PURPOSE: In patients with unilateral diaphragm paralysis (UDP), improvement or decline in pulmonary function (PF) over time may help guide management decisions. We wished to determine if patient characteristics influenced the time course of PF in this disorder.
METHODS: 21 patients with UDP underwent serial measurements of spirometry, lung volume and DLCO at 0, 1, 2 and 3 years after presentation in the pulmonary clinic. Baseline patient characteristics included gender, obesity (BMI>30), older age (>70), right-vs.-left UDP, and presence of underlying lung or heart disease. From the entire group, we identified patients whose % predicted forced vital capacity (FVC%) decreased over the 1-3 year interval. Fisher’s exact test was used to determine whether a decline in FVC% was contingent on any of these patient characteristics.
RESULTS: Among all patients, there was no significant change over 1-3 years in the percent predicted values for FEV-1, FVC, functional residual capacity (FRC) or DLCO. Eleven of 21 patients showed a decline in %FVC with time, 3 of whom had a substantial (>15%) decline. Female gender was significantly associated with a decline in FVC% (P=0.02), and age>70 was associated with a trend toward decline in FVC% (P=0.09). There was no significant effect of obesity, presence of underlying cardiopulmonary disease or right vs. left UDP.
CONCLUSIONS: Overall pulmonary function does not decline over 1-3 years in patients with UDP. Half of these patient experience a decline in FVC over time that is usually small (<15%). The probability of a decline in FVC is significantly higher in females and marginally higher in elderly patients. Underlying cardiopulmonary disease and obesity do not increase the odds of a decline in FVC%.
CLINICAL IMPLICATIONS: In unilateral diaphragm paralysis, the finding that elderly females are at risk of declining vital capacity over time suggests that a more aggressive treatment strategy may be warranted in this group.
DISCLOSURE: The following authors have nothing to disclose: Pomin Yeung, Paul Richman, Gerald Smaldone
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