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Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.ORCID iD: 0000-0003-0976-6910
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2023 (English)In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 23, no 1, article id 110Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Dynamic spirometry is an important investigation to differentiate between impaired and normal lung function. This study aimed to evaluate the results of lung function testing in a cohort of subjects from Northern Sweden without any known heart or pulmonary disease. Our focus was to compare with two reference materials that have showed differences in the age-dependency of lung function in Swedish subjects.

METHODS: The study population consisted of 285 healthy adults (148 males, 52%) between 20-90 years of age. The subjects had been randomly selected from the population register for inclusion in a study investigating cardiac function in heart-healthy subjects, but were also assessed with dynamic spirometry. At least seven percent reported smoking. Sixteen subjects presented with pulmonary functional impairments and were excluded from the current study. The sex-specific age-dependency in lung volumes was estimated using the LMS model, where non-linear equations were derived for the mean value (M), the location (L) or skewness, and the scatter (S) or coefficient of variation. This model of the observed lung function data was compared with reference values given by the original LMS model published by the Global Lung Initiative (GLI), and with the model from the recent Obstructive Lung Disease In Norrbotten (OLIN) study, where higher reference values were presented for Swedish subjects than those given by the GLI model.

RESULTS: No differences were found in the age-dependency of pulmonary function between the LMS model developed in the study and the OLIN model. Although the study group included smokers, the original GLI reference values suggested significantly lower normal values of FEV1 (forced expiratory volume) and FVC (forced vital capacity), and consequently fewer subjects below the lower limit of normality, than both the rederived LMS and OLIN models.

CONCLUSIONS: Our results are in line with previous reports and support that the original GLI reference values underestimate pulmonary function in the adult Swedish population. This underestimation could be reduced by updating the coefficients in the underlying LMS model based on a larger cohort of Swedish citizens than was available in this study.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 110
Keywords [en]
Clinical physiology, Linear regression, Lung function, Reference values, Spirometry
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-206770DOI: 10.1186/s12890-023-02403-wISI: 000963360400001PubMedID: 37020237Scopus ID: 2-s2.0-85151789612OAI: oai:DiVA.org:umu-206770DiVA, id: diva2:1753332
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Heart and lung function - in health and disease: methodological studies in clinical physiology
Open this publication in new window or tab >>Heart and lung function - in health and disease: methodological studies in clinical physiology
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Hjärt-och lungfunktion vid hälsa och sjukdom
Abstract [en]

The human heart and lungs constitute an intricate and dynamic system. Various clinical physiological examinations can be used to evaluate cardio-pulmonary function and identify abnormalities. Thus, it is important to understand how normal physiology presents, to be able to identify pathological findings. To distinguish normal from abnormal findings in a patient population compared to healthy controls, adequate, accurate and up-to-date reference materials are required. 

There is currently a lack of well-established sex and age specific reference materials that clearly state boundaries of normality for electrocardiography (ECG) variables. For lung function examinations there are several different reference materials available, being discordant between ethnicities. In addition, the relation between lung function, age, sex, and height has generally been difficult to model in an optimal way. This highlights the need for more adequate sex-specific models regarding age- and height-dependency of spirometry variables. 

Heart rate variability (HRV) is a method for evaluating the autonomic nervous system (ANS) and its influence on heart rate and blood pressure. Autonomic disturbances are characterized by an imbalance between the sympathetic and the parasympathetic nervous systems. It is well known that decreased HRV is associated with increased mortality. Autonomic imbalances are also associated with various pathological conditions, of which rheumatoid arthritis (RA) and ischemic heart disease (IHD) are studied in this thesis.

The purpose of this thesis was to describe the properties of different clinical physiological examinations and to investigate reference values relating to cardiovascular and pulmonary function in healthy individuals regarding age and sex. In addition, the aim was to assess the relationship between HRV, RA and CVD both cross sectionally and longitudinally. 

In a subjectively healthy population (n=219) of varying age, there were age and sex-dependent differences in ECG examinations. This emphasizes former findings and supports the need to establish age- and sex-specific reference values in the future. 

Lung function examinations in subjectively healthy persons (n=285) support and emphasize that the reference values presented by the Global Lung function Initiative (GLI) underestimate the pulmonary function in the adult Swedish population. The study showed that the model used in GLI can be updated with new values that are specific for the Caucasian population in Sweden. 

Patients with RA (n=50) presented with lower HRV than healthy controls (n=100) during autonomic provocation tests, both at baseline examinations and after five years. This indicates a cardiac autonomic imbalance. Furthermore, increased systolic blood pressure was associated with reduced HRV, thus a decrease in HRV could be a risk marker for developing arterial hypertension in this patient group.

Females with IHD (n=197) presented with lower HRV compared to controls (n=141) at baseline, and a higher mortality rate after 15 years. The higher mortality rate was only present in females < 60 years of age. For measurements obtained in the upright position, HRV was higher in females that died during follow-up compared to those who were alive. 

This thesis emphasizes the importance of validated and updated sex- and age- specific reference materials, and models that are well suited for different clinical physiological examinations. Additionally, HRV examinations exposed changes in the ANS related to RA as well as IHD, where findings were shown to be persistent over time and particularly pronounced during provocations. In the future, HRV assessment could be a useful tool to identify the increased risk of developing hypertension in patients with RA, or to customize treatment based on ANS response as the field of personalized medicine continues to evolve.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 95
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2263
Keywords
clinical physiology, reference materials, ECG, dynamic spirometry, HRV, rheumatoid arthritis, cardiovascular disease, ischemic heart disease
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy Rheumatology and Autoimmunity Physiology
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:umu:diva-216108 (URN)9789180701907 (ISBN)9789180701914 (ISBN)
Public defence
2023-12-01, Bergasalen, Norrlands universitetssjukhus, 13:00 (Swedish)
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Supervisors
Available from: 2023-11-10 Created: 2023-11-02 Last updated: 2023-11-02Bibliographically approved

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Erelund, SofiaKarp, KjellArvidsson, SandraJohansson, BengtSundström, NinaWiklund, Urban

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