RESUMEN

Antecedentes: Las características de la curva flujo-volumen espiratoria máxima (MEFV) no se han determinado en residentes de la ciudad de México clínicamente sanos, lo que es importante considerando la altitud y contaminación atmosférica de esta ciudad. Objetivo: Analizar las curvas MEFV en sujetos sanos de la ciudad de México. Métodos: Entre 1991 y 1999 estudiamos 875 sujetos (481 mujeres, 394 hombres), la mayoría alumnos de licenciatura. Para las mediciones se usó un sistema de baja impedancia e inercia acoplado a una computadora. Los resultados se expresaron como porcentaje de los valores predichos por Ellis y col. Resultados: Las curvas MEFV fueron normales o con valores mayores que los predichos en 414 sujetos (47%), mostraron un patrón obstructivo en 362 (41%), restrictivo en 35 (4%) y mixto en 64 (7%). En comparación con las mujeres que tuvieron curva MEFV normal, las mujeres con curvas anormales fueron más jóvenes, las que mostraron patrón mixto tenían menor peso corporal, y las que mostraron patrón obstructivo tenían menor estatura. Conclusiones: Los datos muestran que hasta un 53% de los sujetos clínicamente sanos residentes de la ciudad de México tienen una curva MEFV anormal, y que la edad, el peso y la estatura se asocian con anormalidades de la curva MEFV en mujeres.

PALABRAS CLAVE

Curva flujo-volumen, curva MEFV, individuos sanos, pruebas de función pulmonar, ciudad de México.

REFERENCIAS

1. American Thoracic Society. Future directions for research on diseases of the lung. Am J Respir Crit Care Med 1995; 152:1713-1735.

2. Green M, Mead J, Hoppin F, Wohl ME. Analysis of the forced expiratory maneuver. Chest 1973; 63: 33S-36S.

3. Higgins B. Peak expiratory flow variability in the general population. Eur Respir J (Suppl) 1997; 24: 45S-48S.

4. Lebowitz MD, Sherril DL, Kaltenborn WS, Burrows B. Peak expiratory flow from maximum expiratory flow volume curves in a community population: cross-sectional and longitudinal analyses. Eur Respir J (Suppl) 1997; 24: 29S-38S.

5. Anthonisen RN. Test of mechanical function. In: Fishman A, editor. The respiratory system. Bethesda: American Physiological Society; 1983. p. 753.

6. Bass H. The flow volume loop: normal standards and abnormalities in chronic obstructive pulmonary disease. Chest 1973; 63: 171-176.

7. Johanson WG, Pierce AK, Sanford JP. Pulmonary function in uncomplicated influenza. Am Rev Respir Dis 1969; 100: 141-146.

8. Mead J. Analysis of the configuration of maximum expiratory flow-volume curves. J Appl Physiol 1978; 44: 156-165.

9. American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995; 152: 1107-1136.

10. Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 1971; 103: 57-61.

11. Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. Normal standards, variability, and effects of age. Am Rev Respir Dis 1976; 113: 587-600.

12. Ellis JH, Perera SP, Levin DC. A computer program for calculation and interpretation of pulmonary function studies. Chest 1975; 68: 209-213.

13. Gautier H, Peslin A, Grassino J, et al. Mechanical properties of the lungs during acclimatization to altitude. J Appl Physiol 1982; 52: 1407-1415.

14. Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981; 123: 659-664.

15. Clement J, Van de Woestijne KP. Variability of maximum expiratory flow volume curves and effort independency. J Appl Physiol 1971; 31: 55-62.

16. Sanchez EJ. Determinación de los valores normales de la capacidad vital, capacidad respiratoria máxima y capacidad vital cronometrada en la Ciudad de México (Tesis para obtener el título de Médico Cirujano). México: Facultad de Medicina, Universidad Nacional Autónoma de México; 1967.

17. Torres GE. Tipos y mecanismos productores de la insuficiencia respiratoria. Frecuencia en la Ciudad de México. Arch Inst Cardiol Mex 1966; 36: 200-224.

18. Dickman ML, Schmidt CD, Gardner RM, Marshall HW, Day WC, Warner HR. On-line computerized spirometry in 738 normal adults. Am Rev Respir Dis 1969; 100: 780-790.

19. Torres GE, Emerson P. The effects of intermittent positive pressure breathing on the intrapulmonary distribution of inspired air. Am J Med 1960; 6: 949-952.

20. Brand PL, de Gooijer A, Postma DS. Changes in peak expiratory flow in healthy subjects and in patients with obstructive lung disease. Eur Respir J (Suppl) 1997; 24: 69S-71S.

21. Lebowitz MD, Krzyzanowski M, Quackenboss JJ, O’Rourke MK. Diurnal variation of PEF and its use in epidemiological studies. Eur Respir J (Suppl) 1997; 24: 49S-56S.

22. Torres GE. Insuficiencia respiratoria. México: Prensa Médica Mexicana; 1991.

23. Bubis MJ, Sigurdson M, McCarthy DS, Anthonisen NR. Differences between slow and fast vital capacity in patients with obstructive disease. Chest 1980; 77: 626-631.

24. Newhouse TM, Becklake MR, Macklem TP. Effect of alterations of end tidal CO2 tension on flow resistance. J Appl Physiol 1974; 19: 745.

25. Saunders NA, Betts MF, Pengelly LD, Rebuck AS. Changes in lung mechanical induced by acute isocapnic hypoxia. J Appl Physiol 1977; 42: 413-419.

