Is Balance Impairment an Issue for Younger Patients With COPD?

CT scan showing COPD
In COPD, how early in the disease process should clinician assess patients for balance impairment issues?

Balance is impaired in patients with chronic obstructive pulmonary disease (COPD) who are less than 65 years of age, according to study results recently published in the Clinical Respiratory Journal. Given this finding, study authors suggested that patients with COPD receive early testing for both balance and cognitive function, which are closely associated.

Few studies have examined the issue of balance impairment in COPD, especially among younger patients, despite evidence that balance/cognitive issues are COPD sequelae. Turkish researchers in the current study assessed balance/cognitive functions in 60 patients with COPD vs 60 healthy controls who were all under 65 years of age. Patients with COPD were divided into 2 groups according to dyspnea severity.

The investigators found that Berg balance scale and mini mental test (MMT) scores were significantly decreased in those with COPD (P =.009). Average values of the Berg balance scale and MMT were low in the severe dyspnea group and were associated with MMT findings. Berg balance scale scores were also associated with Beck depression inventory, forced expiratory volume in 1 second percentage (FEV1%), oxygen saturation (SpO2), number of hospitalizations, and other findings. The correlation between Berg balance scale scores and oxygen saturation was statistically significant (P =.008).

Routine tests of balance are not included in international guidelines, although balance impairment should be monitored, stated the authors. They noted that the use of such tests is supported by the American Thoracic Society and the European Respiratory Society. Furthermore, the treatment of balance impairment is emerging as a component of pulmonary rehabilitation.

One limitation of the current study is that the authors did not measure muscle strength/exercise capacity in participants. Negative correlations between Berg and the incidence of hospitalizations bolsters the notion that catabolic effects of exacerbations negatively affect muscle strength.

“Considering that impairments of balance and cognitive function increase with age, early examination, and close follow up of COPD patients are thought to be important for early diagnosis and treatment of functional losses,” concluded the authors. “We recommend focusing on pulmonary rehabilitation to prevent balance loss. Also, the depression level and cognitive function that are related to balance impairment for COPD patients have to be evaluated.”


Kaygusuz MH, Oral Tapan O, Tapan U, Genc S. Balance impairment and cognitive dysfunction in patients with chronic obstructive pulmonary disease under 65 years. Clin Respir J. Published online January 26, 2022. doi:10.1111/crj.13469