Balance impairment and systemic inflammation in chronic obstructive pulmonary disease

Abstract

Background/purposeChronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with systemic inflammation and balance impairment. The aim of our study was to evaluate the impact on equilibrium of stable and exacerbation (acute exacerbation of COPD [AECOPD]) phases of COPD and to investigate if there is a connection between lower extremity muscle weakness and systemic inflammation.MethodsWe enrolled 41 patients with COPD (22 stable and 19 in AECOPD) and 20 healthy subjects (control group), having no significant differences regarding the anthropometric data. We analyzed the differences in balance tests scores: Falls Efficacy Scale-International (FES-I) questionnaire, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Single Leg Stance (SLS), 6-minute walking distance (6MWD), isometric knee extension (IKE) between these groups, and also the correlation between these scores and inflammatory biomarkers.ResultsThe presence and severity of COPD was associated with significantly decreased score in IKE (P<0.001), 6MWD (P<0.001), SLS (P<0.001), and BBS (P<0.001), at the same time noting a significant increase in median TUG score across the studied groups (P<0.001). The AECOPD group vs stable group presented a significant increase in high-sensitive C-reactive protein (hs-CRP) levels (10.60 vs 4.01; P=0.003) and decrease in PaO2 (70.1 vs 59.1; P<0.001). We observed that both IKE scores were significantly and positive correlated with all the respiratory volumes. In both COPD groups, we observed that fibrinogen reversely and significantly correlated with the 6MWD, and FES-I questionnaire is correlated positively with TUG test. Hs-CRP correlated reversely with the walking test and SLS test, while correlating positively with TUG test and FES-I questionnaire.ConclusionAccording to this study, COPD in advanced and acute stages is associated with an increased history of falls, systemic inflammation, balance impairment, and lower extremity muscle weakness.

Neurocognitive Impairment as Systemic Effects of COPD

“…Age and other features may include lower limb muscle weakness, overall fatigue, dizziness, diferent functional impairment, body imbalance and others [14].…”

Impaired calcium signaling in muscle fibers from intercostal and foot skeletal muscle in a cigarette smoke-induced mouse model of COPD

“…In support of this hypothesis, recent reports have shown that COPD in advanced stages is associated with an increased history of falls, balance impairment, and lower extremity muscle weakness. [65][66][67][68] Our results highlight that intercostal and intrinsic foot muscle Ca 21 signaling dysregulation occurs in cigarette smoke exposure. Understanding in more detail the pathophysiology of COPD and its effects in different skeletal muscles could help to further our knowledge of the natural history of the disease and to develop targeted treatments aimed to improve the performance of specific muscle groups.…”

“…We hypothesize that intrinsic foot muscle dysfunction could contribute to the increased susceptibility to falls in individuals with chronic COPD. In support of this hypothesis, recent reports have shown that COPD in advanced stages is associated with an increased history of falls, balance impairment, and lower extremity muscle weakness …”

Physical and Functional Impairment During and After Hospitalization in Subjects With Severe COPD Exacerbation

“…Regarding postural steadiness, the study conducted by Tudorache et al 37 showed that the presence of COPD with stable or exacerbation phases is associated with impairment in postural steadiness. Our results showed that hospitalization led to impairment in postural steadiness.…”