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• Published: 11 October 2018

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

BMC Pulmonary Medicine volume 18, Commodity number:159 (2018) Cite this article

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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 torso position on lung office in healthy persons and specific patient groups.

Methods

A search to identify English language-language papers published from 1/1998–12/2017 was conducted using MEDLINE and Google Scholar with key words: body position, lung office, lung mechanics, lung book, position change, positioning, posture, pulmonary function testing, sitting, standing, supine, ventilation, and ventilatory change. Studies that were quasi-experimental, pre-postal service intervention; compared ≥2 positions, including sitting or standing; and assessed lung office in not-mechanically ventilated subjects aged ≥18 years were included. Primary consequence measures were forced expiratory volume in 1 south (FEV1), forced vital capacity (FVC, FEV1/FVC), vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), summit expiratory flow (PEF), full lung capacity (TLC), residual volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Continuing, sitting, supine, and correct- and left-side lying positions were studied.

Results

40-three studies met inclusion criteria. The study populations included healthy subjects (29 studies), lung disease (nine), heart disease (four), spinal cord injury (SCI, 7), neuromuscular diseases (three), and obesity (iv). In most studies involving good for you subjects or patients with lung, center, neuromuscular disease, or obesity, FEV1, FVC, FRC, PEmax, PImax, and/or PEF values were higher in more cock positions. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. sitting. In healthy subjects, DLCO was college 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, 1 should take into consideration that pulmonary physiology and function are influenced by torso position.

Peer Review reports

Background

Pulmonary part tests (PFTs) provide objective, quantifiable measures of lung office. They are used to evaluate and monitor diseases that bear upon heart and lung function, to monitor the effects of environmental, occupational, and drug exposures, to appraise risks of surgery, and to assist in evaluations performed earlier employment or for insurance purposes. Spirometric exam is the well-nigh common form of PFT [ane]. According to ATS/ERS guidelines, PFTs may be performed either in the sitting or standing position, and the position should be recorded on the report. Sitting is preferable for safety reasons to avert falling due to syncope [2], and might also exist more than user-friendly because of the measurement devices and patient comfort. Nonetheless, people who suffer from neuromuscular disease, morbid obesity, and other conditions may observe it hard to sit or stand up during this examination, which may influence their results.

1 of the principal goals of positioning, and specifically the employ of upright positions, is to amend lung office in patients with respiratory disorders, heart failure, neuromuscular disease, spinal cord injury (SCI), and obesity, and in the past xx years, diverse studies regarding the influence of trunk position on respiratory mechanics and/or function have been published. Nevertheless, we did not find a systematic review that integrates findings from studies involving non-mechanically ventilated adults to derive clinical implications for respiratory care and pulmonary office test (PFT) execution.

Nosotros aimed to systematically review studies that evaluated the effect of body position on lung function in salubrious subjects and non-mechanically ventilated patients with lung affliction, center disease, SCI, neuromuscular disease, and obesity.

Methods

2 researchers (SK., E-LM.) searched MEDLINE and Google Scholar for studies published from Jan 1998–December 2017 using the key words body position, lung office, lung mechanics, lung volumes, position change, positioning, posture, PFTs, sitting, standing, supine, ventilation, and ventilatory change, in various combinations. Each search term combination included at least ane key word related to pulmonary function and at to the lowest degree one related to body position. The twelvemonth 1998 was called as the get-go point due to the publication of the seminal study by Meysman and Vincken [3]. A total of 972 abstracts identified in the search were screened by the same 2 researchers, and full text of 151 potentially relevant articles was obtained. The full texts were evaluated and categorized, and 108 articles not fulfilling the inclusion criteria were excluded (Fig. 1).

Fig. i

Study menstruum diagram

Full size image

Articles were included if they met the following criteria: (one) Quasi-experimental, pre-postal service intervention. (2) Ii or more than body positions compared, including at least the sitting or standing position. (three) Result measures included assessment of lung function by forced vital capacity (FVC), forced expiratory volume in 1 southward (FEV1), FEV1/FVC, vital capacity (VC), functional residue capacity (FRC), maximal expiratory force per unit area (PEmax), maximal inspiratory pressure (PImax), peak expiratory menstruation (PEF), total lung capacity (TLC), residue volume (RV), or diffusing capacity of the lungs for carbon monoxide (DLCO). (four) Study population of non-mechanically ventilated subjects. (5) Participants anile ≥18 years. (vi) English language. Studies assessing lung function using other criteria and those without statistical comparisons of lung function in different positions, those enrolling individuals < eighteen years or on mechanical ventilation, published briefing abstracts, and systematic reviews were excluded.

Positions studied

1. 1.

   Standing – unsupported agile standing

2. 2.

   Sitting – sitting on a chair or wheelchair with the backrest at 90° and all limbs supported

3. 3.

   Supine – lying flat on the back

4. 4.

   Right-side lying (RSL) – lying straight on the correct side

5. 5.

   Left-side lying (LSL) – lying straight on the left side

Outcome measures and defined thresholds for clinical significance

1. 1.

   FVC – forced vital chapters

   • Alter of 200 ml or 12% from baseline values in FVC [iv]

2. 2.

   FEV1– forced expiratory book in 1 due south

   • Modify of 200 ml or 12% from baseline values in FEV1 [4]

3. 3.

   FEV1/FVC – forced expiratory volume in 1 s divided past forced vital capacity

   • FEV1/FVC < 0.vii is defined as obstructive illness

4. 4.

   VC – vital capacity

5. 5.

   FRC – functional residual capacity

   • Modify > 10% [five]

6. 6.

   TLC – total lung chapters

   • Change > 10% [5]

7. vii.

   RV – residual volume

8. 8.

   Maximal expiratory force per unit area (PEmax)

   • Alter ≥24 cmH2O [6,vii,8]

9. nine.

   Maximal inspiratory pressure (PImax)

   • Alter ≤ − 13 cmH2O [vi,7,8]

10. 10.

    Peak expiratory flow (PEF)

    • Change > 10% or threescore Fifty/min [ix, x]

11. 11.

