Resumo
Introdução: a espirometria é um teste de função pulmonar utilizado na avaliação de programas de reabilitação para avaliar exposição a tóxicos e alérgenos, em estudos epidemiológicos e no desenvolvimento de equações de referência em populações específicas; estes valores podem variar de acordo com a altura. Objetivo: estabelecer as diferenças entre os valores de referência da espirometria forçada em adultos residentes em alturas maiores e menores a 1500 metros acima do nível do mar. Métodos: revisão sistemática, foram encontrados 536 estudos, foram avaliados 66 em texto completo, 33 em qualidade metodológica com as listas de exame Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies e Quality Assessment of Case-Control Studies; 21 estudos foram selecionados para revisão e 12 produziram metanálise. Resultados: 48 923 participantes tiveram alturas entre 2,4 e 4440 m s. n. m. Existem diferenças iniciais ao relacionar altura (+/-1500 m s. n. m) com VEF1 (homens: DM 0,29; IC: 0,03-0,55; mulheres: DM 0,27; IC: -0,07-0,60) e valores de referência com sexo: CVF (DM 1,31; IC: 1,24-1,37) e VEF1 (DM: 1,03; IC: 0,95-1,11). Foi relatada alta heterogeneidade e risco de enviesamento. Discussão: estas diferenças são dadas em função de aspectos antropométricos e fisiológicos como a aclimatação e o envelhecimento pulmonar. Os mecanismos que influenciam estas alterações são a adaptação genética, molecular, fisiológica e anatômica, que permitem compensar os efeitos da hipóxia aguda ou crônica, o que aumenta a ventilação alveolar e os valores espirométricos. Conclusões: os valores de referência da espirometria variam de acordo com a altura (maiores em alturas > 1500 m s. n. m) e sexo (mais elevados em homens). É necessário ter provas mais amplas e contundentes na temática.
Referências
Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Graham LH, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med. 2019; 200(8): e70-e88. doi: http://dx.doi.org/10.1164/rccm.201908-1590ST
García F, Calle M, Burgos F, Casan P, Del Campo F, Galdiz JB, et al. Espirometría. Arch Bronconeumol. 2013; 49(9): 388–401. doi: http://dx.doi. org/10.1016/j.arbres.2013.04.001
Acero R. Enfermedades pulmonares relacionadas con la Altura. En: Torres-Duque CA, editor. Fundamentos de Medicina, Neumología. 5a Ed. Medellín: Celsus; 1998. 486-492 p.
Compte-Torrero L, Botella de Maglia J, de Diego- Damiá A, Gómez-Pérez L, Ramírez-Galleymore P, Perpiñá-Tordera M. Changes in spirometric parameters and arterial oxygen saturation during a mountain ascent to over 3000 meters. Arch Bronconeumol. 2005; 41(10): 547-552. doi: https:// doi.org/10.1016/s1579-2129(06)60281-4
Pollard AJ, Mason NP, Barry PW, Pollard RC, Collier DJ, Fraser RS, et al. Effect of altitude on spirometric parameters and the performance of peak flow meters. Thorax. 1996; 51(2): 175-178.
