Prevalence of Risk of Fall among Individuals with COPD visiting Out- Patient Services in Tertiary Care Hospitals

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in progressive airflow limitation and respiratory distress and is one of the most important causes of death worldwide .Studies suggest that the people living with COPD also suffer from many non-respiratory manifestations including skeletal muscle dysfunction, systemic inflammation, nutritional depletion and malnutrition. The estimated global burden of COPD was 300 to 400 million globally between 2018 and 2019. India ranks number two globally with an estimated 37.8 million cases of COPD, contributing to 17.8% of the global burden of COPD as reported in study by Elroy Boers et al. The prevalence of COPD varies across different regions and states of India. Karnataka is ranked sixth among other states in terms of the prevalence of COPD ,with the prevalence reported to be 4.36% in Bangalore

Risk factors for COPD include smoking, use of cooking fuel, biomass fuel and firewood, outdoor air pollution, increasing age, occupation, gender, pulmonary impairment after tuberculosis. The risk of COPD increases with age, education level, lack of awareness about the health effects of smoking, poorer socioeconomic status, high air pollution regions, and more exposure to tobacco smoke and dust from occupations.

According to the Global Initiative for Chronic Obstructive Lung Diseases (2018), skeletal muscle dysfunction is one of the most common extra-pulmonary symptoms observed in COPD patients, accounting for 384 million cases of the disease. This dysfunction is characterized by decreased muscle strength and endurance. Peripheral and respiratory muscles are both affected by skeletal muscle dysfunction in COPD. Peripheral muscle functioning in both the upper and lower limbs is impaired in patients with COPD; however, the abnormalities are more severe in the lower limbs. The muscle group most affected is the quadriceps. As a result Patients with COPD have impaired balance and a higher risk of fall.

The prevalence of COPD fallers was reported to be 30%, and frequent fallers was 24%. The incidence rate of falls in stable COPD varied from 1.17 to 1.49 falls/person-year .Evidence suggests that identification of risk factors for falls may help in improving the understanding of screening for those at risk and help in forming the protocol for falls prevention programs.

 Risk of fall in elderly is assessed using the Timed-Up and Go(TUG) test. A TUG score of 10.9 seconds corresponds to 100% sensitivity and 97% specificity in assessing risk of fall in elderly. Among the various tests used to assess risk of fall the TUG Test and Berg balance scale have been proven to be reliable and validatedtools for evaluating risk of fall in individuals with COPD . A TUG score with a cutoff time of 12- seconds demonstrated high sensitivity and specificity (93% and 74% respectively) while evaluating risk of fall in patients with COPD.

Incorporating the TUG into the clinical setting for COPD patient evaluation would be simple and less time consuming. It has the ability to predict risk of fall. However, the paucity of literature on prevalence of risk of fall among COPD individuals visiting out-patient services in tertiary care hospitals defines the need of this study. Therefore, this study aims to determine the prevalence of risk of fall among individuals with COPD visiting out-patient services in tertiary care hospitals.