    Diffusing capacity of the lungs for carbon monoxide (DLCO)

    • Change ≥10% in DLCO [11, 12]

Two experienced pulmonologists (NA, AR) reviewed the included studies in consensus to identify statistically pregnant and clinically important differences in pulmonary function. Results from manufactures included in the review were evaluated past all authors and categorized past study population, trunk positions studied, and event measures. Data from included studies was extracted by iv authors (NA, AR, SK, E-LM.) independently and in consultation when questions arose. The review was performed according to the PRISMA guidelines [thirteen].

Although these are not interventional studies, strictly speaking, we take called to assess them equally "before and afterwards intervention," wherein the posture/position change is the maneuver of interest. Level of evidence was assessed according to the American Academy of Neurology (AAN) Classification of Evidence for therapeutic intervention [fourteen]. Hazard of bias was assessed according to the Quality Cess Tool for Earlier-Later on (Pre-Postal service) Studies with No Control Group developed by the National Heart, Lung and Blood Institute (NHLBI) of the U.s.a. National Institutes of Health (NIH) [15]. This tool is comprised of 12 questions assessing various aspects of the quality of the study. Two authors (E-LM, SK) independently scored each study using the technique from Kunstler et al. [sixteen]. Differences were resolved in consensus, in consultation with a 3rd author (YZ). The take chances of bias was categorized as low (score 76–100%), moderate (26–75%) or high (0–25%).

Results

Studies included in the review

A full of 43 studies fully met inclusion criteria and were included in the review (Fig. 1). All studies used either consecutive, convenience, or volunteer sampling to enroll healthy individuals or subjects with various medical weather. All studies provide Course Three level of evidence.

The protocols and level of bias in the various studies are shown in Tabular array 1 and Additional file 1: Tabular array S1. Risk of bias was assessed as moderate in 41 studies and low in two. Quality issues were primarily related to sampling techniques for enrolling written report participants. All studies used non-random sampling. Some studies investigating healthy subjects included convenience samples of young participants, mainly students. Only seven/43 studies reported sample size calculations required to reach statistical ability. In addition, the details of the intervention protocol were not conspicuously reported in some studies (Table ane) and due to the nature of the study assessors could not be blinded to patient position or outcomes from previous tests.

Table 1 Written report protocols

Full size table

A summary of study characteristics, including the positions studied, consequence measures, and master results co-ordinate to the study population, is shown in Table 2. Out of 43 studies, 29 included good for you subjects, nine included patients with lung disease, 4 included patients with heart disease, seven included patients with SCI, iii included patients with neuromuscular diseases, and four included patients with obesity. Additional file 2: Table S2 summarizes but the statistically meaning findings for each relevant outcome variable, according to position, for each of the populations studied.

Table 2 Summary of written report characteristics co-ordinate to study population

Full size table

FVC

The association between FVC and body position in healthy subjects was investigated in 13 studies [3, 17,18,nineteen,twenty,21,22,23,24,25,26,27,28]. In that location was a clinical and statistically meaning increase in FVC in sitting vs. supine positions [3, eighteen, 22,23,24,25,26,27], in sitting vs. RSL and LSL [3, 21], standing vs. supine [19, 23], and standing vs. RSL and LSL [19]. In a smaller number of studies there was no change between continuing and sitting [nineteen], sitting and supine [17, 21, 28] or sitting and RSL or LSL [21], and ane study [22] institute a decrease in FVC from sitting to standing that was statistically but not clinically significant. Thus, in the bulk of studies the more upright position was associated with increased FVC.

Four studies included subjects with lung disease [29,30,31,32]. Amongst asthmatic patients in one study FVC increased significantly from supine to continuing [30]; even so, there was no significant difference betwixt standing and sitting or betwixt sitting and supine, RSL, or LSL. Some other study reported a statistically and clinically significant increase in FVC in standing vs. sitting, supine, RSL, and LSL and in sitting vs. supine, RSL and LSL [31]. Among obese asthmatic patients [32], and amongst patients with chronic obstructive pulmonary disease (COPD) [29], no difference was constitute in FVC betwixt standing and sitting.

3 studies included subjects with congestive heart failure (CHF) [18, 21, 27]. In one study, FVC was reported 200 ml higher in sitting vs. RSL and LSL [21], and in the other two studies FVC was higher in sitting vs. supine past 350–400 ml, which has clinical significance [18, 27].

Half-dozen studies included patients with SCI [17, 33,34,35,36,37]. The effect of body position on FVC depends on the level and extent of injury. Among those with cervical SCI, FVC was higher in the supine vs. sitting position [17, 33, 34]. Other studies [35,36,37] did not notice meaning differences in FVC for patients with SCI in a pooled grouping of all levels of injury for these positions. However, in patients with cervical SCI, likewise as those with thoracic injury in one study [36], in that location was an increased FVC in the supine vs. sitting, while in those with thoracic or lumbar injury FVC was higher in the sitting position [37]. The differences did non always reach statistical significance. Nevertheless, it is important to annotation that in these devitalized patients with SCI, even a small modify in FVC is probably clinically significant.

Three studies evaluated patients with neuromuscular diseases [25, 34, 38]. In patients with myotonic dystrophy and in those with amyotrophic lateral sclerosis (ALS), there was a clinically and statistically significant decrease in FVC from sitting to supine [25, 34, 38]. In subjects with obesity (mean BMI 36.7) no significant difference was reported between standing and sitting [32].

FEV1

In healthy subjects, FEV1 was reported to be higher in sitting vs. supine [3, eighteen, 22, 23, 26, 27, 39], in sitting vs. RSL and LSL [3, 19, 20], in continuing vs. sitting [23], and in standing vs. sitting, supine, RSL, and LSL [nineteen]. Nevertheless, other studies [21, 24, 28, 40] did not find pregnant deviation for FEV1 between sitting and supine, RSL, and LSL. One study [22] reported a decrease of 120 ml in FEV1 from sitting to continuing, which is statistically simply not clinically pregnant.

Among asthmatic patients, FEV1 was college in the standing vs. supine position, a statistically and clinically significant alter; still, there was no significant difference betwixt sitting vs. supine, RSL, and LSL positions [30]. Another study in asthmatic patients reported FEV1 to exist higher in standing vs. sitting, supine, RSL, and LSL, and in sitting  vs. supine, RSL and LSL [31]. Amidst obese asthmatic patients and those with COPD, there was no pregnant difference in FEV1 between standing and sitting [29, 32].

