Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents

Margarita Barral-Fernández; María Amalia Jácome Pumar; Sonia Souto-Camba; Luz González-Doniz; María Antonia Ramón Belmonte; Marta Amor-Barbosa; Ane Arbillaga-Etxarri; Guillermo Mazzucco; Pilar Bravo Cortés; Tamara del Corral; Rocío Martín-Valero; Carlos Llorca Cerdà; Fabiola Murcia Lillo; Jose Antonio Sanchez-Santos; Marina Francín-Gallego; Concepción Martín Cortijo; Esther García Delgado; Cristina Serrano Veguillas; Ana B. Varas de la Fuente; Paula San José Herranz; Carolina González Montañez; Elena Gimeno-Santos; Rodrigo Torres-Castro; Guilherme A.F. Fregonezi; Mireia Pardàs Peraferrer; Jordi Vilaró Casamitjana; Angeles Fernandez-Cadenas; Antonio T. Ríos-Cortes; María José Moreno Valera; Daniel Langer; Ana Lista-Paz

doi:10.1016/j.arbres.2025.09.009

Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents

Margarita Barral-Fernández
, María Amalia Jácome Pumar
, Sonia Souto-Camba
, Luz González-Doniz
, María Antonia Ramón Belmonte
, Marta Amor-Barbosa
, Ane Arbillaga-Etxarri
, Guillermo Mazzucco
, Pilar Bravo Cortés
, Tamara del Corral
, Rocío Martín-Valero
, Carlos Llorca Cerdà
, Fabiola Murcia Lillo
, Jose Antonio Sanchez-Santos
, Marina Francín-Gallego
, Concepción Martín Cortijo
, Esther García Delgado
, Cristina Serrano Veguillas
, Ana B. Varas de la Fuente
, Paula San José Herranz

Carolina González Montañez, Elena Gimeno-Santos, Rodrigo Torres-Castro, Guilherme A.F. Fregonezi, Mireia Pardàs Peraferrer, Jordi Vilaró Casamitjana, Angeles Fernandez-Cadenas, Antonio T. Ríos-Cortes, María José Moreno Valera, Daniel Langer, Ana Lista-Paz^*

^*Corresponding author for this work

Research output: Indexed journal article › Article › peer-review

Abstract

Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6–18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores ≥ 1.645 standard deviation (SD) below group means. Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: (1) PImax: boys = −41.41 + 10.21 * age + 6.26 * body mass index (BMI) − 0.37 * age * BMI; girls = 125.96–0.34 * age − 0.41 * age² − 5.75 * BMI + 0.63 * age * BMI; (2) PEmax: boys = 20.93 + 5.23 * age + 2.93 * BMI; girls = −12.67 + 11.98 * age − 0.39 * age² + 2.57 * BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p < .001). Depending on age, PImax cut-offs range from 46 to 85 cmH₂O in boys and from 45 to 68 cmH₂O in girls, while PEmax cut-offs span 54–98 cmH₂O in boys and 57–85 cmH₂O in girls. Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programmes.

Original language	English
Number of pages	8
Journal	Archivos de Bronconeumologia
DOIs	https://doi.org/10.1016/j.arbres.2025.09.009
Publication status	Accepted/In press - 2025

Keywords

Maximal respiratory pressures
Muscle strength
Paediatrics
Reference values
Respiratory function tests
Respiratory muscles

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10.1016/j.arbres.2025.09.009

Cite this

Barral-Fernández, M., Jácome Pumar, M. A., Souto-Camba, S., González-Doniz, L., Ramón Belmonte, M. A., Amor-Barbosa, M., Arbillaga-Etxarri, A., Mazzucco, G., Bravo Cortés, P., del Corral, T., Martín-Valero, R., Llorca Cerdà, C., Murcia Lillo, F., Sanchez-Santos, J. A., Francín-Gallego, M., Martín Cortijo, C., García Delgado, E., Serrano Veguillas, C., Varas de la Fuente, A. B., ... Lista-Paz, A. (Accepted/In press). Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents. Archivos de Bronconeumologia. https://doi.org/10.1016/j.arbres.2025.09.009

@article{3576a84e8e8041fc8c2ba0b85c1bdef5,

title = "Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents",

abstract = "Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6–18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores ≥ 1.645 standard deviation (SD) below group means. Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: (1) PImax: boys = −41.41 + 10.21 * age + 6.26 * body mass index (BMI) − 0.37 * age * BMI; girls = 125.96–0.34 * age − 0.41 * age2 − 5.75 * BMI + 0.63 * age * BMI; (2) PEmax: boys = 20.93 + 5.23 * age + 2.93 * BMI; girls = −12.67 + 11.98 * age − 0.39 * age2 + 2.57 * BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p < .001). Depending on age, PImax cut-offs range from 46 to 85 cmH2O in boys and from 45 to 68 cmH2O in girls, while PEmax cut-offs span 54–98 cmH2O in boys and 57–85 cmH2O in girls. Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programmes.",

keywords = "Maximal respiratory pressures, Muscle strength, Paediatrics, Reference values, Respiratory function tests, Respiratory muscles",

