Transthoracic ultrasonographic evaluation of diaphragmatic excursion in patients with chronic obstructive pulmonary disease

Ayman Amin,Moustafa Zedan

doi:10.4103/1687-8426.217411

Ayman Amin, Moustafa Zedan

Open Access

https://doi.org/10.4103/1687-8426.217411

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Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a multisystem disorder that mainly besides the lungs also affects the muscle mass. The force generated by the respiratory muscles decreases, resulting in a negative effect on ventilation and exercise capacity. Recent studies have reported that M-mode ultrasonography is reliable and relatively easy to use for assessment of diaphragmatic motion.ObjectiveTo evaluate diaphragmatic excursion by M-mode ultrasonography in patients with COPD and to correlate it with different clinical and ventilatory variables.Patients and methodsA total of 40 patients with COPD who attended Chest Diseases Department Al-Azhar University Hospitals from January 2017 to May 2017 were recruited in this study. Informed consent was obtained. Diagnosis and severity of COPD was made according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. All patients in this study were subjected to full medical history, clinical examination, pulmonary function tests, calculation of BMI, arterial blood gases analysis, 6-min walk test, and ultrasound imaging of the diaphragm.ResultsDiaphragmatic excursion during quiet breathing did not differ significantly between the patients and the controls (P=0.085). However, during deep breathing, the degree of diaphragmatic excursion was lower in the patients (P=0.001). Diaphragmatic excursion during deep breathing correlated significantly with disease severity(r=0.86); the percentage of the predicted forced expiratory volume in the first second, forced vital capacity, and forced expiratory volume in the first second/forced vital capacity (r=0.84, 0.72, and 0.80, respectively); and the 6-min walk test (r=0.47). Conclusion M-mode ultrasonography is an easy, noninvasive and inexpensive method for evaluation of diaphragmatic excursion. Patients with COPD had significantly lower diaphragmatic excursion than normal ones.

Highlights

Diaphragmatic dysfunction is not uncommon in patients with chronic obstructive pulmonary disease (COPD)
Diagnosis and severity of Chronic obstructive pulmonary disease (COPD) was made according to the Global Initiative for Chronic Obstructive Lung Disease guidelines
During deep breathing, the degree of diaphragmatic excursion was lower in the patients (P=0.001)

Summary

Introduction

Diaphragmatic dysfunction is not uncommon in patients with chronic obstructive pulmonary disease (COPD). The commonest and oldest known cause for diaphragmatic dysfunction in patients with COPD is mechanical disadvantage owing to overinflation of the lungs [1]. More recently recognized reasons for the diaphragmatic weakness are remodeling [2], exposure to oxidative stress [3], and a reduction of myosin filaments owing to reduced protein production and increased apoptosis of muscle cells [4]. Diaphragmatic mobility, as determined by ultrasound, has proven to be a good predictor of failure to wean off mechanical ventilation [9] and has been shown to correlate significantly with disease severity [10]. Chronic obstructive pulmonary disease (COPD) is a multisystem disorder that mainly besides the lungs affects the muscle mass. Recent studies have reported that M-mode ultrasonography is reliable and relatively easy to use for assessment of diaphragmatic motion

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