In subjects with CHF, one written report establish a statistically and clinically significant increase in FEV1 in sitting vs. RSL and LSL, but no difference between sitting and supine [21], while two other studies reported higher FEV1 in sitting vs. supine [18, 27].

In patients with SCI, FEV1 was recently reported to increase from sitting to supine [40]; however, other studies constitute that the effect of position on FEV1 in those with SCI depends on the level and extent of injury. In i study among all subjects with SCI, FEV1 was non significantly influenced by moving from sitting to supine [35], merely patients with cervical injuries showed a trend for increased FEV1 in the supine vs. sitting position while those with thoracic injuries tended towards increased FEV1 in the sitting position. Along the aforementioned vein, another written report [36] found an increment is FEV1 in the sitting vs. the supine position in patients with lumbar injury while FEV1 was higher in the supine position for those with cervical spine or thoracic injuries. Although the differences betwixt positions were not statistically significant, the consequence of level of injury was statistically and clinically pregnant.

In another report [33], FEV1 was college in supine vs. sitting in patients with consummate tetraplegia, while in patients with incomplete injury there was no meaning difference betwixt positions. Another group [37] reported no significant change in FEV1 between the sitting and supine positions for a pooled group of patients with SCI, simply in the subgroup of patients with incomplete motor injury and in those with incomplete thoracic motor injury at that place was a subtract in the supine position.

In patients with myotonic dystrophy, FEV1 decreased from sitting to supine [38]. Among those with obesity, FEV1 was higher in sitting vs. supine both before and after bariatric surgery [41]. In another study among obese patients, at that place was no difference in FEV1 between standing and sitting [32].

FEV1/FVC

Seven studies compared FEV1/FVC for different body positions in healthy subjects [18, 19, 23, 24, 27, 28, 42]. In several studies, FEV1/FVC was reported to be higher in sitting vs. supine [23, 28], in sitting vs. LSL [19], and in continuing vs. supine, RSL, and LSL [19]; all the same, FEV1/FVC was > lxx% in all torso positions so the difference was not clinically meaning. Other studies plant no difference between sitting and supine [18, 24, 27] or standing, sitting, and supine [42].

Among subjects with asthma, CHF, and obesity no statistically significant difference in FEV1/FVC was found between the different body postures [18, 27, 32, 42].

Vital chapters

The effect of body position on vital capacity was evaluated in six studies of salubrious subjects [21, 24, 28, 39, 43, 44]. In nigh studies no difference was reported betwixt sitting and supine [21, 24, 28, 43] or betwixt sitting and RSL or LSL [21]. One written report [39] found that VC was higher in the sitting vs. supine position. However, another study [44] found that VC was higher in the supine vs. sitting position, but only in females.

In patients with CHF, VC was reported to exist higher in sitting vs. supine in one report [27] while another study found no statistically significant difference between these positions [21]. In patients with spinal cord injury, VC was higher in the supine vs. sitting position [xl]. In subjects with obesity, no difference in VC was reported between the sitting and supine positions [41, 43].

PEF

PEF in different body positions was evaluated in thirteen studies [iii, 22,23,24, 31, 33, 45,46,47,48,49,50,51]. 8 studies evaluated just healthy adults [three, 22,23,24, 45, 48, l, 51], three evaluated healthy subjects and patients with COPD or asthma [31, 46, 49], one included adult cystic fibrosis patients [47], and one included subjects with SCI [33]. Nine studies that compared standing or sitting positions vs. supine or RSL and LSL found higher PEF in standing and sitting [3, 22,23,24, 31, 45,46,47,48]. Three of half dozen studies comparing the continuing and sitting positions found college PEF in continuing [46, l, 51] and 1 reported higher PEF in sitting [22]. All the same, information technology is nigh probable that none of the differences reported in PEF are clinically pregnant. In SCI patients with complete tetraplegia PEF was found to be 12% college in the supine vs. sitting position [33].

FRC

FRC was evaluated using helium dilution in five studies [27, 41, 43, 52, 53]. Among healthy subjects, FRC was higher in standing [53] and in sitting [27, 43] vs. supine, with the differences reaching statistical and clinical significance. Withal, the difference in sitting vs. supine was not significant among patients with obesity (mean BMI 44–45) [41, 43] or CHF [27], and was college in sitting vs. supine in patients after bariatric surgery (hateful BMI 31) [41]. Another study [52] involving subjects with mild-to-moderate obesity (hateful BMI 32), reported that FRC was significantly higher both statistically and clinically in sitting vs. supine.

Total lung chapters

Ii studies that evaluated TLC using helium dilution in salubrious subjects [43] and in subjects with obesity [41, 43] found no statistically pregnant difference betwixt the sitting and supine positions.

Residuum volume

Two studies that evaluated RV using helium dilution in good for you subjects [43] and those with obesity [41, 43] establish no statistically meaning difference between sitting and supine.

PEmax

6 studies investigated the association betwixt body position and PEmax in salubrious subjects [iii, 28, 39, 46, 54, 55]. PEmax was higher in standing vs. supine, in continuing vs. sitting and RSL, in sitting vs. supine [54], and in sitting vs. supine and RSL [46]; withal, the differences reported in those studies were non clinically pregnant. Other studies institute no difference in PEmax betwixt sitting and supine [28, 39], or between sitting, supine, RSL, and LSL [3, 55].

In COPD patients, PEmax was college in continuing or sitting vs. supine or RSL [46], and was higher in standing and sitting vs. RSL in patients with cystic fibrosis [47]. The differences were not clinically significant.

In subjects with SCI, PEmax was significantly higher in sitting vs. supine for all subjects, and for patients with motor complete injury or incomplete cervical motor injury [37].

PImax

In healthy subjects, PImax was improved in sitting vs. supine in two studies [iii, 54]. Even so, other studies plant no difference in PImax in sitting vs. supine [28, 39, 55], or sitting vs. RSL and LSL [three, 55]. In subjects with chronic SCI, no meaning change was seen in PImax betwixt sitting and supine, with the exception of a subgroup of patients with complete thoracic motor paresis where there was statistically and clinically pregnant improvement in sitting [37].