Dreyse J, Gil R. Ecuaciones de referencia para informe de espirometrías. ¿Será tiempo de adoptar las ecuaciones de la Global Initiative for Lung Function? Rev Chil Enferm Respir. 2020; 36(1): 13-17. doi: http://dx.doi.org/10.4067/S0717- 73482020000100013
Martin Holguera R, Turrion Nieves AI, Rodriguez Torres R, Alonso MC. The effects of truncal adiposity in forced spirometry: Sex differences. Resp Physio Neurobiol. 2018; 24: 167-173. doi: http://dx.doi.org/10.1016/j.resp.2017.10.009
Llanos-Salcedo C, Muñoz-Farfán K, Maguiña JL. Valores referenciales de los parámetros espirométricos en trabajadores sanos de diferentes niveles de altitud en el Perú. Acta Méd Peru. 2020; 37(4): 455-462. doi: http://dx.doi.org/10.35663/ amp.2020.374.1061
Quemba-Mesa MP, Pirachicán-Soto LC, Umbacia- Salas FA, Wilches-Wilches MR, Lara-Echeverry AI. Diferencias entre los valores de referencia de la espirometría forzada en población adulta residente en lugares ubicados a altitudes bajas, moderadas, altas y muy altas sobre el nivel del mar. Revisión sistemática de la literatura. PROSPERO. 2021: CRD42021259248. Disponible en: https:// www.crd.york.ac.uk/prospero/display_record. php?ID=CRD42021259248
Urrútia G, Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis [PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses]. Med Clin (Barc). 2010;135(11):507-511. doi: http://dx.doi. org/10.1016/j.medcli.2010.01.015
National Institutes of Health [Internet]. Bethesda: NIH; 2021 [Citado 1 Enero 2021]. Study Quality Assessment Tools. Disponible en: https://www. nhlbi.nih.gov/health-topics/study-quality-assessment-tools
Ana GR, Odeshi TA, Sridhar MK, Ige MO. Outdoor respirable particulate matter and the lung function status of residents of selected communities in Ibadan, Nigeria. Perspect Public Health. 2014; 134(3): 169-715. doi: http://dx.doi. org/10.1177/1757913913494152
Horner A, Soriano JB, Puhan MA, Studnicka M, Kaiser B, Vanfleteren LEGW, et al. Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study. Respir Res. 2017; 18, 162. doi: https://doi.org/10.1186/s12931- 017-0643-5
Jaganath D, Miranda JJ, Gilman RH, Wise RA, Diette GB, Miele CH, et al. CRONICAS Cohort Study Group. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res. 2015; 16(1):40. doi: http://dx.doi.org/10.1186/s12931-015-0198-2
Siavash E, Ahmad A. Spirometric reference values for healthy adults in the Mazandaran province of Iran. J Bras Pneumol. 2011; 37(5):615-620. doi: https:// doi.org/10.1590/S1806-37132011000500008
Córdova E, Rojas F, Mujica E. Valores espirométricos en pobladores de altura con sobrepeso. Valores espirométricos en pobladores de altura con sobrepeso. An Fac med. 2018; 79(4): 288-292. doi: http://dx.doi.org/10.15381/anales.v79i4.15631
Pistelli F, Bottai M, Carrozzi L, Baldacci S, Simoni M, Di Pede F, et al. Reference equations for spirometry from a general population sample in central Italy. Respir Med. 2007; 101(4): 814-825. doi: http://dx.doi.org/10.1016/j. rmed.2006.06.032
Kainu U, Timonen KL, Toikka J, Qaiser B, Pitkäniemi J, Kotaniemi JT, et al. Reference values of spirometry for Finnish adults. Clin Physiol Funct Imaging. 2016; 36(5): 346-358. doi: http://dx.doi. org/10.1111/cpf.12237
Fulambarker A, Sinan Copur A, Javeri A, Sujata Jere, Cohen M. Reference values for pulmonary function in Asian Indians living in the United State. Chest. 2004; 126(4): 1225-1233. doi: http://dx.doi. org/10.1378/chest.126.4.1225
Sulaiman X, Xu WF, Cai LH, Huang XY, Cheng LF, Zhang YP. Hematologic and spirometric characteristics of Tajik and Kyrgyz highlanders in the Pamir Mountains. Am. J. Hum. Biol. 2021; 33 (2): e23459. doi: http://dx.doi.org/10.1002/ ajhb.23459
Cid-Juárez S, Thirión-Romero I, Torre-Bouscoulet L, Gochicoa-Rangel L, Martínez-Briseño D, Hernández-Paniagua IY, et al. Inspiratory Capacity and Vital Capacity of Healthy Subjects 9-81 Years of Age at Moderate-High Altitude. Respir Care. 2019;64(2):153-160. doi: http://dx.doi.org/10.4187/ respcare.06284
22. Fiori G, Facchini F, Ismagulov O, Ismagulova A, Tarazona-Santos E, Pettener D. Lung volume, chest size, and hematological variation in low-, medium-, and high-altitude central Asian populations. Am J Phys Anthropol. 2000; 113(1): 47-59. doi: https://doi. org/10.1002/1096-8644(200009)113:1<47::AID-AJPA5>3.0.CO;2-K
23. Havryk AP, Gilbert M, Burgess KR. Spirometry values in Himalayan high-altitude residents (Sherpas). Respir Physiol Neurobiol. 2002; 132: 223-232. doi: http://dx.doi.org/10.1016/S1569- 9048(02)00072-1
24. Oyarzún G Manuel. Función respiratoria en la senectud. Rev Med Chile. 2009; 137(3): 411- 418. doi: http://dx.doi.org/10.4067/S0034- 98872009000300014
25. Casan P, Togores B, Giner J, Nerin I, Drobnic F, Borderias L, Caminero J, Duce F, Agusti AG. Lack of effects of moderate-high altitude upon lung function in healthy middle-age volunteers. Respir Med, 93 (1999), pp. 739-43
26. Beall CM, Strohl KP, Blangero J, Williams-Blangero S, Almasy LA, Decker MJ, et al. Ventilation and hypoxic ventilatory response of Tibetan and Aymara high altitude natives. Am. J. Phys. Anthropol. 1997; 104: 427–447.
