Airflow obstruction and reversibility in spinal cord injury: evidence for functional sympathetic innervation.
OBJECTIVE
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.


METHODS
Prospective cross-sectional intervention study.


METHODS
James J. Peters Veterans Administration Medical Center.


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


METHODS
Not applicable.


METHODS
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 20 Hz (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.
Radulovic
Miroslav
M
Veterans Affairs Rehabilitation Research and Development Service, Center of Excellence for the Medical Consequences of Spinal Cord Injury, Department of Medicine, The James J. Peters VA Medical Center, Bronx, NY 10468, USA. Miroslav.Radulovic@va.gov
Schilero
Gregory J
GJ
Wecht
Jill M
JM
Weir
Joseph P
JP
Spungen
Ann M
AM
Bauman
William A
WA
Lesser
Marvin
M
D000328:Adult; D000402:Airway Obstruction / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D001980:Bronchi / Q000294:innervation*; D001993:Bronchodilator Agents / Q000494:pharmacology; D016022:Case-Control Studies; D018680:Cholinergic Antagonists / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D006801:Humans; D009241:Ipratropium / Q000494:pharmacology; D009130:Muscle, Smooth / Q000294:innervation*; D010264:Paraplegia / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation; D010991:Plethysmography; D011446:Prospective Studies; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation; D012129:Respiratory Function Tests / Q000379:methods; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation; D013147:Spirometry; D013564:Sympathetic Nervous System / Q000187:drug effects*
D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D009241:Ipratropium