Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 8 , Pages 1499-1506, August 2008

Determinants of Lung Volumes in Chronic Spinal Cord Injury

Presented as a poster to the American Thoracic Society, May 18–23, 2007, San Francisco, CA.

  • Evan L. Stepp, MD

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, West Roxbury, MA
    • Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Health Care System, West Roxbury, MA
    • Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
    • Harvard Medical School, Boston, MA
    • ,
  • Robert Brown, MD

      Affiliations

    • Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
    • Harvard Medical School, Boston, MA
    • ,
  • Carlos G. Tun, MD

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, West Roxbury, MA
    • Rehabilitation Medicine Service, VA Boston Health Care System, West Roxbury, MA
    • Harvard Medical School, Boston, MA
    • ,
  • David R. Gagnon, MD, MPH, PhD

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, West Roxbury, MA
    • VA Cooperative Studies Program, VA Boston Health Care System, West Roxbury, MA
    • Department of Biostatistics, Boston University School of Public Health, Boston, MA
    • ,
  • Nitin B. Jain, MD

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, West Roxbury, MA
    • Programs in Research at VA, VA Boston Health Care System, West Roxbury, MA
    • Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, Boston, MA
    • Harvard Medical School, Boston, MA
    • Harvard Medical School, Boston, MA
    • ,
  • Eric Garshick, MD, MOH

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, West Roxbury, MA
    • Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Health Care System, West Roxbury, MA
    • Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, Boston, MA
    • Harvard Medical School, Boston, MA
    • Corresponding Author InformationReprint requests to Eric Garshick, MD, MOH, Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Pkwy, West Roxbury, MA 02132

Abstract 

Stepp EL, Brown R, Tun CG, Gagnon DR, Jain NB, Garshick E. Determinants of lung volumes in chronic spinal cord injury.

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) (−38.7mL·kg−1·m−2), functional residual capacity (FRC) (−73.9mL·kg−1·m−2), residual volume (RV) (−40.4mL·kg−1·m−2), and expiratory reserve volume (ERV) (−32.2mL·kg−1·m−2). The effect of BMI on RV was most pronounced in quadriplegia (−72mL·kg−1·m−2). Lifetime smoking was associated with a greater FRC (5.3mL/pack-year) and RV (3.1mL/pack-years). The effects of lifetime smoking were also greatest in quadriplegia (11mL/pack-year for FRC; 7.8mL/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.

Key Words: Body mass index, Lung volume measurements, Rehabilitation, Spinal cord injuries

List of Abbreviations: ASIA, American Spinal Injury Association, AIS, ASIA Impairment Scale, ATS, American Thoracic Society, BMI, body mass index, CI, confidence interval, COPD, chronic obstructive pulmonary disease, CRP, C-reactive protein, ERV, expiratory reserve volume, FEV1, forced expiratory volume in 1 second, FRC, functional residual capacity, FVC, forced vital capacity, MEP, maximal expiratory pressure, MIP, maximal inspiratory pressure, RV, residual volume, SCI, spinal cord injury, SVC, slow vital capacity, TLC, total lung capacity

 

 Supported by the National Institute of Child Health and Human Development, National Institutes of Health (grant no. RO1 HD42141), Health Services Research and Development, and the Cooperative Studies Program, Department of Veterans Affairs, Massachusetts Veterans Epidemiology Research and Information Center.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00319-5

doi:10.1016/j.apmr.2008.02.018

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 8 , Pages 1499-1506, August 2008

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