Am. J. Respir. Crit. Care Med., Volume 163, Number 4, March 2001, 936-941

Exercise Capacity Predicts Health Status in ₁-Antitrypsin Deficiency

LEE J. DOWSON, CLARE NEWALL, PETER J. GUEST, SUSAN L. HILL, and ROBERT A. STOCKLEY

Lung Investigation Unit, Nuffield House, Queen Elizabeth University Hospital, Birmingham, United Kingdom

Resting lung function is only weakly related to health status in chronic obstructive pulmonary disease, reflecting the multifactorial causes of impairment and the heterogeneous nature of the condition. The current study examined whether density mask analysis of high-resolution computed tomography (HRCT) or exercise capacity were better surrogates for health status in a well-defined, homogeneous group of patients with ₁-antitrypsin deficiency (PiZ). Twenty-nine patients with predominantly lower zone emphysema on HRCT were studied. Exercise was assessed by incremental treadmill ( O₂ peak) and shuttle walking tests (ISWT) and health status by the St. George's Respiratory Questionnaire (SGRQ) and SF-36. Although lower zone expiratory HRCT was related to exercise capacity (rho = 0.64 and 0.63 for O₂ peak and ISWT, respectively, p < 0.001), multiple regression analysis suggested that FEV₁ was a marginally better predictor (rho = 0.64 and 0.65, p < 0.001). HRCT also related significantly to health status (rho = 0.37 for SGRQ activity, p < 0.05), although again FEV₁ showed a stronger relationship (rho = 0.43, p = 0.01). However, exercise capacity was the best predictor of health status with the ISWT accounting for up to 55% of the variability seen in SGRQ total and up to 53% of the SF-36 domain scores (physical functioning). Although both HRCT and lung function relate to health status, exercise capacity is the best predictor of patients disability in these patients with predominantly lower zone emphysema.

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