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An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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STUDY DESIGN: Observational study. OBJECTIVE: Assess associations between vitamin D levels and other risk factors on future chest illness in a chronic spinal cord injury (SCI) cohort. SETTING: Veterans Affairs Boston and the Boston, MA community. METHODS: Between August 2009 and August 2017, 253 participants with chronic SCI were followed over a median of 3.2 years (up to 7.4 years) with two to four visits a median of 1.7 years apart. At each visit, plasma 25-hydroxyvitamin D level was obtained, spirometry performed, and a respiratory questionnaire assessing chest illnesses since last visit was completed. Repeated measures negative binomial regression was used to assess chest illness risk longitudinally. RESULTS: At entry, 25% had deficient vitamin D levels (<20 nanograms/milliliter (ng/ml)), 52% were insufficient (20 to <30 ng/ml), and 23% were sufficient (≥30 ng/ml). Over 545 study visits, chest illnesses (n = 106) were reported by 60 participants. In multivariable models (including previous chest illness history), deficient vitamin D levels (compared with those with sufficient levels) were associated with future chest illness though with wide confidence limits (relative risk (RR) = 1.36, 95% confidence intervals (CI) = 0.74, 2.47). The strongest association with chest illness during the follow-up period was in persons who reported pneumonia/bronchitis after injury and a chest illness in the three years before study entry (RR = 7.62; 95% CI = 3.70, 15.71). CONCLUSION: Assessed prospectively in chronic SCI, there was a suggestive association between deficient vitamin D levels and future chest illness. Past chest illness history was also strongly associated with future chest illness.
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Enfermedades Pulmonares/etiología , Traumatismos de la Médula Espinal/sangre , Traumatismos de la Médula Espinal/complicaciones , Vitamina D/análogos & derivados , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Estudios Longitudinales , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Estados Unidos , United States Department of Veterans Affairs , Vitamina D/sangreRESUMEN
STUDY DESIGN: Cross-sectional study. OBJECTIVES: Determine dietary, lifestyle, and clinical factors associated with plasma 25-hydroxyvitamin D [25(OH)D] levels in persons with chronic spinal cord injury (SCI). SETTING: Veterans Affairs Medical Center in Boston, MA. METHODS: 174 participants completed food frequency and health questionnaires, provided a blood sample, and underwent dual x-ray absorptiometry (DXA) to assess %total body fat. Linear regression models were used to assess cross-sectional associations of personal, lifestyle, and nutritional factors with plasma 25(OH)D. RESULTS: Independent factors positively associated with higher plasma 25(OH)D included vitamin D intake, age, hours of planned exercise, female sex, white race, wine consumption, and if a never or former smoker. The most important predictor of 25(OH)D was supplement intake. The majority of subjects (98.9% for vitamin D and 74.1% for calcium) did not meet the recommended daily allowance for adults from their diet alone. Level and completeness of SCI, injury duration, mobility, %total body fat, time outside, and comorbid diseases were not associated with plasma 25(OH)D. CONCLUSIONS: Plasma 25(OH)D level in chronic SCI is not associated with clinical factors specific to SCI such as injury level and completeness, injury duration, and mobility mode, but related to supplement intake and other lifestyle factors.
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Dieta , Estilo de Vida , Estado Nutricional/fisiología , Traumatismos de la Médula Espinal/sangre , Traumatismos de la Médula Espinal/psicología , Vitamina D/análogos & derivados , Absorciometría de Fotón , Adulto , Anciano , Composición Corporal , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Examen Neurológico , Estudios Retrospectivos , Encuestas y Cuestionarios , Estados Unidos , United States Department of Veterans Affairs , Vitamina D/sangreRESUMEN
CONTEXT/OBJECTIVE: Individuals with chronic spinal cord injury (SCI) have an increased risk of morbidity and mortality attributable to respiratory diseases. Previous studies in non-SCI populations suggest that vitamin D may be a determinant of respiratory health. Therefore, we sought to assess if lower vitamin D levels were associated with decreased pulmonary function in persons with chronic SCI. DESIGN: Cross-sectional study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: 312 participants (260 men and 52 women) with chronic SCI recruited from VA Boston and the community participating in an epidemiologic study to assess factors influencing respiratory health. METHODS: Participants provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma 25-hydroxyviatmin D and spirometric measures of pulmonary function. OUTCOME MEASURES: Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS: Adjusted and unadjusted for a number of confounders, there was no significant association between plasma vitamin D levels and FEV1, FVC, or FEV1/FVC. For example, in fully adjusted models, each 10â ng/ml increase in vitamin D was associated with a 4.4â ml (95%CI -64.4, 73.2, P = 0.90) ml change in FEV1. Conclusion: There was no significant cross-sectional association between plasma vitamin D and FEV1, FVC, or FEV1/FVC in this cohort of individuals with chronic SCI.
