Original article
Determinants of Forced Expiratory Volume in 1 Second (FEV1), Forced Vital Capacity (FVC), and FEV1/FVC in Chronic Spinal Cord Injury

Presented to the American Paraplegia Society, September 7−9, 2004, Las Vegas, NV.
https://doi.org/10.1016/j.apmr.2006.06.015Get rights and content

Abstract

Jain NB, Brown R, Tun CG, Gagnon D, Garshick E. Determinants of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC in chronic spinal cord injury.

Objective

To assess factors that influence pulmonary function, because respiratory system dysfunction is common in chronic spinal cord injury (SCI).

Design

Cross-sectional cohort study.

Setting

Veterans Affairs Boston SCI service and the community.

Participants

Between 1994 and 2003, 339 white men with chronic SCI completed a respiratory questionnaire and underwent spirometry.

Interventions

Not applicable.

Main Outcome Measures

Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC.

Results

Adjusting for SCI level and completeness, FEV1 (–21.0mL/y; 95% confidence interval [CI], –26.3 to –15.7mL/y) and FVC (–17.2mL/y; 95% CI, –23.7 to –10.8mL/y) declined with age. Lifetime cigarette use was also associated with a decrease in FEV1 (–3.8mL/pack-year; 95% CI, –6.5 to –1.1mL/pack-year), and persistent wheeze and elevated body mass index were associated with a lower FEV1/FVC. A greater maximal inspiratory pressure (MIP) was associated with a greater FEV1 and FVC. FEV1 significantly decreased with injury duration (–6.1mL/y; 95% CI, –11.7 to –0.6mL/y), with the greatest decrement in the most neurologically impaired. The most neurologically impaired also had a greater FEV1/FVC, and their FEV1 and FVC were less affected by age and smoking.

Conclusions

Smoking, persistent wheeze, obesity, and MIP, in addition to SCI level and completeness, were significant determinants of pulmonary function. In SCI, FEV1, FVC, and FEV1/FVC may be less sensitive to factors associated with change in airway size and not reliably detect the severity of airflow obstruction.

Section snippets

Patient Population

Between October 1994 and June 2003, 484 participants free from acute illness were recruited from the SCI Service of the Veterans Affairs (VA) hospital in West Roxbury, MA, and by advertisement from the community. A recruitment criterion of being 1 or more years post-SCI was selected to ensure that we tested subjects who had survived acute injury and related complications. Participants requiring mechanical ventilation or having a tracheostomy were not tested. The recruitment was from a pool of

Results

Baseline characteristics are presented with the cohort divided into 3 motor injury level and completeness groups (table 1) because some of the 9 injury level and severity groups had few subjects. The mean age of study participants was 50.7±14.9 years (range, 21.8−87.0y), and they were tested at an average of 17.4±12.8 years postinjury (range, 0.9−54.7y). Of the 120 people with a chest injury or operation, 64 (53%) reported broken ribs and 36 (30%) reported a history of a “punctured” or

Discussion

Although previous investigations on pulmonary function in SCI have assessed factors in addition to SCI level and completeness in large cross-sectional cohorts, to our knowledge the contribution of respiratory muscle strength and coexisting medical conditions has not been considered previously.4, 5, 6, 7, 8, 9, 10, 11, 12, 13 The results for cigarette smoking have also varied. Some previous studies4, 5, 6, 7, 8, 13 included relatively few participants, resulting in inadequate power to assess

Conclusions

Our study shows that in SCI, in addition to level and severity of injury, pulmonary function is influenced by previous chest injury or operation, age, time since injury, lifetime smoking, obesity, wheeze, and MIP. The effects of age and lifetime smoking were less apparent in participants with greater degrees of neurologic impairment and muscle weakness. Hence, decrements in FEV1, FVC, and FEV1/FVC in tetraplegia, and by extension in others with respiratory muscle weakness, may not reliably

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    Supported by National Institute of Child Health and Human Development, National Institutes of Health (grant no. RO1 HD42141), the Massachusetts Veterans Epidemiology Research and Information Center, Cooperative Studies Program, and Health Services Research and Development, Department of Veterans Affairs.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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