Breathlessness in spinal cord injury depends on injury level

Little is known about the prevalence and predictors of breathlessness in individuals with neurologically complete chronic spinal cord injury (SCI). Between December 1992 and September 1993, we mailed a respiratory questionnaire to 1,147 community-based individuals with chronic SCI. The questionnaire included four questions about the presence of breathlessness during activities related to moving about. Of the 485 who replied (42 percent response rate), analysis was limited to adult males with neurologically complete motor injuries who reported using a hand-propelled wheelchair more than 50 percent of the time to get around. Of 130 subjects (33 tetraplegics, 53 high thoracic SCI, 44 lower injury levels), the patients with tetraplegia reported breathlessness more frequently (range for the four questions, 21-33%) than those with high thoracic (range, 9-15%) or lower injury levels (range, 2-11%). For each of the four questions there was a significant trend (p < 0.05) for subjects with higher levels of injury to report the greatest prevalence of breathlessness (tetraplegia > high thoracic > lower). The frequency of breathlessness was greatest in those with neurologically complete cervical injuries, an effect that was independent of obesity, smoking, age, and years since SCI. The mechanisms of breathlessness in SCI are unclear but elucidation might lead to strategies for providing relief.