Endoscopic Lung Volume Reduction Results in Improvement of Diaphragm Mobility as Measured by Sonography.

Abstract

BackgroundHyperinflation in patients with pulmonary emphysema is an important cause of reduced diaphragm mobility. We investigated whether endoscopic lung volume reduction (ELVR) could improve diaphragm mobility.MethodsDiaphragm mobility data obtained by sonography from 44 patients were compared before and 3–6 months after ELVR therapy with a Spiration™ valve system. These patients were asked whether they wanted this procedure again after they had learned of their treatment outcome; this was a subjective indicator of outcome. Lung function parameters and blood gases were also measured.ResultsAfter ELVR, 30 patients (82%) developed atelectasis of ≥50% of the targeted lung lobe. These patients had a diaphragm mobility increase of 28.97 ± 15.93 mm, while the remaining patients experienced an improvement in diaphragm mobility of 16.07 ± 21.17 mm; this difference was significant (p = 0.030). All 30 patients with atelectasis and additional 6 patients without radiologically demonstrated atelectasis perceived an improved outcome after ELVR. Their diaphragm mobility increased by 28.89 ± 17.26 mm. Conversely, the patients with no perceived improvement in outcome had a diaphragm mobility increase of 6.75 ± 12.76 mm; this difference was significant (p = 0.001).ConclusionELVR can improve diaphragm mobility, and this improvement is correlated with a perceived positive outcome in patients.