Respiratory Impairment in Older Persons: When Less Means More - 21/12/12
, Thomas M. Gill, MD b, Gail McAvay, PhD b, Philip H. Quanjer, MD, PhD c, Peter H. Van Ness, PhD, MPH b, John Concato, MD a, b
Requests for reprints should be addressed to Carlos A. Vaz Fragoso, MD, Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, Mailcode 151B, West Haven, CT 06250-8025Abstract |
Background |
Among older persons, within the clinical context of respiratory symptoms and mobility, evidence suggests that improvements are warranted regarding the current approach for identifying respiratory impairment (ie, a reduction in pulmonary function).
Methods |
Among 3583 white participants aged 65 to 80 years (Cardiovascular Health Study), we calculated the prevalence of respiratory impairment using the current spirometric standard from the Global Initiative for Obstructive Lung Disease (GOLD) and an alternative spirometric approach termed “lambda-mu-sigma” (LMS). Results for GOLD- and LMS-defined respiratory impairment were evaluated for their (cross-sectional) association with respiratory symptoms and gait speed, and for the 5-year cumulative incidence probability of mobility disability.
Results |
The prevalence of respiratory impairment was 49.7% (1780/3583) when using the GOLD and 23.2% (831/3583) when using LMS. Differences in prevalence were most evident among participants who had no respiratory symptoms, with respiratory impairment classified more often by the GOLD (38.1% [326/855]) than LMS (12.3% [105/855]), as well as among participants who had normal gait speed, with respiratory impairment classified more often by the GOLD (46.4% [1003/2164]) than LMS (19.3% [417/2164]). Conversely, the 5-year cumulative incidence probability of mobility disability for respiratory impairment was higher for LMS than GOLD (0.313 and 0.249 for never-smokers, and 0.352 and 0.289 for ever-smokers, respectively), but was similar for normal spirometry by LMS or GOLD (0.193 and 0.185 for never-smokers, and 0.219 and 0.216 for ever-smokers, respectively).
Conclusions |
Among older persons, the LMS approach (vs the GOLD approach) classifies respiratory impairment less frequently in those who are asymptomatic and is more strongly associated with mobility disability.
Le texte complet de cet article est disponible en PDF.Keywords : Gait speed, Mobility disability, Respiratory impairment, Respiratory symptoms
Plan
| Funding: Dr Vaz Fragoso is a recipient of a Career Development Award from the Department of Veterans Affairs and an R03 award from the National Institute on Aging (R03AG037051). Dr Gill is the recipient of a National Institute on Aging Midcareer Investigator Award in Patient-Oriented Research (K24AG021507). Dr Concato is supported by the Department of Veterans Affairs Cooperative Studies Program. |
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| Conflict of Interest: The study was conducted at the Veterans Affairs Clinical Epidemiology Research Center and the Yale Claude D. Pepper Older Americans Independence Center (P30AG2134). The investigators retained full independence in the conduct of this research. The Cardiovascular Health Study (CHS) was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the United States in collaboration with the CHS Study Investigators. This manuscript was prepared using a limited access dataset obtained from the NHLBI and does not necessarily reflect the opinions or views of the CHS or the NHLBI. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 126 - N° 1
P. 49-57 - janvier 2013 Retour au numéro
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