Pulmonary function in chronic spinal cord injury: A cross-sectional survey of 222 Southern California adult outpatients☆☆☆★★★♢♢♢

Abstract 

Linn WS, Adkins RH, Gong H Jr, Waters RL. Pulmonary function in chronic spinal cord injury: a cross-sectional survey of a large southern California outpatient population. Arch Phys Med Rehabil 2000;81:757-63. Objectives: To evaluate risk factors for respiratory morbidity in chronic spinal cord injury (SCI). Setting: Model SCI care system based at an urban public rehabilitation medical center. Design: Case series with evaluation of pulmonary function by conventional spirometric testing. Participants: Two hundred twenty-two adults with SCI of more than 1-year duration who were not chronically dependent on mechanical ventilation, including 98 with tetraplegia (62 with complete and 26 with incomplete motor lesions) and 124 with paraplegia (87 with complete and 37 with incomplete motor lesions). Main Outcome Measures: Forced vital capacity (FVC), forced expired volume in 1 second (FEV₁), and peak expiratory flow rate (PEFR), all measured in the supine and erect seated positions and compared with predicted normal values for industrial workers. Results: FVC and FEV₁ were normal in persons with low-level paraplegia who had never smoked, but both decreased similarly with rising SCI level, more markedly in those with tetraplegia. PEFR decreased with rising SCI level. Incomplete lesions mitigated function loss in those with tetraplegia. In middle-aged individuals with tetraplegia, longer duration of injury was associated with greater function loss, independent of age. Current smokers showed excess function loss, except for those with high tetraplegia. Most people with complete tetraplegia showed FVC and FEV₁ increases in the supine position relative to the erect position. Conclusions: Pulmonary function is compromised by most lesions of the spinal cord, even in those with paraplegia, and is affected relative to the level of lesion. Efforts to help SCI patients minimize respiratory complications—in particular, assistance in smoking cessation—should be given high priority. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Keywords:  Paraplegia, Tetraplegia, Spirometry, Smoking, Rehabilitation