Pulmonary function in chronic spinal cord injury: A cross-sectional surveyof 222 Southern California adult outpatients

Objectives: To evaluate risk factors for respiratory morbidity in chronic s pinal cord injury (SCI). Setting: Model SCI care system based at an urban public rehabilitation medi cal center. Design: Case series with evaluation of pulmonary function by conventional s pirometric testing. Participants: Two hundred twenty-two adults with SCI of more than 1-year du ration who were not chronically dependent on mechanical ventilation, includ ing 98 with tetraplegia (62 with complete and 26 with incomplete motor lesi ons) and 124 with paraplegia (87 with complete and 37 with incomplete motor lesions). Main Outcome Measures: Forced vital capacity (FVC), forced expired volume i n 1 second (FEV1), and peak expiratory flow rate (PEFR), all measured in th e supine and erect seated positions and compared with predicted normal valu es for industrial workers. Results: FVC and FEV1 were normal in persons with low-level paraplegia who had never smoked, but both decreased similarly with rising SCI level, more markedly in those with tetraplegia. PEFR decreased with rising SCI level. I ncomplete lesions mitigated function loss in those with tetraplegia. In mid dle-aged individuals with tetraplegia, longer duration of injury was associ ated with greater function loss, independent of age. Current smokers showed excess function loss, except for those with high tetraplegia. Most people with complete tetraplegia showed FVC and FEV1 increases in the supine posit ion relative to the erect position. Conclusions: Pulmonary function is compromised by most lesions of the spina l cord, even in those with paraplegia, and is affected relative to the leve l of lesion. Efforts to help SCI patients minimize respiratory complication s-in particular, assistance in smoking cessation-should be given high prior ity.