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Calcifediol/sangre , Volumen Espiratorio Forzado/fisiología , Traumatismos de la Médula Espinal/sangre , Traumatismos de la Médula Espinal/fisiopatología , Capacidad Vital/fisiología , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espirometría , Estados Unidos , United States Department of Veterans AffairsRESUMEN
BACKGROUND: Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness. OBJECTIVE: To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort. DESIGN: Cross-sectional study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health. METHODS: Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered. MAIN OUTCOME MEASUREMENTS: forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS: There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (-93.1 mL; 95% confidence interval = -166.2, -20.0) and decrease in FVC (-130.7 mL; 95% confidence interval = -219.4, -42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC. CONCLUSION: Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI. LEVEL OF EVIDENCE: II.
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Volumen Espiratorio Forzado/fisiología , Leptina/sangre , Pulmón/fisiopatología , Traumatismos de la Médula Espinal/sangre , Capacidad Vital/fisiología , Biomarcadores/sangre , Enfermedad Crónica , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Respiración , Estudios Retrospectivos , Traumatismos de la Médula Espinal/fisiopatología , EspirometríaRESUMEN
Context/Objective Persons with chronic spinal cord injury (SCI) have an increased risk of respiratory-related morbidity and mortality and chronic respiratory symptoms are clinical markers of future respiratory disease. Therefore, we sought to assess potentially modifiable factors associated with respiratory symptoms, with a focus on circulating vitamin D and measures of body fat. Design Cross-sectional study. Setting Veterans Affairs Medical Center. Participants Three hundred forty-three participants (282 men and 61 women) with chronic SCI participating in an epidemiologic study to assess factors influencing respiratory health recruited from VA Boston and the community. Methods Participants provided a blood sample, completed a respiratory health questionnaire, and underwent dual x-ray absorptiometry (DXA) to assess % body fat. Logistic regression was used to assess cross-sectional associations between respiratory symptoms and plasma vitamin D and measures of body fat with adjustment for a number of potential confounders. Outcome Measures Chronic cough, chronic phlegm, any wheeze, persistent wheeze. Results After adjustment for a number of confounders (including smoking), participants with greater %-android, gynoid, trunk, or total body fat had increased odds ratios for any wheeze and suggestive associations with persistent wheeze, but not with chronic cough or phlegm. Vitamin D levels were not associated with any of the respiratory symptoms. Conclusion Increased body fat, but not vitamin D, was associated with wheeze in chronic SCI independent of a number of covariates.
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Adiposidad , Respiración , Traumatismos de la Médula Espinal/fisiopatología , Vitamina D/sangre , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/sangreRESUMEN
BACKGROUND: Systemic inflammation has been associated with reduced pulmonary function in individuals with and without chronic medical conditions. Individuals with chronic spinal cord injury (SCI) have clinical characteristics that promote systemic inflammation and also have reduced pulmonary function. We sought to assess the associations between biomarkers of systemic inflammation with pulmonary function in a chronic SCI cohort, adjusting for other potential confounding factors. METHODS: Participants (n = 311) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma C-reactive protein (CRP) and interleukin-6 (IL-6) with forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS: There were statistically significant inverse relationships between plasma CRP and IL-6 assessed in quartiles or continuously with FEV1 and FVC. In fully adjusted models, each interquartile range (5.91 mg/L) increase in CRP was associated with a significant decrease in FEV1 (-55.85 ml; 95% CI: -89.21, -22.49) and decrease in FVC (-65.50 ml; 95% CI: -106.61, -24.60). There were similar significant findings for IL-6. There were no statistically significant associations observed with FEV1/FVC. CONCLUSION: Plasma CRP and IL-6 in individuals with chronic SCI are inversely associated with FEV1 and FVC, independent of SCI level and severity of injury, BMI, and other covariates. This finding suggests that systemic inflammation associated with chronic SCI may contribute to reduced pulmonary function.