author = "Margarita Barral-Fern{\'a}ndez and \{J{\'a}come Pumar\}, \{Mar{\'i}a Amalia\} and Sonia Souto-Camba and Luz Gonz{\'a}lez-Doniz and \{Ram{\'o}n Belmonte\}, \{Mar{\'i}a Antonia\} and Marta Amor-Barbosa and Ane Arbillaga-Etxarri and Guillermo Mazzucco and \{Bravo Cort{\'e}s\}, Pilar and \{del Corral\}, Tamara and Roc{\'i}o Mart{\'i}n-Valero and \{Llorca Cerd{\`a}\}, Carlos and \{Murcia Lillo\}, Fabiola and Sanchez-Santos, \{Jose Antonio\} and Marina Franc{\'i}n-Gallego and \{Mart{\'i}n Cortijo\}, Concepci{\'o}n and \{Garc{\'i}a Delgado\}, Esther and \{Serrano Veguillas\}, Cristina and \{Varas de la Fuente\}, \{Ana B.\} and \{San Jos{\'e} Herranz\}, Paula and \{Gonz{\'a}lez Monta{\~n}ez\}, Carolina and Elena Gimeno-Santos and Rodrigo Torres-Castro and Fregonezi, \{Guilherme A.F.\} and \{Pard{\`a}s Peraferrer\}, Mireia and \{Vilar{\'o} Casamitjana\}, Jordi and Angeles Fernandez-Cadenas and R{\'i}os-Cortes, \{Antonio T.\} and \{Moreno Valera\}, \{Mar{\'i}a Jos{\'e}\} and Daniel Langer and Ana Lista-Paz",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

doi = "10.1016/j.arbres.2025.09.009",

language = "English",

journal = "Archivos de Bronconeumologia",

issn = "0300-2896",

publisher = "Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR)",

}

Barral-Fernández, M, Jácome Pumar, MA, Souto-Camba, S, González-Doniz, L, Ramón Belmonte, MA, Amor-Barbosa, M, Arbillaga-Etxarri, A, Mazzucco, G, Bravo Cortés, P, del Corral, T, Martín-Valero, R, Llorca Cerdà, C, Murcia Lillo, F, Sanchez-Santos, JA, Francín-Gallego, M, Martín Cortijo, C, García Delgado, E, Serrano Veguillas, C, Varas de la Fuente, AB, San José Herranz, P, González Montañez, C, Gimeno-Santos, E, Torres-Castro, R, Fregonezi, GAF, Pardàs Peraferrer, M, Vilaró Casamitjana, J, Fernandez-Cadenas, A, Ríos-Cortes, AT, Moreno Valera, MJ, Langer, D & Lista-Paz, A 2025, 'Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents', Archivos de Bronconeumologia. https://doi.org/10.1016/j.arbres.2025.09.009

TY - JOUR

T1 - Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents

AU - Barral-Fernández, Margarita

AU - Jácome Pumar, María Amalia

AU - Souto-Camba, Sonia

AU - González-Doniz, Luz

AU - Ramón Belmonte, María Antonia

AU - Amor-Barbosa, Marta

AU - Arbillaga-Etxarri, Ane

AU - Mazzucco, Guillermo

AU - Bravo Cortés, Pilar

AU - del Corral, Tamara

AU - Martín-Valero, Rocío

AU - Llorca Cerdà, Carlos

AU - Murcia Lillo, Fabiola

AU - Sanchez-Santos, Jose Antonio

AU - Francín-Gallego, Marina

AU - Martín Cortijo, Concepción

AU - García Delgado, Esther

AU - Serrano Veguillas, Cristina

AU - Varas de la Fuente, Ana B.

AU - San José Herranz, Paula

AU - González Montañez, Carolina

AU - Gimeno-Santos, Elena

AU - Torres-Castro, Rodrigo

AU - Fregonezi, Guilherme A.F.

AU - Pardàs Peraferrer, Mireia

AU - Vilaró Casamitjana, Jordi

AU - Fernandez-Cadenas, Angeles

AU - Ríos-Cortes, Antonio T.

AU - Moreno Valera, María José

AU - Langer, Daniel

AU - Lista-Paz, Ana

PY - 2025

Y1 - 2025

N2 - Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6–18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores ≥ 1.645 standard deviation (SD) below group means. Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: (1) PImax: boys = −41.41 + 10.21 * age + 6.26 * body mass index (BMI) − 0.37 * age * BMI; girls = 125.96–0.34 * age − 0.41 * age2 − 5.75 * BMI + 0.63 * age * BMI; (2) PEmax: boys = 20.93 + 5.23 * age + 2.93 * BMI; girls = −12.67 + 11.98 * age − 0.39 * age2 + 2.57 * BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p < .001). Depending on age, PImax cut-offs range from 46 to 85 cmH2O in boys and from 45 to 68 cmH2O in girls, while PEmax cut-offs span 54–98 cmH2O in boys and 57–85 cmH2O in girls. Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programmes.

AB - Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6–18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores ≥ 1.645 standard deviation (SD) below group means. Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: (1) PImax: boys = −41.41 + 10.21 * age + 6.26 * body mass index (BMI) − 0.37 * age * BMI; girls = 125.96–0.34 * age − 0.41 * age2 − 5.75 * BMI + 0.63 * age * BMI; (2) PEmax: boys = 20.93 + 5.23 * age + 2.93 * BMI; girls = −12.67 + 11.98 * age − 0.39 * age2 + 2.57 * BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p < .001). Depending on age, PImax cut-offs range from 46 to 85 cmH2O in boys and from 45 to 68 cmH2O in girls, while PEmax cut-offs span 54–98 cmH2O in boys and 57–85 cmH2O in girls. Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programmes.

KW - Maximal respiratory pressures

KW - Muscle strength

KW - Paediatrics

KW - Reference values

KW - Respiratory function tests

KW - Respiratory muscles

UR - https://www.scopus.com/pages/publications/105018701273

U2 - 10.1016/j.arbres.2025.09.009

DO - 10.1016/j.arbres.2025.09.009

M3 - Article

AN - SCOPUS:105018701273

SN - 0300-2896

JO - Archivos de Bronconeumologia

JF - Archivos de Bronconeumologia

ER -

Reference Equations for Maximal Respiratory Pressures in Healthy Children and Adolescents

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