Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

6533b854fe1ef96bd12af617

RESEARCH PRODUCT

Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

Claudio Pedone Filippo Luca Fimognari Simone Scarlata Raffaele Antonelli Incalzi Vincenzo Bellia Forastiere Francesco

subject

Male Risk Spirometry Pulmonary and Respiratory Medicine Longitudinal study medicine.medical_specialty Waist Vital Capacity Settore MED/10 - Malattie Dell'Apparato Respiratorio elderly Lung restriction Pulmonary function testing Pulmonary Disease Chronic Obstructive Forced Expiratory Volume Internal medicine Epidemiology medicine Humans Lung Diseases Obstructive Mortality Geriatric Assessment Lung Stroke Depression (differential diagnoses)Pulmonary function tests Aged Proportional Hazards Models Aged 80 and over medicine.diagnostic_test Proportional hazards model business.industry Longitudinal studies Prognosis medicine.disease Health Surveys Italy Spirometry Physical therapy Female business Follow-Up Studies

description

SummaryObjectivesTo evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity).DesignLongitudinal study.SettingCommunity-based.ParticipantsTwelve hundred sixty-five patients (51.9% men) aged 65–97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study.MeasurementsParticipants were divided in 4 groups: normal spirometry (NS): FEV1/FVC≥70%, FVC≥80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC≥70%, FVC<80%; obstructive ventilatory pattern (OVP): FEV1/FVC<70%, FVC≥80%, and mixed ventilatory pattern (MVP): FEV1/FVC<70%, FVC<80%. We calculated the association between restriction and mortality corrected for potential confounders using a multivariable Cox regression model.ResultsWe found a prevalence of RVP, OVP and MVP of 10.9%, 25.4%, and 17.3%, respectively. Compared to people with normal spirometric pattern, disability (19.6% vs. 10.1%), poor physical performance (35.4% vs. 22.3%), cognitive impairment (21.0% vs. 11.5%), increased waist circumference (62.1% and 26.8%), and kyphoscoliosis (56.8 and 13.5%) were more prevalent in the RVP group. After correction for potential confounders, RVP was associated with increased mortality (HR: 1.89; 95% CI: 1.15–3.11), as well as OVP (HR: 2.33; 95% CI: 1.58–3.11) and MVP (HR: 2.60; 95% CI: 1.74–3.93). Other factors associated with mortality were disability (HR: 1.92; 95% CI: 1.35–2.72), poor physical performance (HR: 1.37; 95% CI: 1.01–1.85), cognitive impairment (HR: 1.55; 95% CI: 1.06–2.27), depression (HR: 1.57; 95% CI: 1.16–2.13) and diagnosis of stroke (HR: 1.90; 95% CI: 1.18–3.05).ConclusionsRVP is associated with higher mortality in the elderly and, thus, deserves the same attention paid to an obstructive pattern. However, mechanisms mediating this association need to be clarified.

year	journal	country	edition	language
2008-09-01	Respiratory Medicine

10.1016/j.rmed.2008.02.021 http://dx.doi.org/10.1016/j.rmed.2008.02.021