Role of chest ultrasonography in assessment of diaphragmatic mobility in chronic obstructive pulmonary disease patients on pulmonary rehabilitation program

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) affects all skeletal muscles including the diaphragm as an extra pulmonary complication. Diaphragmatic mobility improves by pulmonary rehabilitation (PR). Chest ultrasound can be used in assessment of diaphragmatic mobility.AimEvaluation of chest ultrasound as a simple, noninvasive tool in assessment of diaphragmatic mobility in COPD patients undergoing PR and its correlation with maximal inspiratory pressure (Pi MAX), 6-min walk test (6MWT) and clinical chronic obstructive pulmonary disease questionnaire (CCQ).Patients and methodsThis study was conducted upon 30 COPD male patients aged 54.50±8.81 years old. All patients were recruited in to a PR program including 16 sessions over 8 weeks. The program included upper limb exercise, lower limb exercise and inspiratory muscle training. Baseline spirometry, Pi MAX, modified medical research council (mMRC) dyspnea scale, CCQ, 6MWT and sonographic assessment of diaphragmatic excursion and thickness were done. Follow-up sonographic evaluation of the diaphragm, CCQ and mMRC every 2 weeks were done. Re-evaluation after the program by the same baseline parameters was done.ResultsThere was statistically significant improvement in diaphragmatic excursion and thickness after PR program as evidenced by chest ultrasound. There was also significant functional improvement evidenced by 6MWT and Pi MAX. Also, there was significant improvement in mMRC and CCQ, but PR did not significantly affect spirometric parameters as forced expiratory volume in first second (FEV1)%, FEV1 value in liter or FEV1/forced vital capacity.ConclusionChest ultrasound is a beneficial tool in diaphragmatic assessment in COPD patients undergoing PR.