People living with serious mental illness (SMI), such as schizophrenia and bipolar disorder, face a well-documented excess of premature morbidity and mortality. While suicide and cardiovascular disease are widely recognized, respiratory health has often been neglected in psychiatric care. Yet, reduced lung function in the general population is strongly associated with increased risks of chronic disease and mortality. Could this also be true for people with SMI?
What we did
In this study, published in Frontiers in Physiology, we conducted a cross-sectional analysis across nine community mental health centers in Andalusia (Spain). We included 287 participants: 169 with SMI (schizophrenia or bipolar disorder) and 118 controls without psychiatric conditions. All underwent standardized spirometry according to the 2021 ATS/ERS guidelines, performed by trained nurses.
This is the first study to apply the 2021 ATS/ERS z-score standards to assess lung function in people with SMI. To facilitate comparison with earlier research, we also reported results using % predicted values, making both approaches available to clinicians and researchers.
What we found
The findings were notable. People with SMI showed significantly lower spirometry values compared to controls.
This is the first study to apply the 2021 ATS/ERS z-score standards to assess lung function in people with SMI. To facilitate comparison with earlier research, we also reported results using % predicted values, making both approaches available to clinicians and researchers.
What we found
The findings were notable. People with SMI showed significantly lower spirometry values compared to controls.
- 36% of individuals with SMI had abnormal spirometry results (versus 17% of controls).
- Both airflow obstruction (18.3% vs 9.3%) and the PRISm pattern (17.8% vs 7.6%) were more common in SMI.
- Multivariate analysis revealed that these abnormalities were mainly driven by modifiable factors: smoking was the key driver of obstructive patterns, while abdominal obesity was linked to PRISm.
- These associations remained significant independently of psychiatric diagnosis, underscoring the importance of lifestyle and metabolic contributors.
Why it matters
For the first time, lung function in people with bipolar disorder has been systematically assessed using the latest ATS/ERS z-score criteria, and this study is also among the first to explore abnormal spirometric patterns in schizophrenia.
Our results demonstrate that lung function impairment is common in SMI, with important implications for respiratory, cardiovascular, and overall health. Crucially, many of these risks can be reduced.
Call to action
Our results demonstrate that lung function impairment is common in SMI, with important implications for respiratory, cardiovascular, and overall health. Crucially, many of these risks can be reduced.
Call to action
Routine monitoring of lung function and early detection of abnormalities should become part of clinical care for people with SMI. Addressing smoking and obesity — the two leading risk factors — is essential. By integrating respiratory health into psychiatric care, we can move closer to narrowing the persistent and unacceptable physical health gap faced by people with serious mental illness.