Document Detail

Development of disability in chronic obstructive pulmonary disease: beyond lung function.
MedLine Citation:
PMID:  21047868     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: COPD is a major cause of disability, but little is known about how disability develops in this condition.
METHODS: The authors analysed data from the Function, Living, Outcomes and Work (FLOW) Study which enrolled 1202 Kaiser Permanente Northern California members with COPD at baseline and re-evaluated 1051 subjects at 2-year follow-up. The authors tested the specific hypothesis that the development of specific non-respiratory impairments (abnormal body composition and muscle strength) and functional limitations (decreased lower extremity function, poor balance, mobility-related dyspnoea, reduced exercise performance and decreased cognitive function) will determine the risk of disability in COPD, after controlling for respiratory impairment (FEV(1) and oxygen saturation). The Valued Life Activities Scale was used to assess disability in terms of a broad range of daily activities. The primary disability outcome measure was defined as an increase in the proportion of activities that cannot be performed of 3.3% or greater from baseline to 2-year follow-up (the estimated minimal important difference). Multivariable logistic regression was used for analysis.
RESULTS: Respiratory impairment measures were related to an increased prospective risk of disability (multivariate OR 1.75; 95% CI 1.26 to 2.44 for 1 litre decrement of FEV(1) and OR 1.57 per 5% decrement in oxygen saturation; 95% CI 1.13 to 2.18). Non-respiratory impairment (body composition and lower extremity muscle strength) and functional limitations (lower extremity function, exercise performance, and mobility-related dyspnoea) were all associated with an increased longitudinal risk of disability after controlling for respiratory impairment (p<0.05 in all cases). Non-respiratory impairment and functional limitations were predictive of prospective disability, above-and-beyond sociodemographic characteristics, smoking status and respiratory impairment (area under the receiver operating characteristic curve increased from 0.65 to 0.75; p<0.001).
CONCLUSIONS: Development of non-respiratory impairment and functional limitations, which reflect the systemic nature of COPD, appear to be critical determinants of disablement. Prevention and treatment of disability require a comprehensive approach to the COPD patient.
Mark D Eisner; Carlos Iribarren; Paul D Blanc; Edward H Yelin; Lynn Ackerson; Nancy Byl; Theodore A Omachi; Stephen Sidney; Patricia P Katz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-11-03
Journal Detail:
Title:  Thorax     Volume:  66     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-24     Completed Date:  2011-03-02     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  108-14     Citation Subset:  IM    
University of California, San Francisco, 505 Parnassus Avenue, M1097, San Francisco, CA 94143-0111, USA.
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MeSH Terms
Activities of Daily Living
Body Composition / physiology
Disability Evaluation
Follow-Up Studies
Forced Expiratory Volume / physiology
Middle Aged
Muscle Strength / physiology
Pulmonary Disease, Chronic Obstructive / physiopathology*,  rehabilitation
Socioeconomic Factors
Grant Support
K23 HL102159/HL/NHLBI NIH HHS; K23 HL102159-02/HL/NHLBI NIH HHS; K24 HL 097245/HL/NHLBI NIH HHS; K24 HL097245-01/HL/NHLBI NIH HHS; R01 HL077618-02/HL/NHLBI NIH HHS; R01 HL077618-03/HL/NHLBI NIH HHS; R01 HL077618-04/HL/NHLBI NIH HHS; R01HL077618/HL/NHLBI NIH HHS; UL1 RR024131/RR/NCRR NIH HHS

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