The effect of body position on pulmonary function: a systematic review

Shikma Katz, Nissim Arish, Ariel Rokach, Yacov Zaltzman, Esther-Lee Marcus, Shikma Katz, Nissim Arish, Ariel Rokach, Yacov Zaltzman, Esther-Lee Marcus

Abstract

Background: Pulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient comfort. This systematic review investigated the influence of body position on lung function in healthy persons and specific patient groups.

Methods: A search to identify English-language papers published from 1/1998-12/2017 was conducted using MEDLINE and Google Scholar with key words: body position, lung function, lung mechanics, lung volume, position change, positioning, posture, pulmonary function testing, sitting, standing, supine, ventilation, and ventilatory change. Studies that were quasi-experimental, pre-post intervention; compared ≥2 positions, including sitting or standing; and assessed lung function in non-mechanically ventilated subjects aged ≥18 years were included. Primary outcome measures were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC, FEV1/FVC), vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Standing, sitting, supine, and right- and left-side lying positions were studied.

Results: Forty-three studies met inclusion criteria. The study populations included healthy subjects (29 studies), lung disease (nine), heart disease (four), spinal cord injury (SCI, seven), neuromuscular diseases (three), and obesity (four). In most studies involving healthy subjects or patients with lung, heart, neuromuscular disease, or obesity, FEV1, FVC, FRC, PEmax, PImax, and/or PEF values were higher in more erect positions. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. sitting. In healthy subjects, DLCO was higher in the supine vs. sitting, and in sitting vs. side-lying positions. In patients with chronic heart failure, the effect of position on DLCO varied.

Conclusions: Body position influences the results of PFTs, but the optimal position and magnitude of the benefit varies between study populations. PFTs are routinely performed in the sitting position. We recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. When treating patients with heart, lung, SCI, neuromuscular disease, or obesity, one should take into consideration that pulmonary physiology and function are influenced by body position.

Keywords: Body position; Lung volume; Physical therapy; Positioning; Posture; Pulmonary function; Sitting; Standing; Supine.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable – systematic review.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram

