Obstructive and restrictive pulmonary dysfunction increases disability in Parkinson disease

Abstract

Objective: The purpose of this study was to determine in Parkinson disease the impact of pulmonary dysfunction on daily living activities (DLA).

Patients: Extrapyramidal motor impairment, pulmonary dysfunction, and DLA disabilities were studied in 58 Parkinson patients consecutively enrolled in a rehabilitation service at a university hospital.

Main outcome measures: Extrapyramidal motor impairments were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and the DLA disabilities by the UPDRS, Hoehn-Yahr, and Schwab-England scales. The pulmonary dysfunctions were assessed by spirometry with flow-volume loops, body plethysmography with lung volumes computation, and maximal inspiratory and expiratory static mouth pressures.

Results: Parkinson patients showed important modifications of pulmonary function with a decrease in forced vital capacity, forced expiratory volume in the first minute, and arterial PO2, and an increase in residual volume and total airway resistance (RAW). In addition, they showed a high incidence of airway ventilatory obstructions and restrictive dysfunction. The impact of lung disease on daily living activities in Parkinson disease patients was higher in subjects with restrictive pulmonary dysfunctions (Schwab-England test and turning in bed and adjusting bedclothes, walking, falling, and freezing when walking items of UPDRS) and airway obstructions (handling utensils, dressing and hygiene items of UPDRS).

Conclusions: Airway obstructions or restrictive pulmonary dysfunctions present a high prevalence in Parkinson disease, contributing as a main factor for DLA dysfunctions. The evaluation and rehabilitation of respiratory disturbances should be systematically included in the management of these patients.