DLCO

Seven studies evaluated the effect of body position on diffusion capacity; half dozen included healthy subjects [xviii, 20, 21, 24, 56, 57], three included patients with CHF [18, 21, 58], and one included COPD patients [57].

Amidst healthy subjects, two studies [24, 56] found statistically and clinically significant improvement in DLCO in supine vs. sitting and one [57] found a trend towards increased DLCO in supine vs. sitting, however this difference did not reach statistical significance. One written report [eighteen] found DLCO to be college in the sitting vs. supine positions while another study found no deviation in DLCO between these positions [21]. Ane study [21] reported higher DLCO in sitting vs. side lying while another report [xx] constitute no difference between these positions. In COPD patients, no statistically significant change in DLCO was institute between the sitting and the supine position [57].

3 studies investigated diffusion capacity in patients with CHF [eighteen, 21, 58]. I study [58] plant that postural changes from the supine to sitting positions induced different responses in diffusion chapters. In some patients diffusion chapters improved in the sitting position and others showed no change or a decline. On the average no statistically significant divergence was found between the 2 positions. The authors attributed the difference in responses to variations in pulmonary apportionment pressures. Some other study [18] found no pregnant deviation in diffusion chapters betwixt the sitting and the supine positions. Side-lying was reported to reduce DLCO in comparison to sitting in the third study [21].

Word

Almost studies in this systematic review of 43 papers evaluating the upshot of body position on pulmonary function found that pulmonary function improved with more than erect posture in both healthy subjects and those with lung affliction, heart affliction, neuromuscular diseases, and obesity. In patients with SCI, the effect is more circuitous and depends on the severity and level of injury. In dissimilarity, improvidence chapters, as assessed by DLCO, increases in the supine position in healthy subjects while the effect in CHF patients is thought to depend upon pulmonary apportionment pressure.

Decreased FVC in more recumbent positions may reflect both increased thoracic claret book due to gravitational facilitation of venous return, which is more than of import in patients with center failure, as well as cephalic displacement of the diaphragm due to intestinal pressure in the recumbent positions, which is more than important in obese subjects [59]. In side-lying positions, even though only the dependent hemi-diaphragm is displaced, the effect on FVC appears to be like to that observed in a supine position [59]. Other factors that may contribute to lower FVC values in side-lying positions include increased airway resistance and decreased lung compliance secondary to anatomical differences between the left and correct lungs, every bit well equally shifting of the mediastinal structures [20].

FEV1 was likewise higher in erect positions. Recumbent positions limit expiratory volumes and flow, which may reflect an increase in airway resistance, a decrease in elastic recoil of the lung, or decreased mechanical advantage of forced expiration, presumably affecting the large airways [20]. In asthmatic patients the increment in FVC while continuing might be due to the increased diameter of the airways in this position [xxx].

In patients with CHF the lungs are strong and heavy, and the heart is big and heavy, increasing the negative effects of lung-centre interdependence [60]. As cardiac dimension increases, lung volume, mechanical function, and diffusion capacity decrease [61, 62]; thus, the eye weighs on the diaphragm while sitting and on one of the lungs while in a side-lying position. This influences the ability of the lungs to expand laterally simply allows the diaphragm to descend and the lungs to aggrandize inferiorly. In side-lying positions, the center weighs on ane lung, compressing both the airways and lung parenchyma, leading to a reduction in FEV1 and FVC due to airway pinch [21]. Both elastic (reduced lung compliance) and resistive loads are simultaneously increased in the supine position in CHF patients [63].

Changes in FVC from the sitting to supine positions may reflect diaphragm strength/paralysis. FVC is thus an important clinical tool for cess of diaphragmatic weakness in patients with neuromuscular diseases [64]. In patients with ALS, supine FVC is a test of diaphragmatic weakness [65] that predicts orthopnea [25] and prognosis for survival [66, 67]. The American Academy of Neurology has ended that in ALS patients, supine FVC is probably more than effective than cock FVC in detecting diaphragm weakness and correlates ameliorate with symptoms of hypoventilation [68].

In patients with cervical SCI (tetraplegia), FVC and FEV1 increase in the supine vs. sitting position. The diaphragm increases its inspiratory circuit in the supine position because its musculus fibers are longer at end expiration, and they operate at a more effective betoken of their length-tension curve [69,70,71]. This mechanism is peculiarly important in patients for whom the diaphragm is the main musculus for breathing, since their intercostal and abdominal muscles are inactive due to SCI.

FRC was reported to increase in upright positions in healthy subjects [27, 43, 53] and in patients with mild-to-moderate obesity [41, 52]. Changing from a supine to an upright position increases FRC due to reduced pulmonary blood volume and the descent of the diaphragm. This may change the point in which tidal breathing occurs in the volume-pressure curve, which leads to increased lung compliance, and thus an identical pressure change would produce a greater inspired volume if there is no change in respiratory bulldoze [53]. However, among patients with CHF, no difference in FRC betwixt sitting and supine was reported [27]. In heart failure, reduction in lung compliance in the supine position might reduce the passive alter in lung volume, just FRC may exist sustained to a higher place relaxation volume by an aligning in respiratory musculus or glottal activity [27]. Among patients with obesity the sitting FRC was less than in healthy subjects just there was no further subtract in the supine position [43].

PEF, PEmax, and PImax were found to increase in upright positions in good for you subjects [3, 23, 24, 46, 48, l, 51] and in those with lung diseases [31, 46, 47]. This may be related to changes in lung volumes with positions.

Standing and sitting accept been shown to atomic number 82 to the highest lung volumes [72, 73]. At college lung volumes the elastic recoil of the lungs and the breast wall is greater. In addition, the expiratory muscles are at a more optimal region of the length-tension bend and thus are capable of generating college intrathoracic pressure, potentially generating higher expiratory pressures and pushing air through narrow airways at high speed, which results in higher PEmax, PEF, and FEV1. Every bit lung volumes decrease, muscle length becomes less optimal, which results in lower PEmax in sitting, compared to the continuing position, and fifty-fifty lower in more recumbent positions. The alter in PEmax influences PEF [46].