References

    1. Crapo RO. Pulmonary-function testing. N Engl J Med. 1994;331(1):25–30. doi: 10.1056/NEJM199407073310107.
    1. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26(1):153–161. doi: 10.1183/09031936.05.00034505.
    1. Meysman M, Vincken W. Effect of body posture on spirometric values and upper airway obstruction indices derived from the flow-volume loop in young nonobese subjects. Chest. 1998;114(4):1042–1047. doi: 10.1378/chest.114.4.1042.
    1. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–968. doi: 10.1183/09031936.05.00035205.
    1. Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(3):511–522. doi: 10.1183/09031936.05.00035005.
    1. Goswami R, Guleria R, Gupta AK, et al. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves’ disease and their reversibility with carbimazole therapy. Eur J Endocrinol. 2002;147(3):299–303. doi: 10.1530/eje.0.1470299.
    1. Keenan SP, Alexander D, Road JD, Ryan CF, Oger J, Wilcox PG. Ventilatory muscle strength and endurance in myasthenia gravis. Eur Respir J. 1995;8(7):1130–1135. doi: 10.1183/09031936.95.08071130.
    1. Nava S, Crotti P, Gurrieri G, Fracchia C, Rampulla C. Effect of a beta 2-agonist (broxaterol) on respiratory muscle strength and endurance in patients with COPD with irreversible airway obstruction. Chest. 1992;101(1):133–140. doi: 10.1378/chest.101.1.133.
    1. Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF. Peak expiratory flow: conclusions and recommendations of a working Party of the European Respiratory Society. Eur Respir J Suppl. 1997;24:2s–8s.
    1. Global initiative for asthma (GINA) Global strategy for asthma management and prevention (2018 update) 2018.
    1. Graham Brian L., Brusasco Vito, Burgos Felip, Cooper Brendan G., Jensen Robert, Kendrick Adrian, MacIntyre Neil R., Thompson Bruce R., Wanger Jack. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. European Respiratory Journal. 2017;49(1):1600016. doi: 10.1183/13993003.00016-2016.
    1. Hathaway EH, Tashkin DP, Simmons MS. Intraindividual variability in serial measurements of DLCO and alveolar volume over one year in eight healthy subjects using three independent measuring systems. Am Rev Respir Dis. 1989;140(6):1818–1822. doi: 10.1164/ajrccm/140.6.1818.
    1. Moher David, Liberati Alessandro, Tetzlaff Jennifer, Altman Douglas G. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Gronseth GS, Woodroffe LM, Getchuis TSD. Clinical practice guideline process manual. 2011. . Accessed 29 May 2018.
    1. Quality assessment tool for before-after (pre-post) studies with no control group. 2014. . Accessed 12 Aug 2018.
    1. Kunstler BE, Cook JL, Freene N, et al. Physiotherapist-led physical activity interventions are efficacious at increasing physical activity levels: a systematic review and meta-analysis. Clin J Sport Med. 2018;28(3):304–315. doi: 10.1097/JSM.0000000000000447.
    1. Ben-Dov I, Zlobinski R, Segel MJ, Gaides M, Shulimzon T, Zeilig G. Ventilatory response to hypercapnia in C(5-8) chronic tetraplegia: the effect of posture. Arch Phys Med Rehabil. 2009;90(8):1414–1417. doi: 10.1016/j.apmr.2008.12.028.
    1. Ceridon ML, Morris NR, Olson TP, Lalande S, Johnson BD. Effect of supine posture on airway blood flow and pulmonary function in stable heart failure. Respir Physiol Neurobiol. 2011;178(2):269–274. doi: 10.1016/j.resp.2011.06.021.
    1. Ganapathi LV, Vinoth S. The estimation of pulmonary functions in various body postures in normal subjects. Int J Advances Med. 2015;2(3):250–254. doi: 10.18203/2349-3933.ijam20150554.
    1. Manning F, Dean E, Ross J, Abboud RT. Effects of side lying on lung function in older individuals. Phys Ther. 1999;79(5):456–466.
