Barral-Fernández, MargaritaJácome, M. A.Souto-Camba, SoniaGonzález Doniz, LuzRamón Belmonte, María AntoniaAmor Barbosa, MartaArbillaga-Etxarri, AneMazzucco, GuillermoBravo Cortés, PilarDel Corral, TamaraMartín-Valero, RocíoLlorca Cerdá, CarlosMurcia Lillo, F.Sánchez-Santos, José AntonioFrancín-Gallego, MarinaMartín Cortijo, ConcepciónGarcía Delgado, EstherSerrano Veguillas, CristinaVaras de la Fuente, Ana B.San José Herranz, PaulaGonzález Montañez, CarolinaGimeno-Santos, ElenaTorres-Castro, RodrigoFregonezi, GuilhermePardás Peraferrer, MireiaVilaró, JordiFernández-Cadenas, ÁngelesRíos-Cortés, A. T.Moreno Valera, María JoséLanger, DanielLista-Paz, Ana2026-03-062026-03-062025-09-22Barral-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. Reference equations for maximal respiratory pressures in healthy children and adolescents. Arch Bronconeumol. 2025 Mar;62(3):154-161.1579-2129https://hdl.handle.net/2183/47605[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 85cmH2O in boys and from 45 to 68cmH2O in girls, while PEmax cut-offs span 54-98cmH2O in boys and 57-85cmH2O 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.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Maximal respiratory pressuresRespiratory function testsRespiratory musclesMuscle strengthReference valuesPaediatricsjournal articleopen access10.1016/J.ARBRES.2025.09.009