26. Bruce EN, Jackson AC. Smoothing of MEFV curves by digital filtering of flow as a function of volume. J Appl Physiol 1980; 48: 202-206.

27. Lisboa C, Roos WR, Jardim J, Macklem PT. Pulmonary pressure-flow curves measured by a data-averaging circuit. J Appl Physiol 1979; 47: 621-627.

28. Hyatt RE. Forced expiration. In: Fishman AP, editor. The respiratory system. III: 1 Mechanics of respiration. Bethesda: American Physiological Society; 1983. p. 295.

29. Fishman AP. Manifestations of respiratory disorders. In: Fishman AP, editor. Pulmonary diseases and disorders. New York: McGraw-Hill; 1980, p. 44.

30. Mead J, Turner MJ, Macklem TP, Little JB. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol 1967; 22: 95-108.

31. Metzger FL, Altose DM, Fishman PA. Evaluation of pulmonary performance. In: Fishman AP, editor. Pulmonary diseases and disorders. New York: McGraw-Hill; 1980, p. 44.

32. Guyatt AR, Alpers JH. Factors affecting airway conductance: a study of 752 working men. J Appl Physiol 1968; 24: 310-316.

33. Guyatt AR, Siddorn JA, Brash HM, Flenley DC. Reproducibility of dynamic compliance and flow-volume curves in normal men. J Appl Physiol 1975; 39: 341-348.

34. Hyatt RE, Black LF. The flow-volume curve. Am Rev Respir Dis 1973; 107: 191-199.

35. Mc Naughton PJ. Portable peak flow meters. Eur Respir J 1997; 9: 26S.

36. Miller MR, Pedersen OF. The peak flow working group: the characteristics and calibration of devices for recording peak expiratory flow. Eur Respir J 1997; 24: 17S-22S.

37. Pedersen FO, Miller RM. The peak flow working group: test of portable peak flow meters by explosive decompression. Eur Respir J 1997; 24: 23S-25S.

38. Mansell AL, Bryan AC, Levison H. Relationship of lung recoil to lung volume and maximum expiratory in normal children. J Appl Physiol 1977; 42: 817-823.

39. Pedersen OF. The peak flow working group: physiological determinants of peak expiratory flow. Eur Resp J 1997; 24: 11S-16S.

40. Pedersen OF, Miller RM. The peak flow working group: the definition of peak expiratory flow. Eur Respir J 1997; 24: 9S-10S.

41. Britton J. Measurement of peak flow variability in community populations: methodology. Eur Respir J 1997; 24: 42S-44S.

42. Burge PS. The relationship between peak expiratory flow and respiratory symptoms. Eur Respir J 1997; 24: 67S-68S.

43. Sly PD. Relationship between change in PEF and symptoms: questions to ask in pediatric clinics. Eur Respir J 1997; 24: 80S-83S.

44. Paoletti P, Paggiaro PL, Lebowitz MD. Environmental factors in PEF variability. Eur Respir J 1997; 24: 64S-66S.

45. Schwartz J, Marcus A. Mortality and air pollution in London: a time series analysis. Am J Epidemiol 1990; 131: 185-194.

46. Paz C. Some consequences of ozone exposure on health. Arch Med Res 1997; 28: 163-170.

47. Schindler C, Ackermann-Liebrich U, Leuenberger P, et. al. Associations between lung function and estimated average exposure to NO2 in eight areas of Switzerland. The SAPALDIA Team. Swiss study of air pollution and lung diseases in adults. Epidemiology 1998; 9: 405-411.

48. Takata S, Aizawa H, Inoue H, Koto H, Hara N. Ozone exposure suppresses epithelium-dependent relaxation in feline airway. Lung 1995; 173: 47-56.

49. Cunningham R, Dockery WD, Speizer EF. Maternal smoking during pregnancy as a predictor of lung function in children. Am J Epidemiol 1994; 139: 1139.

50. Cook NR, Hebert PR, Satterfield S, Taylor JO, Buring JE, Hennekens CH. Height, lung function, and mortality from cardiovascular disease among the elderly. Am J Epidemiol 1994, 139: 1066-1076.

51. Green M, Mead J, Turner MJ. Variability of maximum expiratory flow-volume curves. J Appl Physiol 1974; 37: 67-74.

52. Rich-Edwards JW, Manson JE, Stampfer MJ, et al. Height and the risk of cardiovascular disease in women. Am J Epidemiol 1995; 142: 909-917.

53. Rimm EB, Stampfer MJ, Giovannucci E et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 1995; 141: 1117-1127.

54. Selby JV, Friedman GD, Quesenberry CP. Precursors of essential hypertension: pulmonary function, heart rate, uric acid, serum cholesterol, and other serum chemistries. Am J Epidemiol 1990; 131: 1017-1027.

55. Guillemi S, Wright JL, Hogg JC, Wiggs BR, Macklem PT, Pare PD. Density dependence of pulmonary resistance: correlation with small airway pathology. Eur Respir J 1995; 8: 789-794.

56. Lisboa C, Wood LD, Jardim J, Macklem PT. Relation between flow, curvilinearity, and density dependence of pulmonary pressure-flow curves. J Appl Physiol 1980; 48: 878-885.

57. Hrncir E. Flow resistance of airways under hyperbaric conditions. Physiol Res 1996; 45:153-158.