    1. Palermo Pietro, Cattadori Gaia, Bussotti Maurizio, Apostolo Anna, Contini Mauro, Agostoni Piergiuseppe. Lateral Decubitus Position Generates Discomfort and Worsens Lung Function in Chronic Heart Failure. Chest. 2005;128(3):1511–1516. doi: 10.1378/chest.128.3.1511.
    1. Patel AK, Thakar HM. Spirometric values in sitting, standing, and supine position. Lung Pulm Resp Res. 2015;2(1):00026.
    1. Saxena J, Gupta S, Saxena S. A study of change of posture on the pulmonary function tests : can it help COPD patients? Indian J Community Health. 2006;18(1):10–2. . Accessed 29 May 2018.
    1. Stewart IB, Potts JE, McKenzie DC, Coutts KD. Effect of body position on measurements of diffusion capacity after exercise. Br J Sports Med. 2000;34(6):440–444. doi: 10.1136/bjsm.34.6.440.
    1. Varrato J, Siderowf A, Damiano P, Gregory S, Feinberg D, McCluskey L. Postural change of forced vital capacity predicts some respiratory symptoms in ALS. Neurology. 2001;57(2):357–359. doi: 10.1212/WNL.57.2.357.
    1. Vilke GM, Chan TC, Neuman T, Clausen JL. Spirometry in normal subjects in sitting, prone, and supine positions. Respir Care. 2000;45(4):407–410.
    1. Yap JC, Moore DM, Cleland JG, Pride NB. Effect of supine posture on respiratory mechanics in chronic left ventricular failure. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1285–1291. doi: 10.1164/ajrccm.162.4.9911097.
    1. Tsubaki A, Deguchi S, Yoneda Y. Influence of posture on respiratory function and respiratory muscle strength in normal subjects. J Phys Ther Sci. 2009;21(1):71–74. doi: 10.1589/jpts.21.71.
    1. De S. Comparison of spirometric values in sitting versus standing position among patients with obstructive lung function. Indian J Allergy Asthma Immunol. 2012;26(2):86–88. doi: 10.4103/0972-6691.112554.
    1. Melam GR, Buragadda S, Alhusaini A, Alghamdi MA, Alghamdi MS, Kaushal P. Effect of different positions on FVC and FEV1 measurements of asthmatic patients. J Phys Ther Sci. 2014;26(4):591–593. doi: 10.1589/jpts.26.591.
    1. Mohammed J, Abdulateef A, Shittu A, Sumaila FG. Effect of different body positioning on lung function variables among patients with bronchial asthma. Arch Physiother Global Res. 2017;21(3):7–12. . Accessed 29 May 2018.
    1. Razi E, Moosavi GA. The effect of positions on spirometric values in obese asthmatic patients. Iran J Allergy Asthma Immunol. 2007;6(3):151–154.
    1. Linn WS, Adkins RH, Gong H, Jr, Waters RL. Pulmonary function in chronic spinal cord injury: a cross-sectional survey of 222 southern California adult outpatients. Arch Phys Med Rehabil. 2000;81(6):757–763. doi: 10.1016/S0003-9993(00)90107-2.
    1. Park JH, Kang SW, Lee SC, Choi WA, Kim DH. How respiratory muscle strength correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J. 2010;51(3):392–397. doi: 10.3349/ymj.2010.51.3.392.
    1. Baydur A, Adkins RH, Milic-Emili J. Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. J Appl Physiol. 2001;90(2):405–411. doi: 10.1152/jappl.2001.90.2.405.
    1. Kim M-K, Hwangbo G. The effect of position on measured lung function in patients with spinal cord injury. J Physical Therapy Sci. 2012;24(8):655–7 . Accessed 29 May 2018.
    1. Terson de Paleville DG, Sayenko DG, Aslan SC, Folz RJ, McKay WB, Ovechkin AV. Respiratory motor function in seated and supine positions in individuals with chronic spinal cord injury. Respir Physiol Neurobiol. 2014;203:9–14. doi: 10.1016/j.resp.2014.08.013.
    1. Poussel M, Kaminsky P, Renaud P, Laroppe J, Pruna L, Chenuel B. Supine changes in lung function correlate with chronic respiratory failure in myotonic dystrophy patients. Respir Physiol Neurobiol. 2014;193:43–51. doi: 10.1016/j.resp.2014.01.006.
