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Longitudinal Change in FEV₁ and FVC in Chronic Spinal Cord Injury

¹ Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts; ² Programs in Research at VA Boston, Harvard Medical School, West Roxbury, Massachusetts; ³ VA Cooperative Studies Program, VA Boston Healthcare System, Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; ⁴ Pulmonary and Critical Care Medicine Unit and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; ⁵ Harvard Medical School, Boston, Massachusetts; ⁶ Rehabilitation Medicine Service, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; ⁷ Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, Massachusetts; and ⁸ Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Eric Garshick, M.D., M.O.H., VA Boston Healthcare System, Pulmonary and Critical Care Medicine Section, 1400 VFW Parkway, West Roxbury, MA 02132. E-mail: eric.garshick{at}va.gov

Rationale: Although respiratory dysfunction is common in chronic spinal cord injury (SCI), determinants of longitudinal change in FEV₁ and FVC have not been assessed.

Objectives: Determine factors that influence longitudinal lung function decline in SCI.

Methods: A total of 174 male participants (mean age of 49 and 17 yr after injury) completed a respiratory questionnaire and underwent spirometry over an average follow-up of 7.5 years (range, 4–14 yr).

Measurements and Main Results: In multivariate models, longitudinal decline in FEV₁ was significantly related to continued smoking, persistent wheeze, an increase in body mass index, and respiratory muscle strength. Aging was associated with an accelerated decline in FEV₁ (for ages <40, 40–60, >60 yr: –27, –37, and –71 ml/yr, respectively). Similar effects were observed for FVC.

Conclusions: Longitudinal change in FEV₁ and FVC was not directly related to level and severity of SCI, but was attributable to potentially modifiable factors in addition to age. These results suggest that weight control, smoking cessation, trials directed at the recognition and treatment of wheeze, and efforts to improve respiratory muscle strength may slow lung function decline after SCI.

Key Words: respiratory function • longitudinal studies • smoking • body mass index

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Respiratory dysfunction is common in chronic spinal cord injury; however, determinants of longitudinal change in FEV1 and FVC have not been assessed. What This Study Adds to the Field Longitudinal change in FEV1 and FVC was not directly related to level and severity of SCI, but was attributable to potentially modifiable factors in addition to age. These results suggest that weight control, smoking cessation, trials directed at the recognition and treatment of wheeze, and efforts to improve respiratory muscle strength may slow lung function decline after SCI.