fernández, Margarita; Pumar, María Amalia Jácome; Souto-Camba, Sonia; González-Doniz, Luz; Belmonte, María Antonia Ramón; Amor-Barbosa, Marta; Arbillaga-Etxarri, Ane; Mazzucco, Guillermo; Cortés, Pilar Bravo; Corral, Tamara del; Martín-Valero, Rocío; Cerdà, Carlos Llorca; Lillo, Fabiola Murcia; Sanchez-Santos, Jose Antonio; Francín-Gallego, Marina; Cortijo, Concepción Martín; Delgado, Esther García; Veguillas, Cristina Serrano; de la Fuente, Ana B. Varas; Herranz, Paula San José; Montañez, Carolina González; Gimeno-Santos, Elena; Torres-Castro, Rodrigo; Fregonezi, Guilherme A F; Peraferrer, Mireia Pardàs; Casamitjana, Jordi Vilaró; Cadenas, Angeles Fernandez-; Ríos-Cortes, Antonio T; Valera, María José Moreno; Langer, Daniel; Lista-Paz, Ana

doi:10.1016/j.arbres.2025.09.009

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Margarita Barral-Fernández1, María Amalia Jácome Pumar2, Sonia Souto-Camba3, Luz González-Doniz4, María Antonia Ramón Belmonte5,6, Marta Amor-Barbosa7, Ane Arbillaga-Etxarri8, Guillermo Mazzucco9,10, Pilar Bravo Cortés11, Tamara del Corral12, Rocío Martín-Valero13, Carlos Llorca Cerdà14, Fabiola Murcia Lillo15, Jose Antonio Sanchez-Santos16, Marina Francín-Gallego17, Concepción Martín Cortijo18, Esther García Delgado19, Cristina Serrano Veguillas20, Ana B. Varas de la Fuente21, Paula San José Herranz22..., Carolina González Montañez23, Elena Gimeno-Santos24,25,26, Rodrigo Torres-Castro27,28, Guilherme A F Fregonezi29, Mireia Pardàs Peraferrer30, Jordi Vilaró Casamitjana31, Angeles Fernandez- Cadenas32, Antonio T Ríos-Cortes33, María José Moreno Valera34, Daniel Langer35, Ana Lista-Paz36,

1 Faculty of Physiotherapy, University of A Coruña. Campus Universitario de Oza, nº1, 15006, A Coruña, Spain

2 University of A Coruña, CITIC, MODES group, Faculty of Science,, Rua da Fraga 12, Campus da Zapateira, 15005, A Coruña, Spain

3 Faculty of Physiotherapy, University of A Coruña. Research Group in Psychosocial Intervention and Functional Rehabilitation, University of A Coruña, Spain. Campus Universitario de Oza, nº1, 15006, A Coruña, Spain

4 Faculty of Physiotherapy, University of A Coruña. Research Group in Psychosocial Intervention and Functional Rehabilitation, University of A Coruña, Spain. Campus Universitario de Oza, nº1, 15006, A Coruña, Spain

5 Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain

6 Vall Hebron Research Institute (VHIR), Vall Hebron University Hospital, Pneumology Department. Barcelona, Spain. Campus Sant Cugat,C/ de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona, Spain

7 Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya. Campus Sant Cugat, C/ de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona, Spain

8 Physical Therapy Department, Faculty of Health Science, University of Deusto. Campus Donostia-San Sebastian, Camino de Mundaiz, nº50, 20012, Donostia-San Sebastián, Gipuzkoa, Spain

9 Deusto Physical TherapIker, Department of Physiotherapy, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastian, Spain. Mundaitz Kalea, 50, 20012 Donostia, Spain

10 Cardiopulmonary and Metabolic Rehabilitation Unit, Ammma, Donostia-San Sebastian, Spain

11 Paraplegics National Hospital of Toledo, Finca La Peraleda s/n, 45071, Toledo, Spain

12 Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Health Research Institute of the San Carlos Clinical Hospital (IdISSC), 28040, Madrid, Spain

13 Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa 3, Ampliacion de Campus de Teatinos, 29071 Malaga, Spain

14 Marina Baixa Hospital, La Vila Joiosa – Alicante, Avda. Alcalde En Jaume Botella Mayor, s/n 03570 La Vila Joiosa, Alicante, Spain