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Proteína C-Reactiva/inmunología , Interleucina-6/inmunología , Pulmón/fisiopatología , Traumatismos de la Médula Espinal/inmunología , Adulto , Anciano , Estudios de Cohortes , Femenino , Volumen Espiratorio Forzado , Humanos , Inflamación , Modelos Lineales , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/fisiopatología , Espirometría , Capacidad VitalRESUMEN
CONTEXT/OBJECTIVE: Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study. METHODS: Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders. OUTCOME MEASURES: Percent-predicted forced vital capacity in one second (FEV1), percent-predicted forced vital capacity (FVC), FEV1/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC). RESULTS: After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV1 and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures. CONCLUSION: Increased systemic inflammation was associated with reductions in FEV1 and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.
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Proteína C-Reactiva/metabolismo , Interleucina-6/sangre , Enfermedades Pulmonares/epidemiología , Estrés Oxidativo , Traumatismos de la Médula Espinal/epidemiología , Capacidad Pulmonar Total , Adulto , Anciano , Biomarcadores/sangre , Humanos , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/sangreRESUMEN
OBJECTIVE: Identify factors associated with chest illness and describe the relationship between chest illness and mortality in chronic spinal cord injury (SCI). DESIGN: Cross-sectional survey assessing chest illness and a prospective assessment of mortality. METHODS: Between 1994 and 2005, 430 persons with chronic SCI (mean ± SD), 52.0 ± 14.9 years old, and ≥4 years post SCI (20.5 ± 12.5 years) underwent spirometry, completed a health questionnaire, and reported any chest illness resulting in time off work, indoors, or in bed in the preceding 3 years. Deaths through 2007 were identified. Outcome measures Logistic regression assessing relationships with chest illness at baseline and Cox regression assessing the relationship between chest illness and mortality. RESULTS: Chest illness was reported by 139 persons (32.3%). Personal characteristics associated with chest illness were current smoking (odds ratio =2.15; 95% confidence interval =1.25-3.70 per each pack per day increase), chronic obstructive pulmonary disease (COPD) (3.52; 1.79-6.92), and heart disease (2.18; 1.14-4.16). Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30; 0.88-1.91). In a multivariable model, independent predictors of mortality were greater age, SCI level and completeness of injury, diabetes, a lower %-predicted forced expiratory volume in 1 second, heart disease, and smoking history. Adjusting for these covariates, the effect of a previous chest illness on mortality was attenuated (HR = 1.15; 0.77-1.73). CONCLUSION: In chronic SCI, chest illness in the preceding 3 years was not an independent risk factor for mortality and was not associated with level and completeness of SCI, but was associated with current smoking, physician-diagnosed COPD, and heart disease history.
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Enfermedades Pulmonares/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/mortalidad , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Examen Neurológico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Espirometría/métodos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Chest illnesses commonly cause morbidity in persons with chronic spinal cord injury. Risk factors remain poorly characterized because previous studies have not accounted for factors other than spinal cord injury. DESIGN: Between 1994 and 2005, 403 participants completed a respiratory questionnaire and underwent spirometry. Participants were contacted at a median of 1.7 yrs [interquartile range: 1.3-2.5 yrs] apart over a mean (SD) of 5.1 +/- 3.0 yrs and asked to report chest illnesses that had resulted in time off work, spent indoors, or in bed since prior contact. RESULTS: In 97 participants, there were 247 chest illnesses (0.12/person-year) with 54 hospitalizations (22%). Spinal cord injury level, completeness of injury, and duration of injury were not associated with illness risk. Adjusting for age and smoking history, any wheeze (relative risk = 1.92; 95% confidence interval: 1.19, 3.08), pneumonia or bronchitis since spinal cord injury (relative risk = 2.29; 95% confidence interval: 1.40, 3.75), and physician-diagnosed chronic obstructive pulmonary disease (relative risk = 2.17; 95% confidence interval: 1.08, 4.37) were associated with a greater risk of chest illness. Each percent-predicted decrease in forced expiratory volume in 1 sec was associated with a 1.2% increase in risk of chest illness (P = 0.030). CONCLUSIONS: In chronic spinal cord injury, chest illness resulting in time spent away from usual activities was not related to the level or completeness of spinal cord injury but was related to reduced pulmonary function, wheeze, chronic obstructive pulmonary disease, a history of pneumonia and bronchitis, and smoking.
