Clinical findings of the patients with legal pulmonary disability - Short-term follow-up at a tertiary university hospital in Korea

Kyung, Sun-Young;Kim, Yu-Jin;An, Chang-Hyeok;Lee, Sang-Pyo;Park, Jeong-Woong;Jeong, Sung-Hwan

  • Published : 20080600

Abstract

BACKGROUND/AIMS: Legal pulmonary disability in Korea is decided for chronic respiratory patients who have been diagnosed for a year or more, and the patients haven't gotten better after more than 2 months of sufficient treatment and they have shown no change in their pulmonary function within the two years after their original diagnosis. The purpose of this study was to investigate the clinical features and progress of those patients who have been diagnosed as having pulmonary disability. METHODS: We reviewed retrospectively the medical records of the patients who had been decided as having pulmonary disability at a tertiary university hospital from 2003 to 2004, and these patients could be followed up for more than 6 months. RESULTS: The number of enrolled patients was 118 (male : female = 95 : 23) and their mean age was 60+/-10 years. Their major underlying diseases were chronic obstructive pulmonary disease (n=45, 38%), tuberculous destroyed lung (n=29, 25%), and bronchial asthma (n=27, 23%). Of them, the number of patients with a class 1 pulmonary disability were 24 (20%), there were 28 class 2 patients (24%) and 66 class 3 patients (56%). The FEV1 could be followed up for 42 of these patients, of whom 20 patients showed no change or a decrease in their FEV1 but 22 showed an increased FEV1. Especially, some of them showed the increase of their FEV1 of 10% or more, and the 50% of them were patients with bronchial asthma. During the follow-up period, 6 patients died; 3 were class 1, 1 was class 2 and 2 were class 3. Five of these patients died of their underlying pulmonary diseases or combined pneumonia. CONCLUSIONS: It is necessary to decide the pulmonary disability after sufficient treatment and to perform periodic follow-up testing even after the disability decision for confirming that the disability is stable and also to adjust the class of the disability. Further studies are needed to observe the clinical progress and prognosis of patients with pulmonary disability by performing long-term follow-up for a large number of patients.

Keywords

References

  1. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva, World Health Organization, 1980
  2. Balmes JR, Branhart S. Evaluation of respiratory impairment/ disability. In: Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's textbook of respiratory medicine. 4th ed. p. 795-812, Philadelphia: Elsevier, 2005
  3. American Thoracic Society, Medical Section of the American Lung Association. Evaluation of impairment/disability secondary to respiratory disorders. Am Rev Respir Dis 126:945-951, 1982
  4. American Thoracic Society. Evaluation of impairment/disability secondary to respiratory disorders. Am Rev Respir Dis 133:1205- 1209, 1986
  5. American Thoracic Society, Medical Section of the American Lung Association. Guidelines for the evaluation of impairment/disability in patients with asthma. Am Rev Respir Dis 147:1056-1061, 1993 https://doi.org/10.1164/ajrccm/147.4.1056
  6. Cocchiarella L, Andersson G. Respiratory system. In: Guides to the evaluation of permanent impairment. 5th ed. Chicago, American Medical Association, 2001
  7. Lindgren I, Muller B, Gaensler EA. Pulmonary impairment and disability claims. JAMA 194:499-506, 1965 https://doi.org/10.1001/jama.194.5.499
  8. Lee JH, Chang JH. Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respir Med 97:1237- 1242, 2003 https://doi.org/10.1016/S0954-6111(03)00255-5
  9. Ortega F, Montemayor T, Sanches A, Cabello F, Castillo J. Role of cardiopulmonary exercise testing and the criteria used to determine disbility in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 150:747-751, 1994 https://doi.org/10.1164/ajrccm.150.3.8087347
  10. Cheon SH. The role of the pulmonary function test and the exercise test for assessing impairment/disability in patients with chronic airflow obstruction. Tuberc Respir Dis 43:377-387, 1996 https://doi.org/10.4046/trd.1996.43.3.377
  11. Efremidis G, Tsiamita M, Manolis A, Spiropoulos K. Accuracy of pulmonary function tests in predicted exercise capacity in COPD patients. Respir Med 99:609-614, 2005 https://doi.org/10.1016/j.rmed.2004.08.018
  12. Cotes JE. Rating respiratory disability: a report on behalf of a working group of the European Society for Clinical Respiratory Physiology. Eur Respir J 3:1074-1077, 1990
  13. Epler GR, Saber FA, Gaensler EA. Determination of severe impairment(disability) in interstitial lung disease. Am Rev Respir Dis 121:647-659, 1980