    1. Naitoh Satoko, Tomita Katsuyuki, Sakai Keita, Yamasaki Akira, Kawasaki Yuji, Shimizu Eiji. The Effect of Body Position on Pulmonary Function, Chest Wall Motion, and Discomfort in Young Healthy Participants. Journal of Manipulative and Physiological Therapeutics. 2014;37(9):719–725. doi: 10.1016/j.jmpt.2014.10.005.
    1. Miccinilli S, Morrone M, Bastianini F, et al. Optoelectronic plethysmography to evaluate the effect of posture on breathing kinematics in spinal cord injury: a cross sectional study. Eur J Phys Rehabil Med. 2016;52(1):36–47.
    1. Sebbane M, El Kamel M, Millot A, et al. Effect of weight loss on postural changes in pulmonary function in obese dubjects: a longitudinal study. Respir Care. 2015;60(7):992–999. doi: 10.4187/respcare.03668.
    1. Myint WW, Htay MNN, Soe HHK, et al. Effect of body positions on lungs volume in asthmatic patients: a cross-sectinal study. J Adv Med Pharma Sci. 2017;13(4):1–6.
    1. Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol (1985) 2005;98(2):512–517. doi: 10.1152/japplphysiol.00430.2004.
    1. Roychowdhury P, Pramanik T, Prajapati R, Pandit R, Singh S. In health--vital capacity is maximum in supine position. Nepal Med Coll J. 2011;13(2):131–132.
    1. Antunes BO, de Souza HC, Gianinis HH, Passarelli-Amaro RC, Tambascio J, Gastaldi AC. Peak expiratory flow in healthy, young, non-active subjects in seated, supine, and prone postures. Physiother Theory Pract. 2016;32(6):489–493. doi: 10.3109/09593985.2016.1139646.
    1. Badr C, Elkins MR, Ellis ER. The effect of body position on maximal expiratory pressure and flow. Aust J Physiother. 2002;48(2):95–102. doi: 10.1016/S0004-9514(14)60203-8.
    1. Elkins MR, Alison JA, Bye PT. Effect of body position on maximal expiratory pressure and flow in adults with cystic fibrosis. Pediatr Pulmonol. 2005;40(5):385–391. doi: 10.1002/ppul.20287.
    1. Gianinis HH, Antunes BO, Passarelli RC, Souza HC, Gastaldi AC. Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects. Braz J Phys Ther. 2013;17(5):435–441. doi: 10.1590/S1413-35552012005000116.
    1. McCoy EK, Thomas JL, Sowell RS, et al. An evaluation of peak expiratory flow monitoring: a comparison of sitting versus standing measurements. J Am Board Fam Med. 2010;23(2):166–170. doi: 10.3122/jabfm.2010.02.090120.
    1. Ottaviano G, Scadding GK, Iacono V, Scarpa B, Martini A, Lund VJ. Peak nasal inspiratory flow and peak expiratory flow. Upright and sitting values in an adult population. Rhinology. 2016;54(2):160–163. doi: 10.4193/Rhin15.180.
    1. Wallace JL, George CM, Tolley EA, et al. Peak expiratory flow in bed? A comparison of 3 positions. Respir Care. 2013;58(3):494–497.
    1. Benedik PS, Baun MM, Keus L, et al. Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects. Respir Care. 2009;54(3):334–339.
    1. Chang AT, Boots RJ, Brown MG, Paratz JD, Hodges PW. Ventilatory changes following head-up tilt and standing in healthy subjects. Eur J Appl Physiol. 2005;95(5–6):409–417. doi: 10.1007/s00421-005-0019-2.
    1. Costa R, Almeida N, Ribeiro F. Body position influences the maximum inspiratory and expiratory mouth pressures of young healthy subjects. Physiotherapy. 2015;101(2):239–241. doi: 10.1016/j.physio.2014.08.002.
    1. Ogiwara Shimpachiro, Miyachi Tomoyo. Effect of Posture on Ventilatory Muscle Strength. Journal of Physical Therapy Science. 2002;14(1):1–5. doi: 10.1589/jpts.14.1.
    1. Peces-Barba G, Rodriguez-Nieto MJ, Verbanck S, Paiva M, Gonzalez-Mangado N. Lower pulmonary diffusing capacity in the prone vs. supine posture. J Appl Physiol (1985) 2004;96(5):1937–1942. doi: 10.1152/japplphysiol.00255.2003.
    1. Terzano C, Conti V, Petroianni A, Ceccarelli D, De Vito C, Villari P. Effect of postural variations on carbon monoxide diffusing capacity in healthy subjects and patients with chronic obstructive pulmonary disease. Respiration. 2009;77(1):51–57. doi: 10.1159/000137668.