27. Sato M, Severinghaus JW, Powell FL, Xu F-D, Spellman Jr MJ. Augmented hypoxic ventilatory response in men at altitude. J Appl Physiol. 1992; 73: 101–107.
28. Gonzalez-García M, Maldonado D, Barrero M, Casas A, Perez-Padilla R, Torres-Duque CA. Arterial blood gases and ventilation at rest by age and sex in an adult Andean population resident at high altitude. Eur J Appl Physiol. 2020; 120(12): 2729-2736. doi: http://dx.doi.org/10.1007/s00421- 020-04498-z
29. Fawibe AE, Odeigah LO, Saka MJ. Reference equations for spirometric indices from a sample of the general adult population in Nigeria. BMC Pulm Med. 2017; 17(1): 48. doi: 10.1186/s12890-017- 0390-x
Córdova-Córdova Enrique G, Rojas-Palpán Frany G, Mujica-Albán Elydia. Valores espirométricos en pobladores de altura con sobrepeso. An Fac Med. 2018; 79(4): 288-292. doi: http://dx.doi. org/10.15381/anales.v79i4.15631
Escrig-Sosa VJ, Llueca-Abellab JA, Granel- Villacha L, Bellver-Oliver M. Metaanálisis: una forma básica de entender e interpretar su evidencia. Rev. de Senol. y Patol. Mamar. 2021; 34: 44-51. doi: https://doi.org/10.1016/j.senol.2020.05.007
Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012; 40(6): 1324-1343. doi: http://dx.doi. org/10.1183/09031936.00080312
White NW, Hanley JH, Lalloo UG, Becklake MR. Review and analysis of variation between spirometric values reported in 29 studies of healthy African adults. Am J Respir Crit Care Med. 1994; 150(2): 348-355. doi: http://dx.doi.org/10.1164/ ajrccm.150.2.8049814
Ortiz-Prado E, Encalada S, Mosquera J, Simbaña- Rivera K, Gomez-Barreno L, Duta D, et al. A comparative analysis of lung function and spirometry parameters in genotype-controlled natives living at low and high altitude. BMC Pulm Med. 2022; 22(1): 100. doi: http://dx.doi.org/10.1186/s12890- 022-01889-0
Ulrich S, Furian M, Estebesova B, Toktogulova N, Beishekeeva G, Ulrich S, et al. Spirometry in Central Asian lowlanders and highlanders, a population based study. Front Med (Lausanne). 2020; 6: 308. doi: http:// dx.doi.org/10.3389/fmed.2019.00308
Koch B, Schäper C, Ewert R, Völzke H, Obst A, Friedrich N, et al. Lung function reference values in different German populations. Respir Med. 2011;105(3):352-362. doi: http://dx.doi. org/10.1016/j.rmed.2010.10.014
Desai U, Joshi JM, Chhabra SK, Rahman MU. Prediction equations for spirometry in adults in western India. Indian J Tuberc. 2016; 63(3): 176-182. doi: http://dx.doi.org/10.1016/j.ijtb.2016.08.005
Prieto FE. El balance entre producir y usar el conocimiento. Rev Inv Salud Univ. Boyacá. 2017; 4(1): 11-15. doi: http://dx.doi. org/10.24267/23897325.222
Pala K, Türkkan A, Gerçek H, Osman E, Aytekin H. Evaluation of respiratory functions of residents around the Orhaneli thermal power plant in Turkey. Asia Pac J Public Health. 2012; 24(1): 48-57. doi: http://dx.doi.org/10.1177/1010539510363622
Prata TA, Mancuzo E, Pereira CAC, Miranda SS, Sadigursky LV, Hirotsu C, et al. Spirometry reference values for black adults in Brazil. J Bras Pneumol. 2018; 44(6): 449-455. doi: https://doi. org/10.1590/S1806-37562018000000082
