title: Balance impairment and systemic inflammation in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with systemic inflammation and balance impairment. The aim of our study was to evaluate the impact on equilibrium of stable and exacerbation (acute exacerbation of COPD [AECOPD]) phases of COPD and to investigate if there is a connection between lower extremity muscle weakness and systemic inflammation.
  
  
  METHODS
  We enrolled 41 patients with COPD (22 stable and 19 in AECOPD) and 20 healthy subjects (control group), having no significant differences regarding the anthropometric data. We analyzed the differences in balance tests scores: Falls Efficacy Scale-International (FES-I) questionnaire, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Single Leg Stance (SLS), 6-minute walking distance (6MWD), isometric knee extension (IKE) between these groups, and also the correlation between these scores and inflammatory biomarkers.
  
  
  RESULTS
  The presence and severity of COPD was associated with significantly decreased score in IKE (P<0.001), 6MWD (P<0.001), SLS (P<0.001), and BBS (P<0.001), at the same time noting a significant increase in median TUG score across the studied groups (P<0.001). The AECOPD group vs stable group presented a significant increase in high-sensitive C-reactive protein (hs-CRP) levels (10.60 vs 4.01; P=0.003) and decrease in PaO2 (70.1 vs 59.1; P<0.001). We observed that both IKE scores were significantly and positive correlated with all the respiratory volumes. In both COPD groups, we observed that fibrinogen reversely and significantly correlated with the 6MWD, and FES-I questionnaire is correlated positively with TUG test. Hs-CRP correlated reversely with the walking test and SLS test, while correlating positively with TUG test and FES-I questionnaire.
  
  
  CONCLUSIONS
  According to this study, COPD in advanced and acute stages is associated with an increased history of falls, systemic inflammation, balance impairment, and lower extremity muscle weakness.
authors.affiliation: Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tudorache
authors.affiliation: Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Oancea
authors.affiliation: Physical Education and Sport Faculty, West University of Timisoara, Timisoara, Romania.
authors.forename: Claudiu
authors.initials: C
authors.lastname: Avram
authors.affiliation: Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Fira-Mladinescu
authors.affiliation: Department of Cardiology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Petrescu
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Timar
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016138:Walking
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: COPD; balance; falls; inflammation; muscle