    1. Faggiano P, D’Aloia A, Simoni P, et al. Effects of body position on the carbon monoxide diffusing capacity in patients with chronic heart failure: relation to hemodynamic changes. Cardiology. 1998;89(1):1–7. doi: 10.1159/000006735.
    1. Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J. Lung mechanics in sitting and horizontal body positions. Chest. 1983;83(4):643–646. doi: 10.1378/chest.83.4.643.
    1. Agostoni PG, Marenzi GC, Sganzerla P, et al. Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure. Am J Cardiol. 1995;76(11):793–798. doi: 10.1016/S0002-9149(99)80229-X.
    1. Agostoni PG, Cattadori G, Guazzi M, Palermo P, Bussotti M, Marenzi G. Cardiomegaly as a possible cause of lung dysfunction in patients with heart failure. Am Heart J. 2000;140(5):e24. doi: 10.1067/mhj.2000.110282.
    1. Hosenpud JD, Stibolt TA, Atwal K, Shelley D. Abnormal pulmonary function specifically related to congestive heart failure: comparison of patients before and after cardiac transplantation. Am J Med. 1990;88(5):493–496. doi: 10.1016/0002-9343(90)90428-G.
    1. Nava S, Larovere MT, Fanfulla F, Navalesi P, Delmastro M, Mortara A. Orthopnea and inspiratory effort in chronic heart failure patients. Respir Med. 2003;97(6):647–653. doi: 10.1053/rmed.2003.1495.
    1. Fromageot C, Lofaso F, Annane D, et al. Supine fall in lung volumes in the assessment of diaphragmatic weakness in neuromuscular disorders. Arch Phys Med Rehabil. 2001;82(1):123–128. doi: 10.1053/apmr.2001.18053.
    1. Lechtzin N, Wiener CM, Shade DM, Clawson L, Diette GB. Spirometry in the supine position improves the detection of diaphragmatic weakness in patients with amyotrophic lateral sclerosis. Chest. 2002;121(2):436–442. doi: 10.1378/chest.121.2.436.
    1. Baumann F, Henderson RD, Morrison SC, et al. Use of respiratory function tests to predict survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2010;11(1–2):194–202. doi: 10.3109/17482960902991773.
    1. Schmidt EP, Drachman DB, Wiener CM, Clawson L, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: use in clinical trial design. Muscle Nerve. 2006;33(1):127–132. doi: 10.1002/mus.20450.
    1. Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73(15):1218–1226. doi: 10.1212/WNL.0b013e3181bc0141.
    1. Fugl-Meyer AR. Effects of respiratory muscle paralysis in tetraplegic and paraplegic patients. Scand J Rehabil Med. 1971;3(4):141–150.
    1. Fugl-Meyer AR, Grimby G. Respiration in tetraplegia and in hemiplegia: a review. Int Rehabil Med. 1984;6(4):186–190. doi: 10.3109/03790798409165962.
    1. Huldtgren AC, Fugl-Meyer AR, Jonasson E, Bake B. Ventilatory dysfunction and respiratory rehabilitation in post-traumatic quadriplegia. Eur J Respir Dis. 1980;61(6):347–356.
    1. Wade OL, Gilson JC. The effect of posture on diaphragmatic movement and vital capacity in normal subjects with a note on spirometry as an aid in determining radiological chest volumes. Thorax. 1951;6(2):103–126. doi: 10.1136/thx.6.2.103.
    1. Moreno F, Lyons HA. Effect of body posture on lung volumes. J Appl Physiol. 1961;16:27–29. doi: 10.1152/jappl.1961.16.1.27.
    1. Castile R, Mead J, Jackson A, Wohl ME, Stokes D. Effects of posture on flow-volume curve configuration in normal humans. J Appl Physiol Respir Environ Exerc Physiol. 1982;53(5):1175–1183.
    1. Segizbaeva MO, Pogodin MA, Aleksandrova NP. Effects of body positions on respiratory muscle activation during maximal inspiratory maneuvers. Adv Exp Med Biol. 2013;756:355–363. doi: 10.1007/978-94-007-4549-0_43.
    1. Chang SC, Chang HI, Liu SY, Shiao GM, Perng RP. Effects of body position and age on membrane diffusing capacity and pulmonary capillary blood volume. Chest. 1992;102(1):139–142. doi: 10.1378/chest.102.1.139.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa