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Original Research: DYSPNEA |

Arm Span to Height Ratio Is Related to Severity of Dyspnea, Reduced Spirometry Volumes, and Right Heart Strain FREE TO VIEW

Maw P. Tan, MRCP; Nu Nu Wynn, MBBS; Murad Umerov, MRCP; Alison Henderson, RN; Angela Gillham, RN; Shahid Junejo, FRCP; Sushil K. Bansal, FRCP
Author and Funding Information

*From the Institute for Ageing and Health (Dr. Tan), Newcastle University, Newcastle Upon Tyne, UK; and the Department of Cardiology (Drs. Wynn, Umerov, and Junejo) and the Department of Care of the Elderly (Ms. Henderson, Ms. Gillham, and Dr. Bansal), City Hospitals Sunderland NHS Trust, Sunderland, UK.

Correspondence to: Maw P. Tan, MRCP, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, UK, NE4 5PL; e-mail: mptan@doctors.org.uk


Dr. Junejo has received travel grants and honoraria from Boston-Scientific, Cordis, Sanofi-Aventis to attend educational meetings and as a speaker to primary care physicians. He also served on an advisory board for Sanofi-Aventis in 2007. The other authors have no conflicts of interest to disclose. This project was funded by a research grant from the British Geriatrics Society. Dr. Tan's salary is currently funded by the Royal College of Physicians/ Dunhill Medical Trust Joint Research Fellowship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):448-454. doi:10.1378/chest.08-1270
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Background:  Arm span is the closest physiologic measurement to standing height. Increased arm span to standing height ratio, therefore, indicates possible loss of height, which is a feature of aging, often resulting from osteoporosis-related vertebral collapse. We hypothesize that the discrepancy between arm span and height is associated with reduced airflow volumes, severity of dyspnea, and right-sided cardiac structural changes in older individuals with symptoms of dyspnea.

Method:  Patients with conditions investigated with transthoracic echocardiography for suspected heart failure were invited to participate in our study. All subjects were evaluated with a clinical history and physical examination followed by measurements of arm span, standing height, weight, FEV1, and FVC.

Results:  Sixty-six subjects aged 71 ± 10 years were recruited for our study. Arm span to height ratio was significantly negatively correlated with FEV1 (r = − 0.464; p < 0.001), FVC (r = − 0.479; p < 0.001), and body weight (r = − 0.252; p < 0.05), and positively correlated with the New York Heart Association classification for dyspnea (ρ = 0.309; p < 0.05). Female sex, steroid use, inhaled bronchodilators, orthopnea, paroxysmal nocturnal dyspnea, and right heart chamber dilatation were significantly associated with increased arm span to height ratio.

Conclusion:  We have found a significant association between increased arm span to height ratio, reduced respiratory airflow volumes, increased severity of dyspnea, and echocardiographic features of pulmonary heart disease in a group of predominantly elderly subjects with multiple comorbidities. The role of arm span measurements in assessments of airflow volumes in older patients and the association between loss of height and dyspnea now deserve further evaluation.

Figures in this Article

Arm span is the physiologic measurement with the closest correlation to standing height. Accurate spirometry or lung function estimation requires comparison between the measured FEV1 and FVC with the predicted FEV1 and FVC based on height and age.1 In situations where accurate measurement of standing height is not possible, estimated height can be calculated from arm span either through a fixed ratio2,3 or, more accurately, through regression equations that also include racial differences.4

Standing height may be reduced as a result of skeletal deformities, such as congenital scoliosis, vertebral fractures, arthritis, and physiologic changes associated with aging. A reduction of 10 cm in height is reported to equate to 700 mL of lung volume loss in women with osteoporosis.5 Aging is also associated with physiologic changes in respiratory function, including reduced chest wall compliance, reduced elastic recoil, increased residual volume, and impaired respiratory muscle strength, manifesting as reduced FVC and FEV1.6 Loss of lung volume as a result of loss of height or vertebral fractures are, therefore, likely to have greater effects on lung function in older people.

