The Use of Diaphragm Ultrasonography in Pulmonary Physiotherapy of COPD Patients: A Literature Review.

Agnieszka Lewińska,Karen Shahnazaryan

doi:10.3390/jcm9113525

Abstract

There is potentially a broad range of patient populations in which ultrasound imaging (US) might be beneficial form of physiotherapy process support. Among them, the group of patients with chronic obstructive pulmonary disease (COPD) is of great importance, as in this individuals the diaphragm dysfunction is frequently observed. Pulmonary physiotherapy often includes techniques which are intended to influence the diaphragm muscle but its anatomy does not allow for variety of techniques to assess function. Lack of easily available and reliable measures complicates outcomes interpretation and makes decision-making process difficult. A review of the electronic literature was conducted to identify studies related to the US assessment of physiotherapy process and its outcome in COPD patients. As a consequence, seven papers were identified. Based on the results obtained, it can be concluded that the diaphragm excursion is US measure that is most often described in context of diaphragm-related physiotherapy in COPD patients. The methodology applied, however, varies greatly making it difficult to compare results. Thus, developing standards of outcome assessment methods and therapy monitoring systems which are supported by evidence should be of paramount importance. Future studies could also focus on identifying which components of physiotherapeutic diaphragm-targeted approach provide acceptable level of evidence.

Highlights

Wide range of patient populations potentially exists in which ultrasonography (US) might be beneficial form of physiotherapy process support
The group of patients suffering from chronic obstructive pulmonary disease (COPD) is of great importance, as its high prevalence, morbidity, and mortality is a growing challenge for health-care systems
The review conducted suggests that excursion is the diaphragm US measure that is most often described in context of physiotherapy in COPD patients

Summary

Introduction

Wide range of patient populations potentially exists in which ultrasonography (US) might be beneficial form of physiotherapy process support. The group of patients suffering from chronic obstructive pulmonary disease (COPD) is of great importance, as its high prevalence, morbidity, and mortality is a growing challenge for health-care systems. There was relationship demonstrated between altered mobility of the diaphragm and parameters that quantify air trapping (residual volume and residual volume to total lung capacity ratio) in people with COPD [1]. The decline in diaphragmatic motion reflecting impaired respiratory muscle function is a significant risk factor for increased mortality. A mechanical strain which is imposed on the inspiratory muscles, is caused by increased resistive and elastic loads, resulting from greater airway resistance and reduced dynamic pulmonary compliance. Thoracic hyperinflation caused by air trapping changes diaphragm muscle fibers orientation in a zone of apposition (ZOA), which makes the contraction less effective at lower rib cage expansion. The remodeling results in flattening of the muscle and subsequent decreased diaphragmatic excursion [2]

Methods

Discussion

Conclusion