15 Foietes Specialty Center, Benidorm, Alicante, Avda Venezuela, s/n, 03502 Benidorm, Alicante, Spain

16 San Isidoro University Center (attached to the Pablo de Olavide University of Seville). C/ Leonardo Da Vinci, 17-B. 41092 Seville, Spain. Virgen del Rocío University Hospital. Avda. Manuel Siurot, s/n, 41013 Seville, Spain

17 San Jorge University, University Campus, Autovia A-23 km. 299, 50830 Villanueva de Gállego, Zaragoza, Spain

18 University Hospital Doce de Octubre, Madrid. Av. de Cordoba s/n. 28041 Madrid. Faculty of Nursing, Physiotherapy and Podiatry, Complutense University. Pl. de Ramon y Cajal, 3, 28040 Madrid, Spain

19 University Hospital Doce de Octubre, Madrid. Av. de Cordoba s/n. 28041 Madrid. Faculty of Nursing, Physiotherapy and Podiatry, Complutense University.Pl. de Ramon y Cajal, 3, 28040 Madrid, Spain

20 School University of Physiotherapy ONCE, University Autónoma of Madrid, 24, Nuria Street, 28034, Madrid, Spain

21 School University of Physiotherapy ONCE, University Autonoma of Madrid, 24, Nuria Street, 28034, Madrid, Spain

22 University Hospital of Canarias. Rehabilitation Service, Ctra. Ofra S/N. La Cuesta. 38320. La Laguna, Tenerife, Spain

23 University Hospital of Canarias. Carretera Ofra s/n 38320 San Cristobal de La Laguna. Santa Cruz de Tenerife, School University of Physiotherapy. University of La Laguna. Campus de Ciencias de la Salud Ofra, s/n 38010 San Cristobal de La Laguna, Santa Cruz de Tenerife, Spain

24 Barcelona Institute for Global Health (ISGlobal). Doctor Aiguader, 88, 08003 Barcelona, Spain

25 Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS). Villarroel 170, 08036, Barcelona, Spain

26 Blanquerna School of Health Sciences, Ramon Llull University. Padilla 326, 08025, Barcelona, Spain

27 Department of Physical Therapy, University of Chile, Independencia 1027, Santiago, Chile

28 Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain. Villarroel 170, 08036, Barcelona, Spain

29 PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Caixa Postal 1524, CEP 59078-970 | Natal/RN, Brasil

30 Faculty of Health Sciences Blanquerna, Ramon Llull University, Barcelona, C/Padilla 326, 08025, Barcelona, Spain

31 Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Ramon Llull University, Barcelona, Spain. Padilla 326, 08025, Barcelona, Spain

32 General University Hospital Santa Lucía, C/Minarete S/n 30202. Cartagena (Murcia), Spain

33 General University Hospital Santa Lucía. Calle Mezquita, s/n. 30202 Cartagena. Physiotherapy Department, University of Murcia. Campus de Ciencias de la Salud, avenida Buenavista, 32. 30120 El Palmar, Murcia, Spain

34 Pulmonology Unit, Virgen del Rocío University Hospital. Neonatal Intensive Care Unit, Virgen del Rocio University Hospital. Avda. Manuel Siurot, s/n, 41013 Seville, Spain

35 Department of Rehabilitation Sciences, Research Group of Rehabilitation in Internal Disorders, KU Leuven. ON4 Herestraat 49 - box 1510, 3000 Leuven, Belgium

36 Faculty of Physiotherapy, University of A Coruña. Research Group in Psychosocial Intervention and Functional Rehabilitation, University of A Coruña, Spain. Campus Universitario de Oza, nº1, 15006, A Coruña, Spain

Article information

Abstract

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Abstract

Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness.

Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6-18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores≥1.645 standard deviation (SD) below group means.

Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: 1)PImax: boys=-41.41+10.21*age+6.26*body mass index (BMI)-0.37*age*BMI; girls=125.96-0.34*age-0.41*age2-5.75*BMI+0.63*age*BMI; 2)PEmax: boys=20.93+5.23*age+2.93*BMI; girls=-12.67+11.98*age-0.39*age2+2.57*BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p<.001). Depending on age, PImax cut-offs range from 46-85 cmH₂O in boys and from 45-68 cmH₂O in girls, while PEmax cut-offs span 54-98 cmH₂O in boys and 57-85 cmH₂O in girls.

Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programs.

Keywords:

Maximal Respiratory Pressures

Respiratory function tests

Respiratory muscles

Muscle strength

Reference values

Pediatrics

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