Despite concerns that osteoporotic vertebral fractures are prevalent in older people,7 routine estimation of height with arm span is currently not required in any age group. Allen8 found no significant discrepancies between standardized FEV1 for standing height and arm span in physically active, older women. He concluded that while arm span measurements are good substitutes for standing height in the presence of kyphoscoliosis or in circumstances where standing height measurements are not possible, there is no advantage in using arm span measurements in place of height in the older population.8

We hypothesize that the discrepancy between arm span and height is associated with reduced spirometric airflow volumes, severity of dyspnea, and echocardiographic features of pulmonary heart disease in patients presenting with the nonspecific symptoms of dyspnea. The availability of an open-access echocardiography service9 provided us with an ideal group of predominantly older subjects with the initial presentation of dyspnea and/or peripheral edema and were referred by their primary care physicians for initial investigations. Recruitment of subjects from this preselected group also provided us with echocardiographic features of right heart failure, which is gaining increasing prominence as a prognostic factor for respiratory disorders.10 Therefore, we elected to investigate the relationship between airflow volume, dyspnea scales, and right side cardiac abnormalities with discrepancies in arm span to height ratios in the above group of subjects.

Subjects

Participants were recruited from patients referred by general practitioners to the Department of Echocardiography at Sunderland Royal Hospital, Sunderland, UK, for transthoracic echocardiography for investigation of suspected heart failure. Only patients with measureable tricuspid regurgitant gradients were included. Subjects were stratified into transtricuspid pressure gradient (TTPG) ≥ 30 mm Hg and TTPG < 30 mm Hg. All patients with TTPG ≥ 30 mm Hg were invited, and patients with TTPG < 30 mm Hg were randomly selected on a 1:2 ratio basis. Written informed consent was obtained from all study participants.

Spirometry, Arm Span, and Height

Spirometry was performed using a spirometer (Vitalograph Gold Standard 2150; Vitalograph; Buckingham, UK) by appropriately trained nurses. FEV1 and the FVC in liters were determined. The best of three measurements was considered. Predicted FEV1 and FVC were calculated according to age, sex, and height, using previously published reference ranges.11 COPD was defined as an FEV1/FVC ratio < 0.70, according to the Global Initiative for Chronic Obstructive Lung Disease guidelines.12 Mild COPD was defined as FEV1 ≥ 80% of predicted for age and height, moderate COPD as 50% ≤ FEV1 < 80% of predicted, and severe COPD as FEV1 < 50% of predicted.12

Standing height was measured with footwear removed using a stadiometer to the nearest centimeter. Weight was measured in kilograms. Arm span was defined as the maximal distance between the tips of the two middle fingers with arms outstretched in centimeters and the patient standing against the wall. The estimated height was then calculated using the fixed ratio of 1.01 (height = arm span/1.01) for women and 1.03 (height = arm span/1.03) for men.2

Clinical Features

Subjects were interviewed and examined by medically trained investigators. The degree of dyspnea was assessed using the Medical Research Council (MRC) dyspnea scale13 and the New York Heart Association (NYHA) classification for severity of heart failure (Table 1). Specific enquiries were made about the associated symptoms of orthopnea and paroxysmal nocturnal dyspnea as well as the clinical signs of kyphoscoliosis and peripheral edema.

Table Graphic Jump Location
Table 1 MRC Dyspnea Scale and the NYHA Classification for Dyspnea
Echocardiographic Findings

Transthoracic echocardiography was performed by three experienced echocardiographers using an echocardiography system (SONOS 5500; Hewlett Packard; Andover, MA). The presence or absence of right atrial (RA) and right ventricular (RV) dilatation was noted by visual inspection. Pulmonary arterial systolic pressure was estimated by applying the modified Bernoulli equation (4V2) to the peak transtricuspid regurgitation velocity to obtain the TTPG in mm Hg.14 Other cardiac structures were also imaged as per routine echocardiographic examinations, as the purpose of referrals was to identify left ventricular systolic dysfunction and other cardiac structural abnormalities.