When standing, gravity pulls the mediastinal and intestinal structures downwards, creating more than space in the thoracic cavity, which allows farther expansion of the lungs and greater lung volumes [74]. This, along with the decrease in compression on the lung bases, allows alveoli to recruit and increases lung compliance. The inspiratory muscles tin can expand even more, which allows the diaphragm to continue contracting downwards, thus increasing lung volumes [46].

Sitting often leads to the somewhat reduced lung volumes compared with standing. This tin can be explained by several mechanisms. Showtime, in sitting, abdominal organs are higher, interfering with diaphragmatic motion, thus enabling smaller inspiration. 2nd, the abdominal muscles are in a less optimal signal in the length-tension curve, since the combination of hip flexion and college position of the intestinal contents exert upwardly pressure level. Third, the dorsum of the chair may limit thoracic expansion. These three factors explain a slightly lower PEmax and PEF in sitting vs. standing [46].

Diaphragmatic strength is negatively afflicted by the supine position, and intrathoracic claret volume is increased. These factors lead to decreased PEmax and PEF in the supine position [3].

In side-lying positions (RSL or LSL), when the bed is flat, the abdominal contents autumn frontward. The dependent hemi-diaphragm is stretched to a expert length for tension generation, while the nondependent hemi-diaphragm is more flattened. Changes in lung volumes may thus residue themselves out due to a ameliorate diaphragmatic contraction only decreased space in the thorax [46].

The decreased PImax observed in the supine position could be related to diaphragm overload by intestinal content deportation during maximal inspiratory effort, which could start improved diaphragm position on the length-tension bend. In improver, the length of all other inspiratory muscles may become less optimal in supine position [75].

In patients with cervical spinal cord injury and high tetraplegia, PEF was found to be higher in the supine vs. sitting position [33] respective to the increase in FVC and FEV1 in the supine position.

In healthy subjects, nigh studies showed an increment in DLCO in supine vs. sitting [24, 56, 57]. This improvement is attributed to the moderate increase in alveolar blood volume in the supine position due to recruitment of lung capillary bed on transition from upright to supine. Age may benumb this increase [76]. This may explain why a study that included participants with a mean historic period of 61 [21] institute no difference in DLCO between sitting and supine.

In side-lying positions, the centre weighs on one lung, compressing both airways and lung parenchyma, reducing alveolar claret book, and causing ventilation/ perfusion mismatch. Those effects caused reduction of improvidence capacity in the side-lying positions [21].

In COPD patients, at that place was no change in DLCO betwixt sitting and supine [57]. This might exist related to reduced FVC and alveolar damage in these patients. These effects might have negative impact on diffusion capacity, opposing the positive upshot of the increase in claret volume in the alveoli [57].

In patients with CHF, different patterns of the effect of posture on DLCO were observed [58]. The change in DLCO was probably related to the change in alveolar blood book, most likely due to differences in pulmonary artery pressure and heart dimensions [58].

Limitations of the written report

There are a few limitations to this review. First, the level of prove of the studies is relatively low. Notwithstanding, in this type of research, due to the nature of the populations studied and the interventions applied, information technology is incommunicable to perform a randomized command study. Second, most studies were performed on a small number of subjects and all studies used either consecutive, convenience, or volunteer sampling. The review included but developed subjects and it is therefore not possible to generalize the results to children and adolescents. Finally, research protocols varied betwixt studies and detailed data virtually protocols were often missing. Patient cooperation during lung role testing strongly influences results. This may explain contradictory results obtained in some cases. Studies that included subjects older than sixty years did not mention the cognitive function of participants, a factor that may influence patient cooperation.

Further research in this field is needed, including studies designed to evaluate lung office in a larger number of healthy participants besides as in individuals with a multifariousness of medical weather. There is also a need to utilise a standardized protocol including randomization of postures and times between tests (e.grand. for wash-out of inhaled gasses or redistribution of blood volume) in different positions to enable a better comparing of outcomes.

Conclusions

When performing pulmonary function tests, body position plays a role in its influence over test results. Equally seen in this review, a change in body position may have varying implications depending on the patient populations. American Thoracic Club (ATS) guidelines [2] recommend performing PFTs in the sitting or standing position, but the sitting position is unremarkably preferred. The norms of those functions co-ordinate to gender and age were established from tests performed in this position. This review suggests that for almost of the subjects this is the preferred position for the examination; however, clinicians should consider performing PFTs in other positions in selected patients. In patients with SCI, testing also in the supine position may provide important information. In patients with neuromuscular disorders, performing PFTs in the supine position may help to assess diaphragmatic part.

Positioning plays an of import office in maximizing respiratory function when treating patients with diverse problems and diseases and it is important to know the implications of each position on the respiratory system of a specific patient. Understanding the influence of body position can give healthcare professionals better knowledge of optimal positions for patients with unlike diseases.

Abbreviations

AAN:

American Academy of Neurology

ALS:

Amyotrophic lateral sclerosis

ATS:

American Thoracic Guild

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

DLCO:

Diffusing capacity of the lungs for carbon monoxide

ERS:

European Respiratory Society

FEV1:

Forced expiratory volume in 1 due south

FRC:

Functional remainder capacity

FVC:

Forced vital capacity

LSL:

Left side lying

PEF:

Tiptop expiratory menstruation

PEmax:

Maximal expiratory force per unit area

PFT:

Pulmonary function examination

PImax:

Maximal inspiratory pressure

RSL:

Right side lying

RV:

Residual volume

SCI:

Spinal string injury

TLC:

Total lung capacity

VC:

Vital capacity

References

1. Crapo RO. Pulmonary-function testing. N Engl J Med. 1994;331(1):25–xxx.

   CAS  Article  Google Scholar

2. Miller MR, Crapo R, Hankinson J, et al. Full general considerations for lung part testing. Eur Respir J. 2005;26(1):153–61.

   CAS  Article  Google Scholar

3. Meysman G, Vincken West. Effect of body posture on spirometric values and upper airway obstruction indices derived from the period-volume loop in young nonobese subjects. Chest. 1998;114(4):1042–vii.

   CAS  Article  Google Scholar

4. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.

   CAS  Article  Google Scholar

5. Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(iii):511–22.

   CAS  Commodity  Google Scholar

6. 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(three):299–303.