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Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Adulto , Distribución por Edad , Bronquitis/diagnóstico , Bronquitis/epidemiología , Bronquitis/etiología , Enfermedad Crónica , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Modelos Lineales , Estudios Longitudinales , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neumonía/diagnóstico , Neumonía/epidemiología , Neumonía/etiología , Probabilidad , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/etiología , Cuadriplejía/complicaciones , Cuadriplejía/diagnóstico , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Distribución por Sexo , Espirometría , Encuestas y Cuestionarios , Tasa de SupervivenciaAsunto(s)
Lesiones Encefálicas/diagnóstico , Sistemas Recordatorios , Trastornos por Estrés Postraumático/diagnóstico , Lesiones Encefálicas/complicaciones , Humanos , Personal Militar , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/complicaciones , Estados Unidos , United States Department of Veterans AffairsRESUMEN
OBJECTIVE: To characterize determinants of lung volumes in chronic spinal cord injury (SCI). DESIGN: Cross-sectional. SETTING: VA Boston Healthcare System. PARTICIPANTS: White men (N=330) with chronic SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Questionnaire responses and measurements of lung volumes. RESULTS: Adjusted for SCI severity and stature, greater body mass index (BMI) was associated (all P<.05) with lower total lung capacity (TLC) (-38.7 mL x kg(-1) x m(-2)), functional residual capacity (FRC) (-73.9 mL x kg(-1) x m(-2)), residual volume (RV) (-40.4 mL x kg(-1) x m(-2)), and expiratory reserve volume (ERV) (-32.2 mL x kg(-1) x m(-2)). The effect of BMI on RV was most pronounced in quadriplegia (-72 mL x kg(-1) x m(-2)). Lifetime smoking was associated with a greater FRC (5.3 mL/pack-year) and RV (3.1 mL/pack-years). The effects of lifetime smoking were also greatest in quadriplegia (11 mL/pack-year for FRC; 7.8 mL/pack-year for RV). Time since injury, independent of age, was associated with a decrease in TLC, FRC, ERV, and RV (P<.05). Age was not a predictor of TLC once time since injury was considered. CONCLUSIONS: Determinants of FRC, TLC, ERV, and RV in chronic SCI include factors related and unrelated to SCI. The mechanisms remain to be determined but likely involve the elastic properties and muscle function of the respiratory system and perhaps the effects of systemic inflammation related to adiposity. Addressing modifiable factors such as obesity, muscle stiffness, and smoking may improve respiratory morbidity and mortality in SCI by improving pulmonary function.
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Mediciones del Volumen Pulmonar , Pruebas de Función Respiratoria/estadística & datos numéricos , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/fisiopatología , Índice de Masa Corporal , Boston/epidemiología , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Obesidad/epidemiología , Fumar/epidemiología , Capacidad Pulmonar TotalRESUMEN
OBJECTIVE: To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: Veterans Affairs medical center. PARTICIPANTS: As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Plasma high-sensitivity C-reactive protein (CRP). RESULTS: The mean +/- standard deviation age was 56+/-14y, and participants were assessed 21+/-13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users. CONCLUSIONS: These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health.