Statistic and Data Analysis

Height and arm span were expressed in centimeters, and weight in kilograms. The arm span to height ratio was determined by dividing the arm span (in centimeters) by the height (in centimeters).

Age and other continuous variables were expressed as mean ± SD. Variables were plotted as histograms, and their skewness and kurtosis determined to ensure normal distributions. Continuous variables were compared using the Student t test. Pearson correlation statistics and significance levels were determined for the continuous variables of TTPG, FEV1, FVC, age, and weight, while the Spearman correlation coefficient was used for the MRC scale and NYHA class. Adjustments for age, sex, and weight were made using multiple linear regression. Variables with significant relationships with arm span to height ratio on bivariate analyses were then entered into a stepwise multiple linear regression equation to determine the best predictor model for arm span to height ratio. All statistical analyses were performed using statistical analysis software (SPSS 14.0 for Windows; SPSS; Chicago, IL). This study had obtained a favorable ethical opinion from the Sunderland Local Research Ethics Committee.

Subjects

Sixty-six white subjects consented to the study. Nineteen subjects (29%) had TTPG ≥ 30 mm Hg, and 47 subjects (71%) had TTPG < 30 mm Hg. The mean age of subjects was 71 ± 10 (24 to 87) years, and 41 subjects (62%) were female. Arm span measurements were available for 65 subjects, as 1 subject was unable to fully extend his arm due to severe arthritis. The mean arm span to height ratios for the male and female sexes were significantly different at 1.01 ± 0.04 and 1.05 ± 0.04, respectively (p = 0.001). There was no significant correlation between arm span to height ratio and age (Pearson r = 0.164; p = 0.193), but body weight was significantly negatively correlated with arm span to height ratio (r = − 0.252; p = 0.047).

Clinical Features and Severity of Dyspnea

The clinical characteristics of subjects and their association with arm span to height ratio are summarized in Table 2. The mean arm span to height ratio was similar for subjects with and without medical histories of hypertension, ischemic heart disease, diabetes, osteoarthritis, asthma, COPD, and smoking. Mean arm span to height ratios were significantly higher for subjects who were using inhaled anticholinergics (1.08 ± 0.07 vs 1.03 ± 0.04, p = 0.012), inhaled or oral steroids (1.06 ± 0.05 vs 1.03 ± 0.04; p = 0.011), and inhaled β-agonists (1.05 ± 0.04 vs 1.03 ± 0.04; p = 0.014). The mean arm span to height ratio was significantly higher in subjects with symptoms of orthopnea (1.07 ± 0.06 vs 1.03 ± 0.04, p = 0.002), but not subjects with symptoms or signs of peripheral edema (1.03 ± 0.04 vs 1.04 ± 0.05, p = 0.889). The clinical sign of kyphoscoliosis was present in five subjects (8%), and was significantly associated with a higher arm span to height ratio (1.10 ± 0.06 vs 1.03 ± 0.04, p = 0.001). The correlation between arm span to height ratio and severity of symptoms was statistically significant for the NYHA classification (Spearman ρ = 0.309; p = 0.016), and nearly significant for the MRC dyspnea scale (ρ = 0.209; p = 0.058) [Fig 1].

Table Graphic Jump Location
Table 2 Subject Characteristics*

*Data are presented as mean ± SD.

†Current and previous smoking.

‡Ipratropium or tiotropium.

Figure Jump LinkFigure 1 Scatterplots of NYHA classification for heart failure and MRC dyspnea scale against arm span to height ratio. NYHA class was significantly correlated with arm span to height ratio (Spearman ρ = 0.309; p < 0.05). There was a near significant correlation between MRC dyspnea scale and arm span to height ratio (ρ = 0.209; p = 0.058).Grahic Jump Location

On multiple linear regression analysis, NYHA class, female sex, orthopnea, steroid use, and kyphoscoliosis provided the best predictor model for arm span to height ratio (R2 = 0.492, p < 0.001), with female gender as the strongest independent predictor (p = 0.003) [Table 3]. If only women were considered, NYHA class, orthopnea, and kyphoscoliosis remained independent predictors for arm span to height ratio (R2 = 0.586; p < 0.001) [Table 3].

