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Blowhards Live Longer - 2

Updated: Jan 13


  • Grip strength is an easy, quick, and accurate way to measure health and predict longevity.

  • Your peak expiratory flow (PEF) - aka your ability to blow hard, predicts disability and early mortality risk.

  • Many diseases start by acquiring respiratory infections.

  • Infections create inflammation and reduce PEF.


7. Conclusions

Although significant research gaps still exist, we propose that spirometry can be an efficient, safe and inexpensive global health marker with the potential of identifying, at any age, a group of individuals in the general population at risk of respiratory and non-respiratory NCDs in whom to intervene promptly. A brief historical analogy is worth mentioning. Miners used to carry caged canaries down into the mine to alert of dangerous accumulation of gases, thus providing an early warning to exit the mine and save their lives [92]. We propose here that lung function assessment by spirometry is an overlooked global health marker that can also act as “a canary in the mine”.

Spirometry and Children

Rates of preterm birth (gestational age <37 weeks) have increased globally in the last decades, now accounting for 11% of live births [74]; fortunately, more than 95% of those born preterm currently survive to adulthood [75].

However, because prematurity is often associated with a significant number of multiple chronic diseases in adulthood [50, 52], a marked increase in the health-care demand of adult survivors of preterm birth is expected, similarly to what has already happened with children with cystic fibrosis whose life expectancy has increased extraordinarily in the last decades mainly by treating comprehensively the patient rather than focusing only on the pulmonary component [76-77].

In fact, it has been suggested that persons born prematurely require early evaluation, long-term follow-up and preventive actions to reduce the risk of multiple non-communicable diseases** (NCDs) later in life [78].

In this setting, spirometry offers a simple, non-invasive, reproducible method to identify young individuals at risk of suffering NCDs later.

Of note, this paradigm may apply even to acute diseases, as very recently illustrated by the observation that being born with low birth weight is an independent risk factor (adjusted OR 3.61 [1.55–8.43], p= 0.003) of severe COVID-19 requiring ICU admission in middle aged adults (46–53 years) [79].

**LEWIS NOTE: NCD is a misnomer as it implies the disease is NOT infectious. In fact, these diseases are often caused by chronic infections.

Fig. 1. Potential spirometry trajectories through life according to, on the one hand, differences in lung development during infancy, adolescence and early adulthood and, on the other, rate of lung function decline during adulthood and elderly. From Agusti et al. N Engl J Med 2019;381:1248–56 [18]. Copyright © 2019 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.




To determine whether peak expiratory flow (PEF), when expressed by a validated method using standardized residual (SR) percentile, is associated with subsequent disability and death in older persons.


754 initially nondisabled, community-living persons aged 70 years or older.


The bottom quarter of PEF had the following results.

  • increased risk of Activities of Daily Living disability (HR 1.79 or 79% increase,

  • mobility disability (89% increase), and

  • death (231% increase).


In conclusion, in a large cohort of community-living older persons, we found that a diminished PEF, expressed as an SR-percentile, is associated with subsequent disability and death, independent of multiple confounders, including age, smoking, and chronic lung disease. These results support the use of PEF as a potentially valuable risk assessment tool among older persons.


This is one of many published PEF "normal" values by age and gender. How to you interpret this chart if you are not sure of your gender?


Chlamydia pneumoniae and Peak Expiratory Flow (PEF)

I picked this reference (below) for a couple of reasons.

  1. C pneumoniae was asserted present based on IgG antibodies. 99.999% of American doctors will say that IgG represents past infection only. This study confirms what I have been preaching for 20 years. That is, IgG means chronic infection status.

  2. Roxithromycin in NOT approved in the U.S. but IMHO it is a better and safer antibiotic compared to counterparts available in the U.S. (and you can get it fyi).

An association has been reported between chronic infection with Chlamydia pneumoniae and the severity of asthma, and uncontrolled observations have suggested that treatment with antibiotics active against C. pneumoniae leads to an improvement in asthma control.

We studied the effect of roxithromycin in subjects with asthma and immunoglobulin G (IgG) antibodies to C. pneumoniae > or = 1:64 and/or IgA antibodies > or = 1:16.

A total of 232 subjects, from Australia, New Zealand, Italy, or Argentina, were randomized to 6 wk of treatment with roxithromycin 150 mg twice a day or placebo.


At the end of 6 wk, the increase from baseline in evening peak expiratory flow (PEF) was

  • 15 L/min with roxithromycin and 3 L/min with placebo (p = 0.02). With morning PEF, the increase was 14 L/min with roxithromycin and 8 L/min with placebo (NS). In the Australasian population, the increase in morning PEF was

  • 18 L/min and 4 L/min, respectively (p = 0.04).

Using relative statistics, the treatment increased PEF by 500% and 450%.

Absolute statistic improvement calculation is not possible with the data presented.


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