Chest
Volume 119, Issue 2, February 2001, Pages 376-386
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Clinical Investigations
Pulmonary Function
Thoracic Dimensions at Maximum Lung Inflation in Normal Subjects and in Patients With Obstructive and Restrictive Lung Diseases

https://doi.org/10.1378/chest.119.2.376Get rights and content

Objectives

To compare the distribution of lung volumeat total lung capacity (TLC) among adult men and women known to havenormal lung function or chronic obstructive disease or restrictive lungdisease (RLD).

Design

Five-year retrospectivestudy.

Setting

Review of available clinical pulmonaryfunction testing (PFT) reports and chest radiographs.

Patients

Sixty-four patients presenting with normal PFTand chest radiograph findings (normal subjects), 26 patients withsevere COPD and increased TLC (COPD group), 29 patients with cysticfibrosis (CF) and increased TLC (CF group), and 19 patients with RLDwith a clinical diagnosis of pulmonary fibrosis and a reduced TLC (RLDgroup).

Measurements

Average posteroanterior rib cagediameter (PAave), average lateral rib cage diameter (LAave), andaverage vertical height of the diaphragm (HDIave) were measured usingradiography. Normal prediction equations were generated based onstature, body mass index (BMI), age, and sex as independent variablesand then used in between-group comparisons.

Results

PAave correlated positively with BMI and age butnot with height, whereas LAave correlated positively with BMI andheight but not with age. HDIave correlated positively with height andage but negatively with BMI. PAave and LAave were smaller and HDIavewas greater in women than men having the same stature. In the COPDgroup and in male CF group patients, BMI was low and only HDIave wasgreater than in sex-, age-, and height-matched normal subjects, but infemale CF group patients, only the rib cage diameters were greater thannormal. In the RLD group, PAave and HDIave were smaller thanpredicted and inversely related to each other, but LAave wasnormal.

Conclusion

Variations in maximum lung volumecaused by gender, growth, or by lung diseases are nonisotropic andentail substantial changes in chest wall shape.

Section snippets

Subject Selection

Subjects included in this study were all white and had beenreferred over a period of 5 years to the pulmonary physiologylaboratory for complete pulmonary function testing (PFT) and for whomstandard chest radiographs were available. For the initial screening, 2,638 PFT reports were consulted and four groups of subjects wereidentified using the following criterion. Patients who met American Thoracic Society standards for normal lung function12(ie, with values for FVC, FEV1,single-breath diffusing

Subject Characteristics

The anthropologic characteristics and lung function data of thedifferent groups are summarized in Table 1. The age, height, and bodymass index (BMI) of normal subjects varied widely and uniformly andcovered the range seen in the study patients. In normal subjects, BMIwas significantly and positively correlated with age. For each gender, height was comparable among groups. The CF group, however, wassignificantly younger, and the COPD group and the RLD group weresignificantly older than normal

Discussion

These results show that all anthropologic variablesconsidered contribute significantly, albeit to a different extent, tothe observed variance in thoracic dimensions among adults and thatthese relationships are comparable among normal subjects and patientswith obstructive lung disease and RLD. Radial rib cage dimensions weremore tightly coupled to anthropologic variables than HDI, but the axialdimension contributed more to variations in the volume of the chestwall and lungs. Variations in the

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    This study was supported by the Medical Research Council of Canada.

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