Table Graphic Jump Location
Table 3 Multiple Linear Regression Predictor Models for Arm Span: Height Ratio

*Excluded variables.

†Only women included.

Spirometry Measurements

Spirometry flow volumes were available for 63 subjects. One patient was unable to comply fully with the test, while two subjects had contraindications due to recent myocardial infarction and cataract operation. Thirty-three subjects (52%) had a FEV1/FVC ratio < 0.70. Using standing height to calculate predicted FEV1, 16 subjects (48%) were classified as mild COPD, 12 subjects (36%) had moderate COPD, and 5 subjects (15%) had severe COPD. However, if predicted FEV1 was determined with estimated height using arm span, using fixed ratios of 1.03 for men and 1.01 for women, 15 subjects (45%) had mild COPD, 11 subjects (33%) had moderate COPD, and 7 subjects (21%) had severe COPD. The mean differences between FEV1 and FVC estimated with arm span and height were 6.9 ± 12.8% for FEV1 and 8.3 ± 12.5% for FVC. Twenty-one of the 33 subjects (64%) who had an FEV1/FVC ratio < 0.70 had not had a previous diagnosis of COPD, 7 of whom (33%) had moderate or severe COPD. Six of the 18 subjects (33%) who had a reported medical history of COPD did not have significant airway obstruction on spirometry.

There was a significant negative correlation between FEV1 and FVC with arm span to height ratio (Pearson r = − 0.464; p < 0.001 for FEV1 and r = − 0.479; p < 0.001 for FVC) [Fig 2], but not FEV1/FVC ratio (r = − 0.061; p = 0.633). The mean arm span to height ratio for subjects with and without COPD on spirometric assessment was similar (1.03 ± 0.03 vs 1.03 ± 0.06; p = 0.926). After adjustment for age, sex, and body weight with multiple linear regression, arm span to height ratio remained significantly negatively correlated with FEV1 (partial correlation coefficient = − 0.257; p = 0.047) and FVC (partial correlation = − 0.256; p = 0.049).

Figure Jump LinkFigure 2 Scatterplots of arm span to height ratio against FEV1 (Pearson r = − 0.464; p < 0.001) and FVC (r = − 0.479; p < 0.001).Grahic Jump Location
Transthoracic Echocardiography

The echocardiographic features of our subjects are listed in Table 2. There was no significant difference between mean arm span to height ratio for subjects with TTPG ≥ 30 mm Hg and subjects with TTPG < 30 mm Hg. There was also no significant correlation between TTPG and arm span to height ratio (r = 0.138; p = 0.272). However, the mean arm span to height ratios in subjects with RA and RV dilatation were significantly higher than those in subjects with normal RA (1.06 ± 0.05 vs 1.03 ± 0.04; p = 0.035) and RV (1.06 ± 0.06 vs 1.03 ± 0.04; p = 0.026) diameters. There were no significant differences in mean arm span to height ratio for subjects with and without left side cardiac abnormalities.

In our study, arm span to standing height ratio was positively correlated with degree of dyspnea and negatively correlated with FEV1 and FVC in patients investigated via echocardiography for suspected heart failure. RA dilatation and RV dilatation were associated with a significantly higher arm span to height ratio. There was, however, no significant association between arm span to height ratio and TTPG. The clinical features of kyphoscoliosis and orthopnea but not peripheral edema were associated with a higher arm span to height ratio.

