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Both Pulmonary and Extra-Pulmonary Factors Predict the Development of Disability in Chronic Obstructive Pulmonary Disease

Singer J.P.a, b · Katz P.P.d · Iribarren C.f · Omachi T.A.a, b · Sanchez G.f · Yelin E.H.d · Cisternas M.G.e · Blanc P.D.a-c
aDivision of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and bCardiovascular Research Institute and cDivision of Occupational and Environmental Medicine, Department of Medicine and dInstitute for Health Policy Studies and Department of Medicine, University of California, San Francisco, Calif., eMGC Data Services, Carlsbad, Calif., and fKaiser Permanente Division of Research, Oakland, Calif., USA Respiration 2013;85:375-383 (DOI:10.1159/000338110)


Background: Although chronic obstructive pulmonary disease (COPD) is a major cause of disability worldwide, its determinants remain poorly defined. Objective: We hypothesized that both pulmonary and extra-pulmonary factors would predict prospective disablement across a hierarchy of activities in persons with COPD. Methods: Six hundred and nine participants were studied at baseline (T0) and 2.5 years later (T1). The Valued Life Activities (VLA) scale quantified disability (10-point scale: 0 = no difficulty and 10 = unable to perform), defining disability as any activity newly rated ‘unable to perform' at T1. Predictors included pulmonary (lung function, 6-minute walk distance and COPD severity score) and extra-pulmonary (quadriceps strength and lower extremity function) factors. Prospective disability risk was tested by separate logistic regression models for each predictor (baseline value and its change, T0-T1; odds ratios were scaled at 1 standard deviation per factor. Incident disability across a hierarchy of obligatory, committed and discretionary VLA subscales was compared. Results: Subjects manifested a 40% or greater increased odds of developing disability for each predictor (baseline and change over time). Disability in discretionary activities developed at a rate 2.2-times higher than observed in committed activities, which was in turn 2.5-times higher than the rate observed in obligatory activities (p < 0.05 for each level). Conclusions: Disability is common in COPD. Both pulmonary and extra-pulmonary factors are important in predicting its development.


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