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Tokyo University Hospital Tokyo, Japan
Correspondence to: Shinji Teramoto, MD, FCCP, Department of Geriatric Medicine, Tokyo University Hospital, 7–3-1 Hongo Bunkyo-ku, Tokyo, Japan 113-8655; e-mail: shinjit-tky@umin. ac.jp
To the Editor:
We read with great interest the article by Aggarwal and coworkers (February 1999)1 concerning the interpretation of spirometric data in relation to anthropometric indexes. The authors have demonstrated that height estimated from arm span can be substituted for actual height in patients in whom height cannot be measured reliably.1 This is very important not only for patients with lung disease and spinal deformity, but also for older adults with osteoporosis.1
Although respiratory function is considerably affected by age,2 3 height and anthropometric indexes also are affected by age.3 4 5 Osteoporosis is particularly common in elderly people. Osteoporotic vertebral fractures increase in number and incidence with age, and changes in the shape of the thorax lead to increased dorsal kyphosis and anteroposterior diameter.3 4 5 The reported prevalence of vertebral crush fractures in the United Kingdom is 2.5% for women > 60 years old and reaches 7.5% for those 80 years old.6 The kyphosis and deformation of the thoracic cage secondary to osteoporosis impair pulmonary function, particularly vital capacity, in aged woman.4 Thoracic kyphosis as measured by Cobb’s angle is significantly associated with the FVC in women referred for osteoporosis evaluation.4 7 Because height is considerably affected by the vertebral fractures, Leech et al4 have suggested that arm span should be used for predicting lung function instead of height. Further, we also found that thoracic kyphosis as measured by Cobb’s angle was significantly associated with maximal inspiratory pressure (PImax) and the ratio of residual volume to total lung capacity in elderly people. Because PImax is influenced by the curvature of the diaphragm, the kyphosis-related alteration of diaphragmatic shape may reduce the pressure on inspiratory muscles.
Because an understanding of the normal progression of changes in respiratory function is important in assessing the loss in pulmonary reserve for elderly people with lung disease,7 height estimated from arm span may be important for the assessment of lung function in osteoporotic patients with or without lung disease.
References
Postgraduate Institute of Medical Education and Research Chandigarh, India
Correspondence to: Surinder K. Jindal, MD, FCCP, Postgraduate Institute of Medical Education and Research, Department of Pulmonary Medicine, Chandigarh, 160012, India
To the Editor:
We appreciate the interest shown by Teramoto and colleagues in our article (February 1999),1 and we fully agree with their observations on osteoporosis-induced height changes in the elderly. In fact, we had concluded that arm span is a reasonable surrogate for standing height in patients in whom height cannot be reliably measured, provided that a proper relationship between height and arm span is not available for that population.1 It may be worthwhile to evolve such a relationship for elderly patients. This would be useful not only for interpreting pulmonary function data, but also for other clinical assessments requiring the measurement of height. Height estimated from arm span using either a fixed ratio or a regression equation is better than the use of arm span alone.
References
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