An increase in the arm span to height ratio would indicate a discrepancy between estimated height and actual height, suggesting the presence of loss of height. The mean age of subjects in our study was 71 years, with only two subjects aged < 50 years. Loss of standing height is an established age-related problem. The underlying causes of height reduction include loss of vertebral space, increased spinal curvature due to vertebral fractures, or osteoarthritis.6 Partial vertebral fractures are found in 60% of female and 30% of male subjects aged 75 or greater.15 Arm span to height ratio was inversely correlated with body weight and significantly associated with female sex and steroid use in our study. Low body weight, female sex, and steroid use are established risk factors for osteoporosis.16

Our subjects were patients who presented with symptoms and clinical signs that led to the suspected diagnosis of heart failure by their general practitioners. The clinical features of heart failure, which include dyspnea, orthopnea, peripheral edema, chronic cough, raised jugular venous pressure, respiratory wheeze, and crepitations, are nonspecific. The echocardiographic diagnosis of left ventricular systolic dysfunction was only made in 18% of our subjects. An identical diagnostic yield of 18% was also reported by an open-access echocardiography service similar to ours.9 The availability of this service, therefore, provided us with an ideal patient group being referred by their primary care physicians for the initial investigations for symptoms of dyspnea. This is further evidenced by 53% of our subjects fulfilling the diagnostic criteria for COPD. However, the 53% may be a large overestimate in view of previous evidence17 demonstrating that 35% of asymptomatic elderly nonsmokers also fulfilled the diagnostic criteria of FEV1/FVC < 0.70.

COPD has been associated with osteoporosis and low body weight as established systemic effects.18 The results of our study, however, did not demonstrate any significant correlation between FEV1/FVC and arm span to height ratio. There was also no significant difference in mean arm span to height ratio in subjects with medical histories of COPD or subjects with FEV1/FVC < 0.7 following spirometric assessments. The association between the use of inhaled bronchodilators and increased arm span to height ratio despite the absence of any association in COPD with arm span to height ratio is puzzling, but this may be confounded by steroid use. An alternative explanation is that increased arm span to height ratio leads to increased symptom severity in subjects with COPD, necessitating the prescription of regular inhaled bronchodilator and steroid therapy.

The mean differences between percentages predicted FEV1 and FVC with height and weight were 6% for FEV1% and 8% for FVC, but actual discrepancies of up to 43% and 31%, respectively, were observed. As only 7.5% of our subjects had clinically apparent kyphoscoliosis, > 90% of our subjects would not have had arm span measurements taken if they were referred for lung function tests in routine practice. Allen8 based his conclusion on the relationship between arm span and standing height in physically active, older, female volunteers.8 Our subjects were symptomatic older patients with multiple comorbidities who sought medical attention for dyspnea. While arm span estimation is not indicated in asymptomatic, healthy, older women, our study, which also included male subjects, suggests this may not be applicable in symptomatic older subjects. Multiple regression analysis revealed severity of dyspnea using the NYHA scale, female sex, orthopnea, steroid use, and kyphoscoliosis as independent predictors of arm span to height ratio. The presence of any of the above factors can therefore be used as a guide for the requirement of arm span measurements.

Pulmonary hypertension is an established complication of chronic respiratory disorders and is widely accepted as a negative prognostic indicator.19,20 The echocardiographic features of pulmonary hypertension and right heart failure include RA dilatation, RV dilatation, and increased TTPG.21 The association between right heart chamber dilatation and increased mean arm span to height ratio observed in our subjects suggests that the respiratory compromise due to loss of height may be complicated by right heart failure, further increasing our suspicion of a previously underrecognized chronic respiratory disorder. A possible explanation for the association between loss of height and right heart strain could be the presence of chronic hypoxia either as a result of reduced functional capacity or hypoventilation from increased work of breathing due to skeletal deformities. Chronic hypoxia then leads to increased pulmonary vascular resistance, resulting in pulmonary hypertension, increased RV afterload, and eventual right heart failure or cor pulmonale.22 The lack of association between TTPG and arm span to height ratio in our study may be due to our small number of subjects.

The general applicability of our study is limited by the inclusion of only patients with measureable TTPG, as we were unable to make comparisons between pulmonary arterial systolic pressure and arm span to height ratio in subjects for whom TTPG could not be estimated. The measurement of TTPG on transthoracic echocardiography is only possible with the presence of tricuspid regurgitation, which has been reported to be present in 39 to 83% of subjects evaluated.23 However, the relationship between arm span to height ratio and reduced pulmonary airflow volume and severity in a highly symptomatic group of older subjects has not previously been demonstrated. Our study should, therefore, draw attention to the potential importance of arm span measurements in spirometry assessments in the above group of subjects as well as the potential clinical significance of the discrepancy between arm span and height. Future studies should include recall of previous maximal height and estimation of the angle of curvature of the spine using skeletal radiographs, which will also identify skeletal deformities such as quiescent vertebral fractures. Bone densitometry assessment, as now required for osteoporosis detection, should also be considered.