Rufino R, Costa CH, Lopes AJ, Maiworm AI, Maynard K, Silva LM, et al. Spirometry reference values in the Brazilian population. Braz J Med Biol Res. 2017; 50(3): e5700. Published 2017. doi: https://doi.org/10.1590/1414-431X20175700
Duarte AA, Pereira CA, Rodrigues SC. Validation of new Brazilian predicted values for forced spirometry in caucasians and comparison with predicted values obtained using other reference equations. J Bras Pneumol. 2007; 33(5): 527-535. doi: https://doi. org/10.1590/S1806-37132007000500007
Loth DW, Ittermann T, Lahousse L, Hofman A, Leufkens HG, Brusselle GG, et al. Normal spirometry values in healthy elderly: the Rotterdam Study. Eur J Epidemiol. 2013; 28(4): 329-334. doi: http://dx.doi.org/10.1007/s10654-013-9800-4
Bashir AA, Musa OA. Reference spirometric values in a Sudanese cohort. East Mediterr Health J. 2012; 18(2): 151-158. doi: http://dx.doi. org/10.26719/2012.18.2.151
Musafiri S, van Meerbeeck JP, Musango L, Derom E, Brusselle G, Joos G, et al. Spirometric reference values for an East-African population. Respiration. 2013; 85(4): 297-304. doi: http:// dx.doi.org/10.1159/000337256
López Jové OR, Arce SC, Chávez RW, Alaniz A, Lancellotti D, Chiapella MN, et al. Spirometry reference values for an andean high-altitude population. Respir Physiol Neurobiol. 2018; 247: 133-139. doi: http://dx.doi.org/10.1016/j. resp.2017.09.016
Ip MS, Ko FW, Lau AC, Yu WC, Tang KS, Choo K, et al. Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest. 2006; 129(2): 384-392. doi: http://dx.doi.org/10.1378/chest.129.2.384
Brisman J, Kim JL, Olin AC, Torén K, Bake B. Spirometric reference equations for Swedish adults. Clin Physiol Funct Imaging. 2017; 37(6): 640-645. doi: http://dx.doi.org/10.1111/cpf.12349
Al Ghobain MO, Alhamad EH, Alorainy HS, Al Hazmi M, Al Moamary MS, Al-Hajjaj MS, et al. Spirometric reference values for healthy nonsmoking Saudi adults. Clin Respir J. 2014; 8(1): 72-78. doi: http://dx.doi.org/10.1111/crj.12038
Rojas MX, Dennis RJ. Valores de referencia para parámetros de espirometría en la población adulta residente en Bogotá, D. C., Colombia. Biomedica. 2010; 30(1): 82-84. doi: http://dx.doi.org/10.7705/ biomedica.v30i1.156
Pérez-Padilla R, Valdivia G, Muiño A, López MV, Márquez MN, Montes de Oca M, et al. Valores de referencia espirométrica en 5 grandes ciudades de Latinoamérica para sujetos de 40 o más años de edad. Arch Bronconeumol. 2006; 42(4): 317-325. doi: http://dx.doi.org/10.1157/13090581
Valenzuela-Bejarano MA, Ramos-Martínez E. Medición de la capacidad vital forzada por espirometría en habitantes adultos naturales de Junín (4105 m. s. n. m.). Enfer Tórax (Lima). 2004; 48(2): 149-156.
Ben Saad H, El Attar MN, Hadj Mabrouk K, Ben Abdelaziz A, Abdelghani A, Bousarssar M, et al. The recent multi-ethnic global lung initiative 2012 (GLI2012) reference values don’t reflect contemporary adult’s North African spirometry. Respir Med. 2013; 107(12): 2000-2008. doi: http:// dx.doi.org/10.1016/j.rmed.2013.10.015
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Copyright (c) 2023 Mónica Paola Quemba-Mesa, Adriana Sofía Valero-Ortiz, Marcela América Roa-Cubaque, Flor Angela Umbacia-Salas, Myriam Rocío Wilches-Wilches, Leidy Carolina Pirachicán-Soto