Risk factors for chest illness in chronic spinal cord injury: a prospective study.
OBJECTIVE
Chest illnesses commonly cause morbidity in persons with chronic spinal cord injury. Risk factors remain poorly characterized because previous studies have not accounted for factors other than spinal cord injury.


METHODS
Between 1994 and 2005, 403 participants completed a respiratory questionnaire and underwent spirometry. Participants were contacted at a median of 1.7 yrs [interquartile range: 1.3-2.5 yrs] apart over a mean (SD) of 5.1 +/- 3.0 yrs and asked to report chest illnesses that had resulted in time off work, spent indoors, or in bed since prior contact.


RESULTS
In 97 participants, there were 247 chest illnesses (0.12/person-year) with 54 hospitalizations (22%). Spinal cord injury level, completeness of injury, and duration of injury were not associated with illness risk. Adjusting for age and smoking history, any wheeze (relative risk = 1.92; 95% confidence interval: 1.19, 3.08), pneumonia or bronchitis since spinal cord injury (relative risk = 2.29; 95% confidence interval: 1.40, 3.75), and physician-diagnosed chronic obstructive pulmonary disease (relative risk = 2.17; 95% confidence interval: 1.08, 4.37) were associated with a greater risk of chest illness. Each percent-predicted decrease in forced expiratory volume in 1 sec was associated with a 1.2% increase in risk of chest illness (P = 0.030).


CONCLUSIONS
In chronic spinal cord injury, chest illness resulting in time spent away from usual activities was not related to the level or completeness of spinal cord injury but was related to reduced pulmonary function, wheeze, chronic obstructive pulmonary disease, a history of pneumonia and bronchitis, and smoking.
Stolzmann
Kelly L
KL
Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.
Gagnon
David R
DR
Brown
Robert
R
Tun
Carlos G
CG
Garshick
Eric
E
D000328:Adult; D017677:Age Distribution; D001991:Bronchitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002908:Chronic Disease; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016014:Linear Models; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011336:Probability; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011782:Quadriplegia / Q000150:complications / Q000175:diagnosis; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis*; D013147:Spirometry; D011795:Surveys and Questionnaires; D015996:Survival Rate
J Spinal Cord Med. 1997 Jan;20(1):36-42
9097254
Thorax. 2006 Nov;61(11):951-6
16809414
Chest. 1990 Nov;98(5 Suppl):191S-195S
2226008
Am Rev Respir Dis. 1980 Nov;122(5):697-707
7447154
Am J Phys Med Rehabil. 2006 Sep;85(9):718-26
16924184
Spinal Cord. 1998 Apr;36(4):266-74
9589527
Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1-120
742764
Arch Phys Med Rehabil. 1996 Oct;77(10):1037-43
8857883
J Spinal Cord Med. 2007;30(4):355-61
17853657
Chest. 1997 Jul;112(1):113-6
9228365
Chest. 2003 Mar;123(3):725-30
12628869
J Am Paraplegia Soc. 1993 Oct;16(4):197-203
8270915
Am Rev Respir Dis. 1981 Jul;124(1):41-4
7258818
Arch Phys Med Rehabil. 1999 Nov;80(11):1411-9
10569435
Eur Respir J. 2005 Aug;26(2):319-38
16055882
Spinal Cord. 2000 Oct;38(10):604-10
11093321
Spinal Cord. 2004 Sep;42(9):513-25
15249928
Arch Phys Med Rehabil. 2006 Oct;87(10):1327-33
17023241
Am J Respir Crit Care Med. 1999 Jan;159(1):179-87
9872837
Arch Phys Med Rehabil. 2004 Nov;85(11):1757-63
15520970
J Spinal Cord Med. 2003 Spring;26 Suppl 1:S50-6
16296564
Arch Phys Med Rehabil. 1999 Nov;80(11):1402-10
10569434