title: Risk factors for chest illness in chronic spinal cord injury: a prospective study.
abstract: 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.
authors.affiliation: Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Tun
authors.forename: Eric
authors.initials: E
authors.lastname: Garshick
mesh_terms: 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
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