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Actividades Cotidianas , Proteína C-Reactiva/metabolismo , Inflamación/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Adulto , Biomarcadores/análisis , Biomarcadores/metabolismo , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Enfermedad Crónica , Estudios de Cohortes , Estudios Transversales , Estudios de Seguimiento , Humanos , Inflamación/sangre , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Análisis Multivariante , Aparatos Ortopédicos , Paraplejía/diagnóstico , Paraplejía/rehabilitación , Valor Predictivo de las Pruebas , Probabilidad , Cuadriplejía/diagnóstico , Cuadriplejía/rehabilitación , Traumatismos de la Médula Espinal/diagnóstico , Silla de RuedasRESUMEN
RATIONALE: Although respiratory dysfunction is common in chronic spinal cord injury (SCI), determinants of longitudinal change in FEV(1) and FVC have not been assessed. OBJECTIVES: Determine factors that influence longitudinal lung function decline in SCI. METHODS: A total of 174 male participants (mean age of 49 and 17 yr after injury) completed a respiratory questionnaire and underwent spirometry over an average follow-up of 7.5 years (range, 4-14 yr). MEASUREMENTS AND MAIN RESULTS: In multivariate models, longitudinal decline in FEV(1) was significantly related to continued smoking, persistent wheeze, an increase in body mass index, and respiratory muscle strength. Aging was associated with an accelerated decline in FEV(1) (for ages <40, 40-60, >60 yr: -27, -37, and -71 ml/yr, respectively). Similar effects were observed for FVC. CONCLUSIONS: Longitudinal change in FEV(1) and FVC was not directly related to level and severity of SCI, but was attributable to potentially modifiable factors in addition to age. These results suggest that weight control, smoking cessation, trials directed at the recognition and treatment of wheeze, and efforts to improve respiratory muscle strength may slow lung function decline after SCI.
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Trastornos Respiratorios/prevención & control , Trastornos Respiratorios/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Índice de Masa Corporal , Enfermedad Crónica , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Fuerza Muscular , Trastornos Respiratorios/etiología , Músculos Respiratorios , Factores de Riesgo , Fumar/efectos adversos , Traumatismos de la Médula Espinal/complicaciones , Capacidad VitalRESUMEN
OBJECTIVE: An important goal of rehabilitation and treatment after spinal cord injury (SCI) is to improve function and enhance health-related quality of life (HRQoL). However, previous assessments are limited by use of HRQoL instruments not specific to SCI. Although respiratory dysfunction is common in SCI, it has not been possible to assess the association of comorbid medical conditions, including respiratory symptoms and pulmonary function, to HRQoL. Therefore, we assessed whether these factors were associated with HRQoL in SCI using an SCI-specific HRQoL questionnaire. DESIGN: In our cross-sectional study, 356 participants >or=1 yr post-SCI completed a 23-item SCI-specific HRQoL questionnaire and a detailed health questionnaire, and underwent pulmonary function testing and a neurological exam at VA Boston between 1998 and June 2003. RESULTS: In a multivariate regression model, age, employment status, motor level and completeness of injury, and ambulatory mode (use of hand-propelled or motorized wheelchair, use of crutches or canes, or walking independently) were independently associated with HRQoL. After adjusting for these factors, chronic cough, chronic phlegm, persistent wheeze, dyspnea with activities of daily living, and lower forced expiratory volume in 1 sec and forced vital capacity were each associated with a lower HRQoL. CONCLUSIONS: These results provide evidence for the clinical validity of our SCI-specific HRQoL instrument. We also identify potentially modifiable factors that, if addressed, may lead to HRQoL improvement in SCI.
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Actividades Cotidianas , Estado de Salud , Calidad de Vida , Traumatismos de la Médula Espinal/complicaciones , Adulto , Anciano , Comorbilidad , Estudios Transversales , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Traumatismos de la Médula Espinal/clasificación , Traumatismos de la Médula Espinal/fisiopatología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To assess factors that influence pulmonary function, because respiratory system dysfunction is common in chronic spinal cord injury (SCI). DESIGN: Cross-sectional cohort study. SETTING: Veterans Affairs Boston SCI service and the community. PARTICIPANTS: Between 1994 and 2003, 339 white men with chronic SCI completed a respiratory questionnaire and underwent spirometry. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and FEV(1)/FVC. RESULTS: Adjusting for SCI level and completeness, FEV(1) (-21.0 mL/y; 95% confidence interval [CI], -26.3 to -15.7 mL/y) and FVC (-17.2 mL/y; 95% CI, -23.7 to -10.8 mL/y) declined with age. Lifetime cigarette use was also associated with a decrease in FEV(1) (-3.8 mL/pack-year; 95% CI, -6.5 to -1.1 mL/pack-year), and persistent wheeze and elevated body mass index were associated with a lower FEV(1)/FVC. A greater maximal inspiratory pressure (MIP) was associated with a greater FEV(1) and FVC. FEV(1) significantly decreased with injury duration (-6.1 mL/y; 95% CI, -11.7 to -0.6 mL/y), with the greatest decrement in the most neurologically impaired. The most neurologically impaired also had a greater FEV(1)/FVC, and their FEV(1) and FVC were less affected by age and smoking. CONCLUSIONS: Smoking, persistent wheeze, obesity, and MIP, in addition to SCI level and completeness, were significant determinants of pulmonary function. In SCI, FEV(1), FVC, and FEV(1)/FVC may be less sensitive to factors associated with change in airway size and not reliably detect the severity of airflow obstruction.
