MUSCLE WEAKNESS IS RELATED TO UTILIZATION OF HEALTH-CARE RESOURCES INCOPD PATIENTS

The factors determining utilization of health care resources in patien ts with chronic obstructive pulmonary disease (COPD) are poorly unders tood, In order to obtain insight into these factors, we studied the ut ilization of health care resources in 57 stable COPD patients with a f orced expiratory volume in one second (FEV(1)) of 36+/-9% predicted. P atients were divided into two groups: admitted at least twice in the l ast year (high medical consumption; n=23) or not admitted in the last year (low medical consumption; n=34), Other variables related to utili zation of health care resources studied were: the number of hospital d ays; the number of out-patient visits to a pulmonary department in the last year; and the average daily dose (ADD) of corticosteroids taken in the last 6 months, The actual cost of utilization of health care re sources, however, was not studied. In addition, pulmonary function, se rum electrolytes, blood gas values, 6 min walking distance, respirator y and peripheral muscle force, and appraisal of self-care agency (ASA score) were studied. Pulmonary function, serum electrolytes, blood gas values, ASA score and walking distance were not different between the two groups (e.g, FEV(1) 36+/-8 vs 36+/-10% pred), Respiratory muscle forces tended to be lower in the high medical consumption group, this tendency almost reaching statistical significance for maximal expirato ry pressure (PE,max) (p=0.08), Peripheral muscle force, however, was c learly reduced in the high medical consumption group (quadriceps force 63+/-20 vs 82+/-26% pred; p<0.05). The number of admissions, the numb er of hospital days, the number of out-patient visits, and ADD were in terrelated and also related to ventilatory and peripheral muscle force (r -0.18 to -0.38), This relationship was statistically significant f or PE,max, whilst a similar tendency was present for maximal inspirato ry pressure (PI,max), In stepwise multiple regression analysis, only q uadriceps force was a significant determinant of utilization of health care services. We conclude that utilization of health care services i n patients with chronic obstructive pulmonary disease is related to ve ntilatory and peripheral muscle force, Whether or not reduced muscle f orce is simply an expression of disease severity remains to be determi ned.