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Airflow Obstruction and Reversibility in Spinal Cord Injury: Evidence for Functional Sympathetic Innervation

  • Miroslav Radulovic
    Correspondence
    Correspondence to Miroslav Radulovic, MD, Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center: Room. 1E-02, 130 West Kingsbridge Rd, Bronx, NY 10468
    Affiliations
    Veterans Affairs Rehabilitation Research and Development Service, The James J. Peters VA Medical Center, Bronx, NY

    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY
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  • Gregory J. Schilero
    Affiliations
    Veterans Affairs Rehabilitation Research and Development Service, The James J. Peters VA Medical Center, Bronx, NY

    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The Mount Sinai School of Medicine, New York, NY
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  • Jill M. Wecht
    Affiliations
    Veterans Affairs Rehabilitation Research and Development Service, The James J. Peters VA Medical Center, Bronx, NY

    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The Mount Sinai School of Medicine, New York, NY

    Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY
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  • Joseph P. Weir
    Affiliations
    Des Moines University-Osteopathic Medical Center, Des Moines, IA
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  • Ann M. Spungen
    Affiliations
    Veterans Affairs Rehabilitation Research and Development Service, The James J. Peters VA Medical Center, Bronx, NY

    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY

    Department of Spinal Cord Injury Service, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The Mount Sinai School of Medicine, New York, NY

    Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY
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  • William A. Bauman
    Affiliations
    Veterans Affairs Rehabilitation Research and Development Service, The James J. Peters VA Medical Center, Bronx, NY

    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY

    Department of Spinal Cord Injury Service, The James J. Peters VA Medical Center, Bronx, NY

    Department of Medicine, The Mount Sinai School of Medicine, New York, NY

    Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY
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  • Marvin Lesser
    Affiliations
    Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY
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      Abstract

      Radulovic M, Schilero GJ, Wecht JM, Weir JP, Spungen AM, Bauman WA, Lesser M. Airflow obstruction and reversibility in spinal cord injury: evidence for functional sympathetic innervation.

      Objectives

      The first objective was to assess group differences for specific airway conductance (sGaw) among subjects with tetraplegia, high paraplegia (HP: T2-T6), and low paraplegia (LP: T10-L4). The second objective was to determine the significance of responsiveness to ipratropium bromide (IB) by the assessment of the inherent variability of baseline measurements for impulse oscillation (IOS), body plethysmography, and spirometry.

      Design

      Prospective cross-sectional intervention study.

      Setting

      James J. Peters Veterans Administration Medical Center.

      Participants

      Subjects (N=43): 12 with tetraplegia (C4-8), 11 with HP, 11 with LP, and 9 controls.

      Interventions

      Not applicable.

      Main Outcome Measures

      Measurement of IOS, body plethysmography, and spirometry parameters at baseline and 30 minutes after IB.

      Results

      Baseline sGaw was significantly lower in tetraplegia (0.14±0.03) compared with HP (0.19±0.05) and LP (0.19±0.04) patients. By use of minimal difference to evaluate IB responsiveness in tetraplegia, 4 of 12 and 12 of 12 subjects had significant increases in forced expiratory volume in 1 second and sGaw, respectively, whereas 11 of 12 and 10 of 12 subjects had significant decreases in respiratory resistances measured at 5 and 20Hz (R5 and R20), respectively.

      Conclusions

      The finding of group differences for baseline sGaw supports the hypothesis that human lung contains functional sympathetic innervation. Body plethysmography and IOS were comparable in detecting IB-induced bronchodilation in tetraplegia and significantly more sensitive than spirometry.

      Key Words

      List of Abbreviations:

      ANOVA (analysis of variance), ATS (American Thoracic Society), CI (confidence interval), COPD (chronic obstructive pulmonary disease), FEF (forced expiratory flow rate), FEV1 (forced expiratory volume in 1 second), HP (high paraplegia), IB (ipratropium bromide), ICC (intraclass correlation coefficient), IOS (impulse oscillation system), LP (low paraplegia), MD (minimal difference), PLSD (protected least significant differences), R(AW) (airway resistance), SCI (spinal cord injury), SEM (standard error of the measurement), sGaw (specific airway conductance), Vtg (thoracic gas volume)
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