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Traumatismos de la Médula Espinal/fisiopatología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Asma/complicaciones , Índice de Masa Corporal , Enfermedad Crónica , Estudios de Cohortes , Estudios Transversales , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Músculos Respiratorios/fisiopatología , Fumar/efectos adversos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos Torácicos/complicaciones , Capacidad VitalRESUMEN
OBJECTIVE: To assess factors associated with breathlessness in chronic spinal cord injury (SCI) during daily activities. DESIGN: Cross-sectional survey. SETTINGS: Veterans Affairs SCI service and the community. PARTICIPANTS: Four hundred forty-one participants 1 or more years post-SCI, and without acute illness, were recruited between 1994 and 2003 and were categorized according to their ability to walk unassisted, walk with an aid, or to move about by either hand-propelled wheelchair or motorized wheelchair (MWC). INTERVENTIONS: Assessment of injury extent, respiratory symptoms, cigarette smoking, comorbid medical conditions, and spirometry. MAIN OUTCOME MEASURES: Breathlessness during talking, eating, or dressing. RESULTS: Breathlessness was more common in MWC users (20/85 users, 24%) than in nonusers (20/356, 6%). The main activity associated with breathlessness in 15 MWC users was talking (18%). In MWC users, the risk of breathlessness was related to lifetime cigarette smoking (odds ratio [OR]=1.02; 95% confidence interval [CI], 1.00-1.03 per pack year), and reports of chronic cough (OR=7.8; 95% CI, 2.0-32.7), and wheeze (OR=3.5; 95% CI, 1.04-13.6). SCI level, percentage of predicted forced vital capacity and forced expiratory volume in 1 second, and maximal inspiratory pressures were not related to breathlessness. CONCLUSIONS: Breathlessness during selected daily activities (most commonly talking) was greatest in SCI participants who were most impaired with regard to mobility and was associated with reports of coughing, wheezing, and cigarette smoking.
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Actividades Cotidianas , Disnea/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Distribución de Chi-Cuadrado , Enfermedad Crónica , Estudios Transversales , Disnea/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , New England/epidemiología , Factores de Riesgo , Espirometría , Encuestas y Cuestionarios , Veteranos , Caminata/fisiología , Silla de RuedasRESUMEN
OBJECTIVES: To determine whether alcohol use at time of spinal cord injury (SCI) is more common with cervical injury than with lower levels of spinal injury. METHODS: Veterans and nonveterans with SCI were assessed at a Veteran's Affairs Medical Center from 1994 through 2002 and completed a health questionnaire that included information on alcohol use at time of traumatic injury. RESULTS: Of 362 men, 45% had neurologically complete or incomplete cervical injuries. Participants with cervical injury were more likely to have used alcohol when injured (62/162, 38%) compared with participants without cervical injury (45/200, 23%). Adjusting for age at injury and accident type, participants with cervical SCI had an increased relative odds of having used alcohol at injury compared with participants without cervical SCI (2.06, 95% confidence interval = 1.24-3.43). CONCLUSION: Alcohol use at time of SCI is a risk factor for cervical injury. This finding is of public health concern and should be included in alcohol educational programs.
Asunto(s)
Consumo de Bebidas Alcohólicas , Traumatismos de la Médula Espinal/epidemiología , Adolescente , Adulto , Vértebras Cervicales , Niño , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
The claim of a significant relationship between pulmonary peak expiratory flow rate and cognitive decline in normal aging is bound to raise the question of whether accelerated cognitive decline would be an automatic consequence of long-term tetraplegia, with its significant effects on normal respiratory function. We present a case series of three persons with long-term tetraplegia (11, 15, and 21 yr) comparing their cognitive test results (short-term and working memory, the ability to inhibit interference, and cognitive processing speed) with scores for age-matched noninjured adults. Results showed that long-term tetraplegia, even with compromised respiration, does not inevitably lead to decline in fundamental cognitive functions relative to age-matched noninjured controls.