   CAS  Commodity  Google Scholar

7. Keenan SP, Alexander D, Road JD, Ryan CF, Oger J, Wilcox PG. Ventilatory musculus strength and endurance in myasthenia gravis. Eur Respir J. 1995;8(7):1130–5.

   CAS  Article  Google Scholar

8. Nava South, Crotti P, Gurrieri G, Fracchia C, Rampulla C. Consequence of a beta 2-agonist (broxaterol) on respiratory muscle strength and endurance in patients with COPD with irreversible airway obstruction. Chest. 1992;101(one):133–40.

   CAS  Article  Google Scholar

9. Quanjer PH, Lebowitz Doctor, Gregg I, Miller MR, Pedersen OF. Peak expiratory flow: conclusions and recommendations of a working Party of the European Respiratory Order. Eur Respir J Suppl. 1997;24:2s–8s.

   CAS  PubMed  Google Scholar

10. Global initiative for asthma (GINA): Global strategy for asthma management and prevention (2018 update). 2018. file:///C:/Users/owner/Downloads/wms-GINA-2018-study-V1.3–002.pdf. Accessed 29 May 2018.

    Google Scholar

11. Graham BL, Brusasco 5, Burgos F, et al. 2017 ERS/ATS standards for single-jiff carbon monoxide uptake in the lung. Eur Respir J. 2017;49(1). https://doi.org/10.1183/13993003.00016-2016.

    Article  Google Scholar

12. Hathaway EH, Tashkin DP, Simmons MS. Intraindividual variability in series measurements of DLCO and alveolar volume over one yr in eight healthy subjects using three independent measuring systems. Am Rev Respir Dis. 1989;140(half dozen):1818–22.

    CAS  Commodity  Google Scholar

13. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  Google Scholar

14. Gronseth GS, Woodroffe LM, Getchuis TSD. Clinical practice guideline process transmission. 2011. http://tools.aan.com/globals/axon/assets/9023.pdf. Accessed 29 May 2018.

15. Quality assessment tool for before-later (pre-post) studies with no command group. 2014. https://www.nhlbi.nih.gov/health-topics/study-quality-cess-tools. Accessed 12 Aug 2018.

16. Kunstler BE, Cook JL, Freene North, 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):304–15.

    Commodity  Google Scholar

17. Ben-Dov I, Zlobinski R, Segel MJ, Gaides M, Shulimzon T, Zeilig G. Ventilatory response to hypercapnia in C(5-viii) chronic tetraplegia: the effect of posture. Arch Phys Med Rehabil. 2009;90(viii):1414–7.

    Article  Google Scholar

18. Ceridon ML, Morris NR, Olson TP, Lalande S, Johnson BD. Effect of supine posture on airway blood flow and pulmonary part in stable heart failure. Respir Physiol Neurobiol. 2011;178(2):269–74.

    Article  Google Scholar

19. Ganapathi LV, Vinoth Southward. The estimation of pulmonary functions in various body postures in normal subjects. Int J Advances Med. 2015;2(iii):250–4 http://www.ijmedicine.com/index.php/ijam/article/view/360. Accessed 29 May 2018.

    Article  Google Scholar

20. Manning F, Dean E, Ross J, Abboud RT. Effects of side lying on lung part in older individuals. Phys Ther. 1999;79(five):456–66.

    CAS  PubMed  Google Scholar

21. Palermo P, Cattadori K, Bussotti K, Apostolo A, Contini M, Agostoni P. Lateral decubitus position generates discomfort and worsens lung function in chronic heart failure. Chest. 2005;128(three):1511–half-dozen.

    Commodity  Google Scholar

22. Patel AK, Thakar HM. Spirometric values in sitting, standing, and supine position. Lung Pulm Resp Res. 2015;2(1):00026 http://medcraveonline.com/JLPRR/JLPRR-02-00026.php. Accessed 29 May 2018.

    Google Scholar

23. Saxena J, Gupta S, Saxena South. A study of modify of posture on the pulmonary office tests : can it help COPD patients? Indian J Community Health. 2006;eighteen(one):10–2. http://world wide web.iapsmupuk.org/journal/index.php/IJCH/article/view/108. Accessed 29 May 2018.

24. Stewart IB, Potts JE, McKenzie DC, Coutts KD. Effect of body position on measurements of diffusion capacity afterwards exercise. Br J Sports Med. 2000;34(6):440–four.

    CAS  Article  Google Scholar

25. Varrato J, Siderowf A, Damiano P, Gregory Due south, Feinberg D, McCluskey L. Postural alter of forced vital chapters predicts some respiratory symptoms in ALS. Neurology. 2001;57(two):357–nine.

    CAS  Article  Google Scholar

26. Vilke GM, Chan TC, Neuman T, Clausen JL. Spirometry in normal subjects in sitting, prone, and supine positions. Respir Care. 2000;45(4):407–10.

    CAS  PubMed  Google Scholar

27. 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):1285–91.

    CAS  Article  Google Scholar

28. Tsubaki A, Deguchi S, Yoneda Y. Influence of posture on respiratory function and respiratory musculus forcefulness in normal subjects. J Phys Ther Sci. 2009;21(1):71–4 https://www.jstage.jst.go.jp/commodity/jpts/21/ane/21_1_71/_article. Accessed 29 May 2018.

    Article  Google Scholar

29. De South. Comparison of spirometric values in sitting versus standing position among patients with obstructive lung function. Indian J Allergy Asthma Immunol. 2012;26(2):86–8 http://medind.nic.in/iac/t12/i2/iact12i2p86.pdf. Accessed 29 May 2018.

    Article  Google Scholar

30. Melam GR, Buragadda Southward, 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(four):591–iii.

    Article  Google Scholar

31. 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. http://apgr.wssp.edu.pl/wp-content/uploads/2017/12/APGR-21-three-A.pdf. Accessed 29 May 2018.

32. Razi East, Moosavi GA. The effect of positions on spirometric values in obese asthmatic patients. Islamic republic of iran J Allergy Asthma Immunol. 2007;6(3):151–iv.

    PubMed  Google Scholar

33. Linn WS, Adkins RH, Gong H Jr, Waters RL. Pulmonary function in chronic spinal cord injury: a cross-sectional survey of 222 southern California developed outpatients. Arch Phys Med Rehabil. 2000;81(6):757–63.

