The Disablement Process in COPD

  • Michael D. L. MorganEmail author
Part of the Respiratory Medicine book series (RM)


It is, to some extent, still understandable that chronic obstructive pulmonary disease (COPD) is seen as a one-dimensional problem where airway inflammation caused by cigarette smoking leads to airway obstruction, dyspnoea and activity limitation. In this model, the problem can be simply solved by the avoidance of cigarette smoking or a cure for airway inflammation. Whilst this theory may have continuing appeal for politicians, public health doctors and those scientists interested in airway inflammation, we now realise that it is a misleading over-simplification. The pathway that leads to incapacity in COPD begins with airway damage but becomes increasingly complex as it incorporates factors of influence in a multi system disease.


COPD Airway inflammation Smoking Airway obstruction Dyspnoea Airway inflammation Incapacity Airway damage Multi-system disease 


  1. 1.
    International Classification of Functioning, Disability and Health (ICF). World Health Organisation, Geneva 2001.Google Scholar
  2. 2.
    Pepin V, Saey D, Whittom F, LeBlanc P, Maltais F. Walking versus cycling: sensitivity to bronchodilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(12):1517–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Revill SM, Morgan MD, Singh SJ, Williams J, Hardman AE. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999;54(3):213–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–24.PubMedCrossRefGoogle Scholar
  5. 5.
    ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1): 111–7.Google Scholar
  6. 6.
    Onorati P, Antonucci R, Valli G, Berton E, De Marco F, Serra P, et al. Non-invasive evaluation of gas exchange during a shuttle walking test vs. a 6-min walking test to assess exercise tolerance in COPD patients. Eur J Appl Physiol. 2003;89(3–4):331–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Celli BR, Cote CG, Marin JM, Casanova C, Montes dO, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Evans RA, Singh SJ, Collier R, Williams JE, Morgan MD. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respir Med. 2009;103(7):1070–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Leidy NK. Subjective measurement of activity in chronic obstructive pulmonary disease. COPD. 2007;4(3):243–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Yohannes AM, Roomi J, Winn S, Connolly MJ. The manchester respiratory activities of daily living questionnaire: development, reliability, validity, and responsiveness to pulmonary rehabilitation. J Am Geriatr Soc. 2000;48(11):1496–500.PubMedGoogle Scholar
  12. 12.
    Garrod R, Bestall JC, Paul EA, Wedzicha JA, Jones PW. Development and validation of a standardized measure of activity of daily living in patients with severe COPD: the London Chest Activity of Daily Living scale (LCADL). Respir Med. 2000;94(6):589–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2): M85–94.PubMedGoogle Scholar
  14. 14.
    Butcher SJ, Meshke JM, Sheppard MS. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2004;24(4):274–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Lareau SC, Meek PM, Roos PJ. Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). Heart Lung. 1998;27(3):159–68.PubMedCrossRefGoogle Scholar
  16. 16.
    Richardson MT, Leon AS, Jacobs Jr DR, Ainsworth BE, Serfass R. Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol. 1994;47(3):271–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The physical activity scale for the elderly (PASE): evidence for validity. J Clin Epidemiol. 1999;52(7):643–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Benzo R. Activity monitoring in chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2009;29(6):341–7.PubMedGoogle Scholar
  19. 19.
    Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006;27(5): 1040–55.PubMedCrossRefGoogle Scholar
  20. 20.
    Meek PM. Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you? Chron Respir Dis. 2004;1(1):29–37.PubMedGoogle Scholar
  21. 21.
    Baghai-Ravary R, Quint JK, Goldring JJ, Hurst JR, Donaldson GC, Wedzicha JA. Determinants and impact of fatigue in patients with chronic obstructive pulmonary disease. Respir Med. 2009;103(2):216–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Gagnon P, Saey D, Vivodtzev I, Laviolette L, Mainguy V, Milot J, et al. Impact of preinduced quadriceps fatigue on exercise response in chronic obstructive pulmonary disease and healthy subjects. J Appl Physiol. 2009;107(3):832–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Alshair K, Kolsum U, Berry P, Smith J, Caress A, Singh D, et al. Development, dimensions, reliability and validity of the novel Manchester COPD fatigue scale. Thorax. 2009;64(11):950–5.CrossRefGoogle Scholar
