Thoracic Kyphosis and Ventilatory Dysfunction in Unselected Older Persons: An Epidemiological Study in Dicomano, Italy

Authors

  • Mauro Di Bari MD, PhD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Melisenda Chiarlone MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Daniela Matteuzzi MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Simona Zacchei MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Claudia Pozzi MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Vincenzo Bellia MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Francesca Tarantini MD, PhD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Riccardo Pini MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Giulio Masotti MD,

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Niccoló Marchionni MD

    1. From the*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, ItalyIstituto di Medicina Interna e Pneumologia, University of Palermo and Ospedale V. Cervello, Palermo, Italy.
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  • Funded in part by the Regional Government of Tuscany (special project 333/C).

Address correspondence to Mauro Di Bari, MD, PhD, Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, via delle Oblate, 4, 50141 Florence, Italy. E-mail: dibari@unifi.it

Abstract

Objectives: To assess whether kyphosis is associated with ventilatory dysfunction in older community dwellers.

Design: Cross-sectional study.

Setting: The unselected population of Dicomano, Italy aged≥65 years.

Participants: A total of 323 nonheart failure participants underwent clinical evaluation for the presence of kyphosis and spirometry. The severity of kyphosis was estimated from the difference between standing stature and knee-height-derived stature and from the occiput-wall distance.

Measurements: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and prevalence of obstructive and restrictive ventilatory pattern.

Results: The 130 kyphotic participants (40.2%) had an adjusted 2.5 prevalence odds ratio (POR) for dyspnea (95% confidence interval (CI)=1.1–5.8). FVC% and FEV1% were lower in the presence of kyphosis (P<.01); their deficit was proportional to kyphosis severity. The ventilatory dysfunction was underestimated when reference spirometric parameters were calculated based on standing stature, compared with knee-height derived stature. Of the kyphotic participants, 56.2%, 26.9%, and 16.9% had spirometric normal, obstructive, and restrictive patterns, respectively. Kyphosis was associated with a restrictive (adjusted POR=2.3, 95% CI=1.1–4.8; P=.021) and an obstructive ventilatory pattern (adjusted POR=3.3, 95% CI=1.7–6.5; P<.001).

Conclusion: In unselected older persons, kyphosis is associated with dyspnea and ventilatory dysfunction of a restrictive and an obstructive type. Kyphosis should be included in the differential diagnosis of dyspnea and ventilatory dysfunction in the elderly.

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