    CAS  Article  Google Scholar

34. Park JH, Kang SW, Lee SC, Choi WA, Kim DH. How respiratory muscle forcefulness correlates with cough capacity in patients with respiratory musculus weakness. Yonsei Med J. 2010;51(3):392–vii.

    Article  Google Scholar

35. 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):405–11.

    CAS  Article  Google Scholar

36. 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 https://www.jstage.jst.go.jp/commodity/jpts/24/8/24_JPTS-2012-029/_article. Accessed 29 May 2018.

37. Terson de Paleville DG, Sayenko DG, Aslan SC, Folz RJ, McKay WB, Ovechkin AV. Respiratory motor office in seated and supine positions in individuals with chronic spinal cord injury. Respir Physiol Neurobiol. 2014;203:ix–14.

    Article  Google Scholar

38. Poussel Thousand, 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.

    Article  Google Scholar

39. Naitoh Southward, Tomita One thousand, Sakai Chiliad, Yamasaki A, Kawasaki Y, Shimizu E. The effect of body position on pulmonary function, chest wall motion, and discomfort in young salubrious participants. J Manipulative Physiol Ther. 2014;37(nine):719–25.

    Commodity  Google Scholar

40. Miccinilli S, Morrone Chiliad, Bastianini F, et al. Optoelectronic plethysmography to evaluate the issue of posture on animate kinematics in spinal string injury: a cross exclusive study. Eur J Phys Rehabil Med. 2016;52(1):36–47.

    PubMed  Google Scholar

41. Sebbane K, El Kamel M, Millot A, et al. Effect of weight loss on postural changes in pulmonary function in obese dubjects: a longitudinal written report. Respir Care. 2015;60(7):992–ix.

    Commodity  Google Scholar

42. Myint WW, Htay MNN, Soe HHK, et al. Effect of body positions on lungs volume in asthmatic patients: a cantankerous-sectinal study. J Adv Med Pharma Sci. 2017;thirteen(iv):1–six http://world wide web.journalrepository.org/media/journals/JAMPS_36/2017/Jun/Myint1342017JAMPS33901.pdf. Accessed 29 May 2018.

    Google Scholar

43. Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol (1985). 2005;98(ii):512–7.

    CAS  Article  Google Scholar

44. Roychowdhury P, Pramanik T, Prajapati R, Pandit R, Singh S. In wellness--vital capacity is maximum in supine position. Nepal Med Coll J. 2011;13(two):131–2.

    CAS  PubMed  Google Scholar

45. Antunes BO, de Souza HC, Gianinis HH, Passarelli-Amaro RC, Tambascio J, Gastaldi Ac. Meridian expiratory menses in salubrious, young, non-active subjects in seated, supine, and prone postures. Physiother Theory Pract. 2016;32(6):489–93.

    Article  Google Scholar

46. Badr C, Elkins MR, Ellis ER. The effect of torso position on maximal expiratory pressure and flow. Aust J Physiother. 2002;48(2):95–102.

    Article  Google Scholar

47. Elkins MR, Alison JA, Good day PT. Effect of body position on maximal expiratory pressure and flow in adults with cystic fibrosis. Pediatr Pulmonol. 2005;40(5):385–91.

    Article  Google Scholar

48. 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):435–41.

    Article  Google Scholar

49. McCoy EK, Thomas JL, Sowell RS, et al. An evaluation of acme expiratory menstruum monitoring: a comparison of sitting versus standing measurements. J Am Board Fam Med. 2010;23(2):166–70.

    Article  Google Scholar

50. Ottaviano K, Scadding GK, Iacono V, Scarpa B, Martini A, Lund VJ. Peak nasal inspiratory flow and pinnacle expiratory flow. Upright and sitting values in an developed population. Rhinology. 2016;54(2):160–iii.

    Article  Google Scholar

51. Wallace JL, George CM, Tolley EA, et al. Peak expiratory flow in bed? A comparison of 3 positions. Respir Care. 2013;58(3):494–seven.

    PubMed  Google Scholar

52. 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):334–9.

    PubMed  Google Scholar

53. Chang AT, Boots RJ, Brown MG, Paratz JD, Hodges Pow. Ventilatory changes following caput-upwards tilt and standing in healthy subjects. Eur J Appl Physiol. 2005;95(5–six):409–17.

    Article  Google Scholar

54. Costa R, Almeida N, Ribeiro F. Body position influences the maximum inspiratory and expiratory mouth pressures of immature healthy subjects. Physiotherapy. 2015;101(2):239–41.

    Article  Google Scholar

55. Ogiwara S, Miyachi T. Effect of posture on ventilatory muscle strength. J Phys Ther Sci. 2002;14(1):1–5. https://www.jstage.jst.go.jp/article/jpts/14/1/14_1_1/_pdf/-char/en. Accessed 29 May 2018.

    Commodity  Google Scholar

56. Peces-Barba G, Rodriguez-Nieto MJ, Verbanck S, Paiva K, Gonzalez-Mangado Northward. Lower pulmonary diffusing capacity in the prone vs. supine posture. J Appl Physiol (1985). 2004;96(5):1937–42.

    CAS  Article  Google Scholar

57. Terzano C, Conti V, Petroianni A, Ceccarelli D, De Vito C, Villari P. Event of postural variations on carbon monoxide diffusing capacity in good for you subjects and patients with chronic obstructive pulmonary disease. Respiration. 2009;77(ane):51–7.

    Commodity  Google Scholar

58. Faggiano P, D'Aloia A, Simoni P, et al. Furnishings 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.

    CAS  Article  Google Scholar

59. Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J. Lung mechanics in sitting and horizontal trunk positions. Breast. 1983;83(four):643–half dozen.

    CAS  Article  Google Scholar

60. Agostoni PG, Marenzi GC, Sganzerla P, et al. Lung-center 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):793–8.

    CAS  Commodity  Google Scholar

61. Agostoni PG, Cattadori G, Guazzi Thou, Palermo P, Bussotti M, Marenzi G. Cardiomegaly as a possible cause of lung dysfunction in patients with middle failure. Am Heart J. 2000;140(five):e24.