  24. 24.
    Nair KS. Aging muscle. Am J Clin Nutr. 2005;81(5):953–63.PubMedGoogle Scholar
  25. 25.
    Swallow EB, Reyes D, Hopkinson NS, Man WD, Porcher R, Cetti EJ, et al. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax. 2007;62(2):115–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Polkey MI, Rabe KF. Chicken or egg: physical activity in COPD revisited. Eur Respir J. 2009;33(2):227–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Sandland CJ, Singh SJ, Curcio A, Jones PM, Morgan MD. A profile of daily activity in chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2005;25(3):181–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(9):972–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Sewell L, Singh SJ, Williams JE, Morgan MD. Seasonal variations affect physical activity and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev. 2010;30(5):329–33.PubMedGoogle Scholar
  30. 30.
    Tudor-Locke C, Washington TL, Hart TL. Expected values for steps/day in special populations. Prev Med. 2009;49(1):3–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006;61(9):772–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study. Am J Respir Crit Care Med. 2007;175(5):458–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T, Mishima M. Exercise capacity deterioration in patients with COPD: longitudinal evaluation over 5 years. Chest. 2005;128(1):62–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Casanova C, Cote CG, Marin JM, de Torres JP, Aguirre-Jaime A, Mendez R, et al. The 6-min walking distance: long-term follow up in patients with COPD. Eur Respir J. 2007;29(3):535–40.PubMedCrossRefGoogle Scholar
  35. 35.
    Ringbaek T, Martinez G, Brondum E, Thogersen J, Morgan M, Lange P. Shuttle walking test as predictor of survival in chronic obstructive pulmonary disease patients enrolled in a rehabilitation program. J Cardiopulm Rehabil Prev. 2010;30(6):409–14.PubMedGoogle Scholar
  36. 36.
    Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009;33(2):262–72.PubMedCrossRefGoogle Scholar
  37. 37.
    Watz H, Waschki B, Boehme C, Claussen M, Meyer T, Magnussen H. Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study. Am J Respir Crit Care Med. 2008;177(7):743–51.PubMedCrossRefGoogle Scholar
  38. 38.
    Eisner MD, Iribarren C, Blanc PD, Yelin EH, Ackerson L, Byl N, et al. Development of disability in chronic obstructive pulmonary disease: beyond lung function. Thorax. 2011;66(2): 108–14.PubMedCrossRefGoogle Scholar
  39. 39.
    Donaldson GC, Wilkinson TM, Hurst JR, Perera WR, Wedzicha JA. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(5):446–52.PubMedCrossRefGoogle Scholar
  40. 40.
    Spruit MA, Gosselink R, Troosters T, Kasran A, Gayan-Ramirez G, Bogaerts P, et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58(9):752–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Jones SW, Hill RJ, Krasney PA, O’Conner B, Peirce N, Greenhaff PL. Disuse atrophy and exercise rehabilitation in humans profoundly affects the expression of genes associated with the regulation of skeletal muscle mass. FASEB J. 2004;18(9):1025–7.PubMedGoogle Scholar
  42. 42.
    Vivodtzev I, Lacasse Y, Maltais F. Neuromuscular electrical stimulation of the lower limbs in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2008; 28(2):79–91.PubMedGoogle Scholar
  43. 43.
    Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax. 2002;57(4):333–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Crisafulli E, Gorgone P, Vagaggini B, Pagani M, Rossi G, Costa F, et al. Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J. 2010;36(5):1042–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Pitta F, Breyer MK, Hernandes NA, Teixeira D, Sant’anna TJ, Fontana AD, et al. Comparison of daily physical activity between COPD patients from Central Europe and South America. Respir Med. 2009;103(3):421–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Steiner MC, Evans R, Deacon SJ, Singh SJ, Patel P, Fox J, et al. Adenine nucleotide loss in the skeletal muscles during exercise in chronic obstructive pulmonary disease. Thorax. 2005;60(11):932–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Yohannes AM, Roomi J, Connolly MJ. Elderly people at home disabled by chronic obstructive pulmonary disease. Age Ageing. 1998;27(4):523–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Respiratory MedicineUniversity Hospital of Leicester, Glenfield HospitalLeicesterUK

Personalised recommendations