Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters
Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters
Background/aim: Sonographic assessment of diaphragm structure and function would be a useful clinical tool in patients with chronicobstructive pulmonary disease (COPD). Our aim was to determine the muscle thickness of the diaphragm and the usefulness of clinicalpractice in patients with COPD.Materials and methods: The diaphragmatic thickness of 34 COPD patients and 34 healthy subjects was measured during tidal volume(Tmin) and deep inspiration (Tmax) on both sides using a B-mode ultrasound. The body mass index and the modified Medical ResearchCouncil (mMRC) index values were reported.Results: There was no correlation among TminR (P = 0.134), TminL (P = 0.647), TmaxR (P = 0.721), and TmaxL (P = 0.905) betweenthe patients with COPD and the control group. There was also no significant difference between diaphragmatic thickness and COPDseverity, respiratory function (P = 0.410), and frequency of exacerbations (P = 0.881) and mMRC (P = 0.667).Conclusion: Diaphragmatic dysfunction in COPD is related to mobility restriction rather than muscle thickness.
___
- 1. Martinez FJ, Couser JI, Celli BR. Factors influencing
ventilatory muscle recruitment in patients with chronic airflow
obstruction. American Review of Respiratory Disease 1990;
142 (2): 276-282. doi: 10.1164/ajrccm/142.2.276
- 2. Ottenheijm CA, Heunks LM, Sieck GC, Zhan WZ, Jansen
SM, et al. Diaphragm dysfunction in chronic obstructive
pulmonary disease. American Journal of Respiratory and
Critical Care Medicine 2005; 172 (2): 200-205. doi: 10.1164/
rccm.200502-262OC
- 3. Scheibe N, Sosnowski N, Pinkhasik A, Vonderbank S, Bastian
A. Sonographic evaluation of diaphragmatic dysfunction in
COPD patients. International Journal of Chronic Obstructive
Pulmonary Disease 2015; 10 (1): 1925-1930. doi: 10.2147/
COPD.S85659
- 4. Smargiassi A, Inchingolo R, Tagliaboschi L, Di Marco
Berardino A, Valente S et al. Ultrasonographic assessment
of the diaphragm in chronic obstructive pulmonary disease
patients: relationships with pulmonary function and the
influence of body composition - a pilot study. Respiration
2014; 87 (5): 364-371. doi: 10.1159/000358564
- 5. Marquis K, Debigaré R, Lacasse Y, LeBlanc P, Jobin J et al.
Midthigh muscle cross-sectional area is a better predictor
of mortality than body mass index in patients with chronic
obstructive Pulmonary disease. American Journal of
Respiratory and Critical Care Medicine 2002; 166 (6): 809-813.
doi: 10.1164/rccm.2107031
- 6. Steele RH, Heard BE. Size of the diaphragm in chronic
bronchitis. Thorax 1973; 28 (1): 55-60. doi: 10.1136/thx.28.1.55
- 7. Sferrazza Papa GF, Pellegrino GM, Di Marco F, Imeri G,
Brochard L et al. A review of the ultrasound assessment of
diaphragmatic function in clinical practice. Respiration 2016;
91 (5): 403-411. doi: 10.1159/000446518
- 8. Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim K et al.
B-mode ultrasound assessment of diaphragm structure and
function in patients with COPD. Chest 2014; 146 (3): 680-685.
doi: 10.1378/chest.13-2306
- 9. Eryüksel E, Cimsit C, Bekir M, Cimsit Ç, Karakurt S.
Diaphragmatic thickness fraction in subjects at high-risk for
COPD exacerbations. Respiratory Care 2017; 62 (12): 1565-
1570. doi: 10.4187/respcare.05646
- 10. Cimsit C, Bekir M, Karakurt S, Eryüksel E. Ultrasound
assessment of diaphragm thickness in COPD. Marmara Medical
Journal 2016; 29 (1): 8-13. doi: 10.5472/MMJoa.2901.02
- 11. Davachi B, Lari SM, Attaran D, Tohidi M, Ghofraniha L et
al. The relationship between diaphragmatic movements in
sonographic assessment and disease severity in patients with
stable chronic obstructive pulmonary disease (COPD). Journal
of Cardio-Thoracic Medicine 2014; 2 (3): 187-192.
- 12. Paulin E, Yamaguti WP, Chammas MC, Shibao S, Stelmach R
et al. Influence of diaphragmatic mobility on exercise tolerance
and dyspnea in patients with COPD. Respiratory Medicine
2007; 101 (10): 2113-2118. doi: 10.1016/j.rmed.2007.05.024
- 13. Unal O, Arslan H, Uzun K, Ozbay B, Sakarya ME. Evaluation
of diaphragmatic movement with MR fluoroscopy in chronic
obstructive pulmonary disease. Clinical Imaging 2002; 24 (6):
347-350. doi: 10.1016/S0899-7071(00)00245-X
- 14. Kang HW, Kim TO, Lee BR, Yu JY, Chi SY et al. Influence
of diaphragmatic mobility on hypercapnia in patients with
chronic obstructive pulmonary disease. Journal of Korean
Medical Science 2011; 26 (9): 1209-1213. doi: 10.3346/
jkms.2011.26.9.1209
- 15. Dos Santos Yamaguti WP, Paulin E, Shibao S, Chammas
MC, Salge JM et al. Air trapping: the major factor limiting
diaphragm mobility in chronic obstructive pulmonary disease
patients. Respirology 2008; 13 (1): 138-144. doi: 10.1111/j.1440-
1843.2007.01194.x