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Effects of Side Lying on Lung Function in Older Individuals

F Manning, MD, PT, is Family Medicine Resident, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. This study was completed in partial fulfillment of the requirements for Dr Manning's Master of Science degree
E Dean, PhD, PT, is Professor, School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3 (elizdean{at}rehab.ubc.ca). Address all correspondence to Dr Dean
J Ross, PT, is Section Head, Critical Care, Rehabilitation Services, Vancouver Hospital, Vancouver, British Columbia, Canada
RT Abboud, MD, FRCPC, is Professor, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, and Director, Lung Function Laboratory, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada

Background and Purpose. Body positioning exerts a strong effect on pulmonary function, but its effect on other components of the oxygen transport pathway are less well understood, especially the effects of side-lying positions. This study investigated the interrelationships between side-lying positions and indexes of lung function such as spirometry, alveolar diffusing capacity, and inhomogeneity of ventilation in older individuals. Subjects and Methods. Nineteen nonsmoking subjects (mean age=62.8 years, SD=6.8, range=50–74) with no history of cardiac or pulmonary disease were tested over 2 sessions. The test positions were sitting and left side lying in one session and sitting and right side lying in the other session. In each of the positions, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), single-breath pulmonary diffusing capacity (DLCO/VA), and the slope of phase III (DN₂%/L) of the single-breath nitrogen washout test to determine inhomogeneity of ventilation were measured. Results. Compared with measurements obtained in the sitting position, FVC and FEV₁ were decreased equally in the side-lying positions, but no change was observed in DLCO/VA or DN₂%/L. Conclusion and Discussion. Side-lying positions resulted in decreases in FVC and FEV₁, which is consistent with the well-documented effects of the supine position. These findings further support the need for prescriptive rather than routine body positioning of patients with risks of cardiopulmonary compromise and the need to use upright positions in which lung volumes and capacities are maximized.

Key Words: Body position • Diffusing capacity • Older adults • Oxygen transport • Pulmonary function • Side lying • Recumbency • Ventilatory inhomogeneity