Chronic obstructive pulmonary disease ( COPD ) is a chronic inflammatory lung disease common in smokers. It causes obstructed airflow from the lungs and presents with shortness of breath, cough, wheezing and increased mucus.

Most people are familiar that orthopedic and neurological conditions may increase the risk of falls. But can lung conditions also contribute to risk of falls? If yes, how?

Short answer: most likely COPD impairs blood flow to the brain and causes cognitive deficits which in turn contribute to risk of falls.

Long answer:

A recent report (J Clin Med. 2020 Feb 24;9(2)) demonstrated that 1) patients with COPD show worsened postural control balance measures; and 2) presence of oxygen therapy, fat mass, reduced neurocognitive function, comorbid (pre)diabetes, transcutaneous oxygen saturation, a history of exacerbation, and gait speed explain a large part of postural and balance deficits in the COPD population.

Again, risk factors like impaired gait and diabetes (which often causes neuropathy i.e. decreased foot sensation) do make logical sense as risk factors for balance and postural impairments, but what does the oxygen saturation have to do with balance? Furthermore, what does neurocognitive function have to do with COPD?

An older systematic review on cognitive impairment in COPD patients (J Bras Pneumol. 2015 Mar-Apr; 41(2): 182–190) may shed some light. Authors report that mild cognitive impairment is present in 36% of COPD patients and in 12% of subjects without COPD. Attention and executive function (in particular processing speed) are the most commonly affected cognitive impairments in COPD patients. Visuospatial memory and intermediate visual memory deficits apparently occur in 26.9% and 19.2% respectively in COPD patients. The review highlights studies suggesting that decreased blood oxygen is related to cognitive impairment. For instance, study published in Int J Chron Obstruct Pulmon Dis. 2010 Sep 7; 5():263-9 mentioned in this review shows evidence that low peripheral oxygen saturation (≤ 88%) has been strongly associated with a risk of cognitive impairment in patients with COPD, and the use of home oxygen therapy has been associated with a reduction in that risk.

It should be noted that J Am Geriatr Soc. 2017 May;65(5):916-923 demonstrate that slow processing speed is a risk factor for falls in older adults. Similarly, Aging Clin Exp Res. 2019 Oct 1 showed that visuospatial impairment was able to differentiate between older adults who fall vs those who don’t.

Overall, synthesizing the data together, it may be that COPD causes poor blood oxygen flow which causes impaired cognition, in particular slow processing speed and visuospatial impairment which contribute in increased risk of falls by impairing postural control and balance.

At Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute we provide a comprehensive medical evaluation for our patients based on principles of biomechanics to properly diagnose and manage risk of falls in older adults. We work closely with our expert physical and occupational therapy team to help provide excellent outcomes to our patients. Go to www.steadystridesmd.com to learn more or call (443) 898-8160 to schedule in person or telemedicine (video conference from your home via our secure system) evaluation with our team.