Researchers investigated and reported how chest wall conformation impacts spirometry parameters and outcomes in mild-to-moderate idiopathic pulmonary fibrosis (IPF), as published in Internal and Emergency Medicine.

Restrictive lung syndromes are a group of pulmonary pathologies that reduce the distensibility of the lungs. Chest wall restrictions can be intrinsic or extrinsic; intrinsic restrictions usually relate to lung inflammation, while extrinsic restrictions usually result from neuromuscular disorders.

“In both intrinsic or extrinsic pulmonary conditions, lung volumes become reduced due to restrictions in pulmonary mechanics, with decreased forced vital capacity (FVC), total lung capacity (TLC) and diffusing capacity of the lungs for carbon monoxide (DLCO),” Sonaglioni et al wrote.

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The authors noted the lack of medical literature concerning the influence of anterior chest wall deformity on spirometry parameters in patients with IPF and hence decided to investigate.

Read more about IPF etiology 

They carried out a retrospective study on participants with mild-to-moderate IPF (n=60). The patients were grouped into those with a concave-shaped chest wall (modified Haller index [MHI]>2.5) and those with normal chest conformation (MHI≤2.5). 

The researchers then conducted studies to compare their clinical performance, including main spirometric parameters, physical examinations, and echocardiogram. Follow-up data concentrated on pulmonary or cardiovascular hospitalizations, as well as all-cause mortality.

The results demonstrated that when patients with concave-shaped chest walls were compared with those with normal chest wall conformations, patients had higher systolic pulmonary artery pressures and smaller cardiac chamber dimensions. Follow-up revealed 13 deaths and 16 pulmonary or cardiovascular hospitalizations among the patients in the concave-shaped chest wall group.

“IPF patients with concave-shaped chest wall and/or pectus excavatum (MHI > 2.5) have a poorer prognosis than those with normal chest shape (MHI ≤ 2.5) over a medium-term follow-up,” Sonaglioni and colleagues concluded.


Sonaglioni A, Caminati A, Nicolosi GL, Lombardo M, Harari S. Influence of chest wall conformation on spirometry parameters and outcome in mild-to-moderate idiopathic pulmonary fibrosis. Intern Emerg Med. Published online January 20, 2022. doi:10.1007/s11739-021-02889-4