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)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the Veterans Administration Rehabilitation Research and Development Center of Excellence (grant no. B4162C).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the authors.
Identification
Copyright
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