An increased arm span to height ratio, an indication of possible loss of height, is associated with increased dyspnea and reduced FEV1 and FVC in our group of predominantly older, symptomatic subjects with multiple comorbidities. The association between right heart chamber dilatation and increased arm span to height ratio suggests the possibility of ensuing cardiac complications, further highlighting the potential clinical importance of the discrepancy between arm span and standing height. Future evaluations into the relationship between loss of height with dyspnea, as well as the importance of arm span measurements in lung function assessments, should now be performed.

MRC

Medical Research Council

NYHA

New York Heart Association

RA

right atrial

RV

right ventricular

TTPG

transtricuspid pressure gradient

Our thanks to all the staff members at the Medical Ambulatory Care Unit and the Echocardiography Department, Sunderland Royal Hospital for all their assistance and good will, without which this project would not have been possible.

Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-968. [PubMed] [CrossRef]
 
Hepper NG, Black LF, Fowler WS. Relationships of lung volume to height and arm span in normal subjects and in patients with spinal deformity. Am Rev Respir Dis. 1965;91:356-362. [PubMed]
 
Aggarwal AN, Gupta D, Jindal SK. Interpreting spirometric data: impact of substitution of arm span for standing height in adults from North India. Chest. 1999;115:557-562. [PubMed]
 
Parker JM, Dillard TA, Phillips YY. Arm span-height relationships in patients referred for spirometry. Am J Respir Crit Care Med. 1996;154:533-536. [PubMed]
 
Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141:68-71. [PubMed]
 
Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197-205. [PubMed]
 
Teramoto S, Matsuse T, Ouchi Y. Substitution of arm span for standing height is important for the assessment of predicted value of lung volumes in elderly people with osteoporosis. Chest. 1999;116:1837-1838. [PubMed]
 
Allen SC. The relation between height, arm span, and forced expiratory volume in elderly women. Age and Ageing. 1989;18:113-116. [PubMed]
 
Francis CM, Caruana L, Kearney P, et al. Open access echocardiography in management of heart failure in the community. BMJ. 1995;310:634-636. [PubMed]
 
Voelkel NF, Quaife RA, Leinwand LA, et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114:1883-1891. [PubMed]
 
Quanjer PH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows: report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993;16Suppl:5-40
 
Definition Global Initiative of Chronic Obstructive Lung Disease - Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. MCR Vision. 2007;:1-5
 
Fletcher CM, Elmes PC, Fairbairn AS, et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. BMJ. 1959;2:257-266. [PubMed]
 
Aessopos A, Farmakis D, Taktikou H, et al. Doppler- determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation. J Am Soc Echocardiograph. 2000;13:645-649
 
Riggs BL, Melton L Jr. Involutional osteoporosis. N Engl J Med. 1986;314:1676-1686. [PubMed]
 
De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Intl. 2005;16:1330-1338
 
Hardie JA, Buist AS, Vollmer WM, et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J. 2002;20:1117-1122. [PubMed]
 
Fabbri LM, Luppi F, Beghe B, et al. Complex chronic comorbidities of COPD. Eur Respir J. 2008;31:204-212. [PubMed]
 
Carrington M, Murphy NF, Strange G, et al. Prognostic impact of pulmonary arterial hypertension: a population-based analysis. Int J Cardiol. 2008;124:183-187. [PubMed]
 
Oswald-Mammosser M, Weitzenblum E, Quoix E, et al. Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest. 1995;107:1193-1198. [PubMed]
 
Barbera JA, Peinado VI, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur Respir J. 2003;21:892-905. [PubMed]
 
