Obstructive and restrictive lung disease and functional limitation: data from the Third National Health and Nutrition Examination.

Abstract

OBJECTIVE: To determine functional limitations in adults with obstructive or restrictive lung disease or respiratory symptoms. DESIGN: Cross-sectional study. SUBJECTS: Adult participants in phase 2 of the Third National Health and Nutrition Examination Survey, 1991-94. METHODS: We classified subjects using spirometric criteria into the following mutually exclusive categories using the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the FEV1/FVC ratio and the presence of respiratory symptoms: severe obstruction, moderate obstruction, mild obstruction, respiratory symptoms only, restrictive lung disease and no lung disease. We developed regression models to predict functional limitations (unable to walk a quarter of a mile, unable to lift 10 pounds, needs help with daily activities) that controlled for age, race, sex, education, smoking status, body mass index and comorbid conditions. RESULTS: Severe and moderate obstruction were associated with an increased risk of being unable to walk a quarter of a mile [odds ratio (OR) 8.4, 95% confidence interval (CI) 3.6, 19.9 and OR 2.4, 95% CI 1.4, 4.0]. Restrictive lung disease and the presence of respiratory symptoms in the absence of lung function impairment were also associated with an increased risk of this outcome (OR 2.8, 95% CI 1.4, 5.6 and OR 2.8, 95% CI 2.0, 3.9). Similar results were obtained for the outcomes of being unable to lift 10 pounds or needing help with daily activities. CONCLUSIONS: The presence of obstructive or restrictive lung disease, or respiratory symptoms in the absence of lung function impairment is associated with increased functional impairment.