    CAS  Article  Google Scholar

62. Hosenpud JD, Stibolt TA, Atwal K, Shelley D. Abnormal pulmonary function specifically related to congestive center failure: comparison of patients before and after cardiac transplantation. Am J Med. 1990;88(5):493–half-dozen.

    CAS  Article  Google Scholar

63. 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):647–53.

    CAS  Article  Google Scholar

64. Fromageot C, Lofaso F, Annane D, et al. Supine autumn in lung volumes in the cess of diaphragmatic weakness in neuromuscular disorders. Arch Phys Med Rehabil. 2001;82(1):123–viii.

    CAS  Article  Google Scholar

65. Lechtzin Northward, 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):436–42.

    Article  Google Scholar

66. Baumann F, Henderson RD, Morrison SC, et al. Utilise of respiratory function tests to predict survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2010;11(1–two):194–202.

    Article  Google Scholar

67. Schmidt EP, Drachman DB, Wiener CM, Clawson L, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: utilize in clinical trial blueprint. Muscle Nerve. 2006;33(1):127–32.

    Article  Google Scholar

68. Miller RG, Jackson CE, Kasarskis EJ, et al. Do parameter update: the intendance of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): study of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73(15):1218–26.

    CAS  Article  Google Scholar

69. Fugl-Meyer AR. Effects of respiratory muscle paralysis in tetraplegic and paraplegic patients. Scand J Rehabil Med. 1971;iii(4):141–50.

    CAS  PubMed  Google Scholar

70. Fugl-Meyer AR, Grimby Grand. Respiration in tetraplegia and in hemiplegia: a review. Int Rehabil Med. 1984;6(4):186–90.

    CAS  Commodity  Google Scholar

71. Huldtgren AC, Fugl-Meyer AR, Jonasson Eastward, Bake B. Ventilatory dysfunction and respiratory rehabilitation in post-traumatic quadriplegia. Eur J Respir Dis. 1980;61(6):347–56.

    CAS  PubMed  Google Scholar

72. Wade OL, Gilson JC. The upshot of posture on diaphragmatic movement and vital chapters in normal subjects with a notation on spirometry as an aid in determining radiological chest volumes. Thorax. 1951;6(2):103–26.

    CAS  Article  Google Scholar

73. Moreno F, Lyons HA. Effect of body posture on lung volumes. J Appl Physiol. 1961;16:27–9.

    CAS  Article  Google Scholar

74. Castile R, Mead J, Jackson A, Wohl ME, Stokes D. Effects of posture on flow-book curve configuration in normal humans. J Appl Physiol Respir Environ Exerc Physiol. 1982;53(v):1175–83.

    CAS  PubMed  Google Scholar

75. Segizbaeva MO, Pogodin MA, Aleksandrova NP. Furnishings of torso positions on respiratory muscle activation during maximal inspiratory maneuvers. Adv Exp Med Biol. 2013;756:355–63.

    CAS  Article  Google Scholar

76. Chang SC, Chang How-do-you-do, Liu SY, Shiao GM, Perng RP. Effects of body position and age on membrane diffusing capacity and pulmonary capillary blood volume. Breast. 1992;102(1):139–42.

    CAS  Commodity  Google Scholar

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Acknowledgements

The authors wish to thank Prof. Ora Paltiel, a specialist in Internal Medicine, Hematology, and Oncology who also holds a doctorate in Epidemiology and Biostatistics, for her invaluable assistance in selecting the optimal tools for cess of the quality of testify and potential for bias of studies included in this systematic review.

The authors wish to give thanks Shifra Fraifeld, a medical centre-based medical writer and editor, for her editorial contribution during manuscript preparation.

Author information

Author notes

1. Shikma Katz and Nissim Arish contributed equally to this work.

Affiliations

1. Chronic Ventilator-Dependent Division, Herzog Medical Center, POB 3900, Jerusalem, Israel

   Shikma Katz, Yacov Zaltzman & Esther-Lee Marcus

2. Pulmonary Institute, Shaare Zedek Medical Eye, POB 3235, Jerusalem, Israel

   Nissim Arish & Ariel Rokach

3. Recanati Schoolhouse for Community Health Professions, Faculty of Wellness Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

   Shikma Katz

4. Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel

   Nissim Arish, Ariel Rokach & Esther-Lee Marcus

Contributions

SK, East-LM, NA, AR contributed to the study concept and design. SK, E-LM, NA, AR, YZ contributed to data acquisition and analysis, and estimation of the data. The primary literature search was conducted by SK and E-LM. SK and E-LM drafted the manuscript. SK, Due east-LM, NA, AR, YZ critically reviewed and revised the manuscript for intellectual content. All authors reviewed the final version of the manuscript prior to submission and all accept responsibility for the integrity of the research procedure and findings. All authors read and approved the final manuscript.

Respective author

Correspondence to Ariel Rokach.

Ethics declarations

Ideals blessing and consent to participate

Not applicative – systematic review.

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Non applicable.

Competing interests

The authors declare that they accept no competing interests.

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

Additional files

Additional file i:

Tabular array S1. Scoring for papers included in the systematic review based on the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Command Group of the National Eye, Lung and Blood Establish [3, xv,16,17,xviii,19,20,21,22,23,24,25,26,27,28,29,xxx,31, 33,34,35,36,37,38,39,xl,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58]. (DOCX 63 kb)

Additional file 2:

Tabular array S2. Statistically significant differences in pulmonary function between the various body positions [three, 17,18,19,xx,21,22,23,24,25,26,27,28, 30, 31, 33, 34, 37,38,39,40,41, 43,44,45,46,47,48, 50,51,52,53,54, 56]. (DOCX 104 kb)

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Katz, S., Arish, North., Rokach, A. et al. The effect of body position on pulmonary role: a systematic review. BMC Pulm Med xviii, 159 (2018). https://doi.org/x.1186/s12890-018-0723-iv

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• Received: 06 May 2017

• Accepted: 17 September 2018

• Published: 11 October 2018

• DOI : https://doi.org/10.1186/s12890-018-0723-iv

Keywords

• Torso position
• Lung volume
• Physical therapy
• Positioning
• Posture
• Pulmonary function
• Sitting
• Supine
• Standing

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