Chemla D, Castelain V, Herve P, et al. Haemodynamic evaluation of pulmonary hypertension. Eur Respir J. 2002;20:1314-1331. [PubMed]
 
Barst RJ, McGoon M, Torbicki A, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43:40S-47S. [PubMed]
 

Figures

Figure Jump LinkFigure 1 Scatterplots of NYHA classification for heart failure and MRC dyspnea scale against arm span to height ratio. NYHA class was significantly correlated with arm span to height ratio (Spearman ρ = 0.309; p < 0.05). There was a near significant correlation between MRC dyspnea scale and arm span to height ratio (ρ = 0.209; p = 0.058).Grahic Jump Location
Figure Jump LinkFigure 2 Scatterplots of arm span to height ratio against FEV1 (Pearson r = − 0.464; p < 0.001) and FVC (r = − 0.479; p < 0.001).Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 MRC Dyspnea Scale and the NYHA Classification for Dyspnea
Table Graphic Jump Location
Table 2 Subject Characteristics*

*Data are presented as mean ± SD.

†Current and previous smoking.

‡Ipratropium or tiotropium.

Table Graphic Jump Location
Table 3 Multiple Linear Regression Predictor Models for Arm Span: Height Ratio

*Excluded variables.

†Only women included.

References

Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-968. [PubMed] [CrossRef]
 
Hepper NG, Black LF, Fowler WS. Relationships of lung volume to height and arm span in normal subjects and in patients with spinal deformity. Am Rev Respir Dis. 1965;91:356-362. [PubMed]
 
Aggarwal AN, Gupta D, Jindal SK. Interpreting spirometric data: impact of substitution of arm span for standing height in adults from North India. Chest. 1999;115:557-562. [PubMed]
 
Parker JM, Dillard TA, Phillips YY. Arm span-height relationships in patients referred for spirometry. Am J Respir Crit Care Med. 1996;154:533-536. [PubMed]
 
Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141:68-71. [PubMed]
 
Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197-205. [PubMed]
 
Teramoto S, Matsuse T, Ouchi Y. Substitution of arm span for standing height is important for the assessment of predicted value of lung volumes in elderly people with osteoporosis. Chest. 1999;116:1837-1838. [PubMed]
 
Allen SC. The relation between height, arm span, and forced expiratory volume in elderly women. Age and Ageing. 1989;18:113-116. [PubMed]
 
Francis CM, Caruana L, Kearney P, et al. Open access echocardiography in management of heart failure in the community. BMJ. 1995;310:634-636. [PubMed]
 
Voelkel NF, Quaife RA, Leinwand LA, et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114:1883-1891. [PubMed]
 
Quanjer PH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows: report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993;16Suppl:5-40
 
Definition Global Initiative of Chronic Obstructive Lung Disease - Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. MCR Vision. 2007;:1-5
 
Fletcher CM, Elmes PC, Fairbairn AS, et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. BMJ. 1959;2:257-266. [PubMed]
 
Aessopos A, Farmakis D, Taktikou H, et al. Doppler- determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation. J Am Soc Echocardiograph. 2000;13:645-649
 
Riggs BL, Melton L Jr. Involutional osteoporosis. N Engl J Med. 1986;314:1676-1686. [PubMed]
 
De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Intl. 2005;16:1330-1338
 
Hardie JA, Buist AS, Vollmer WM, et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J. 2002;20:1117-1122. [PubMed]
 
Fabbri LM, Luppi F, Beghe B, et al. Complex chronic comorbidities of COPD. Eur Respir J. 2008;31:204-212. [PubMed]
 
Carrington M, Murphy NF, Strange G, et al. Prognostic impact of pulmonary arterial hypertension: a population-based analysis. Int J Cardiol. 2008;124:183-187. [PubMed]
 
Oswald-Mammosser M, Weitzenblum E, Quoix E, et al. Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest. 1995;107:1193-1198. [PubMed]
 
Barbera JA, Peinado VI, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur Respir J. 2003;21:892-905. [PubMed]
 
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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543