Background. COPD is a common chronic health condition. Because current medical treatments have minimal impact on disease progression, a strategy to prevent COPD-related disability would have important clinical and public health benefits.
Study Aims. To elucidate the disablement process, we will test a specific conceptual model of how disability develops in COPD.
The aims are: (1) To evaluate the impact of respiratory impairment, especially pulmonary function impairment, on the risk of functional limitation in COPD. Using a control group, to elucidate the prevalence of respiratory impairment, functional limitation, and disability that is directly attributable to COPD. (2) In adults with COPD, to delineate the longitudinal effect of functional limitation on the risk of incident disability. We hypothesize that development of functional limitation, and not pulmonary function impairment, is the major determinant of disability. (3) To determine the prospective impact of disability on the risk of future adverse health outcomes. Methods. We will assemble a prospective cohort of 1200 randomly sampled adults with COPD who are members of a large regional health maintenance organization. A matched control group of 300 subjects will be recruited. Subjects will undergo a detailed physical assessment that measures respiratory impairment (e.g., pulmonary function) and functional limitation (e.g., lower extremity function, muscle strength, exercise performance, and cognitive function). Structured telephone interviews will ascertain disability outcomes at baseline and 18-month prospective follow-up. We will also study the modulating effects of specific risk factors and protective factors on the progression from functional limitation to COPD-related disability, including psychological factors, environmental exposures, and health care process factors. Significance. Elucidation of the disablement process is the first step toward designing clinical and public health interventions that target reduction of disability in COPD. By determining the pathway from functional limitation to disability, our goal is to provide a scientific basis for screening and prevention of disability among persons with COPD. Based on this work, intervention strategies can be designed that target reduction of functional limitation and disability to improve downstream health outcomes.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL077618-05
Application #
7434360
Study Section
Epidemiology of Clinical Disorders and Aging Study Section (ECDA)
Program Officer
Smith, Robert A
Project Start
2004-07-01
Project End
2011-06-30
Budget Start
2008-07-01
Budget End
2011-06-30
Support Year
5
Fiscal Year
2008
Total Cost
$504,153
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Katz, Patricia; Iribarren, Carlos; Sanchez, Gabriela et al. (2016) Obesity and Functioning Among Individuals with Chronic Obstructive Pulmonary Disease (COPD). COPD 13:352-9
Singer, Jonathan P; Katz, Patricia P; Iribarren, Carlos et al. (2013) Both pulmonary and extra-pulmonary factors predict the development of disability in chronic obstructive pulmonary disease. Respiration 85:375-83
Omachi, Theodore A; Gregorich, Steven E; Eisner, Mark D et al. (2013) Risk adjustment for health care financing in chronic disease: what are we missing by failing to account for disease severity? Med Care 51:740-7
Eisner, Mark D; Iribarren, Carlos; Blanc, Paul D et al. (2011) Development of disability in chronic obstructive pulmonary disease: beyond lung function. Thorax 66:108-14
Singer, Jonathan; Yelin, Edward H; Katz, Patricia P et al. (2011) Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function. J Cardiopulm Rehabil Prev 31:111-9
Eisner, M D; Blanc, P D; Omachi, T A et al. (2011) Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 65:26-34
Eisner, Mark D; Blanc, Paul D; Yelin, Edward H et al. (2010) Influence of anxiety on health outcomes in COPD. Thorax 65:229-34
Omachi, Theodore A; Katz, Patricia P; Yelin, Edward H et al. (2010) The COPD Helplessness Index: a new tool to measure factors affecting patient self-management. Chest 137:823-30
Gardner, M A; Hills, N K; Sidney, S et al. (2010) The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort. Neurology 74:372-8
Thakur, Neeta; Blanc, Paul D; Julian, Laura J et al. (2010) COPD and cognitive impairment: the role of hypoxemia and oxygen therapy. Int J Chron Obstruct Pulmon Dis 5:263-9

Showing the most recent 10 out of 17 publications