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

Abstract

Background

Chronic 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.

Objective

To evaluate diaphragmatic excursion by M-mode ultrasonography in patients with COPD and to correlate it with different clinical and ventilatory variables.

Patients and methods

A 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.

Results

Diaphragmatic 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.

References

  1. Similowski T, Yan S, Gauthier AP, Macklem PT, Bellemare F. Contractile properties of the human diaphragm during chronic hyperinflation. N Engl J Med 1991; 325:917–923.

    CAS  Article  Google Scholar 

  2. Levine S, Nguyen T, Kaiser LR. Human diaphragm remodeling associated with chronic obstructive pulmonary disease: clinical implications. Am J Respir Crit Care Med. 2003; 168:706–713.

    Article  Google Scholar 

  3. Barreiro E, de la Puente B, Minguella J, Corominas JM, Serrano S, Hussain S, et al. Oxidative stress and respiratory muscle dysfunction in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171:1116–1124.

    Article  Google Scholar 

  4. Ottenheijm CA, Heunks LM, Sieck GC, Zhan WZ, Jansen SM, Degens H, et al. Diaphragm dysfunction in chronic obstructive pulmonary disease.Am J Respir Crit Care Med 2005; 172:200–205.

  5. Lahgi F, Shaik HS, Morales D, Sinderby C, Jubran A, Tobin MJ. Diaphragmatic neuromechanical coupling and mechanisms of hypercapnia during inspiratory loading. Respir Physiol Neurobiol 2014; 198:32–41.

    Article  Google Scholar 

  6. Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim KG, Strommen JA. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2014; 146:680–685.

    Article  Google Scholar 

  7. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014; 69:423–427.

    Article  Google Scholar 

  8. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997; 155:1570–1574.

    CAS  Article  Google Scholar 

  9. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 2011; 39:2627–2630.

    Article  Google Scholar 

  10. Dos Santos Yamaguti WP, Paulin E, Shibao S, Chammas MC, Salge JM, Ribeiro M, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology 2008; 13: 138–144.

    Article  Google Scholar 

  11. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2010. Available at: http://www. goldcopd.org. [Accessed at 15 Feb 2011].

  12. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187:347–365.

    CAS  Article  Google Scholar 

  13. American Thoracic Society (ATS). ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166:111–117.

  14. Harris RS, GiovannettiM, Kim BK. Normal ventilatorymovement of the right hemidiaphragm studied by ultrasonography and pneumotachography. Radiology 1983; 146:141–144.

    CAS  Article  Google Scholar 

  15. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135:391–400.

    Article  Google Scholar 

  16. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 2011; 37:44–52.

    Article  Google Scholar 

  17. Paulin E, Yamaguti WP, Chammas MC, Shibao S, Stelmach R, Cukier A, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med 2007; 101:2113–2118.

    CAS  Article  Google Scholar 

  18. Aka Aktürk U, çaglayan BN, Fidan A, Salepçi B, Turan D, Sener Cömert S, et al. The evaluation of diaphragmatic motion by M-mode ultrasonography in chronic obstructive lung diseases. Eur Respir J 2013; 42(Suppl 57):P1922.

  19. Takazakura R, Takahashi M, Nitta N, Murata K. Diaphragmatic motion in the sitting and supine positions: healthy subject study using a vertically open magnetic resonance system. J Magn Reson Imaging 2004; 19: 605–609.

    Article  Google Scholar 

  20. De Troyer A. Effect of hyperinflation on the diaphragm. Eur Respir J 1997; 10:708–713.

    PubMed  Google Scholar 

  21. Kang HW, Kim TO, Lee BR, Yu JY, Chi SY, Ban HJ, et al. Influence of diaphragmatic mobility on hypercapnia in patients with chronic obstructive pulmonary disease. J Korean Med Sci 2011; 26:1209–1213.

    Article  Google Scholar 

  22. Scheibe N, Sosnowski N, Pinkhasik A, Vonderbank S, Bastian A. Sonographic evaluation of diaphragmatic dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1925–1930.

    PubMed  PubMed Central  Google Scholar 

  23. American Thoracic Society; European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166:518–624.

    Article  Google Scholar 

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Correspondence to Ayman Amin MD.

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Amin, A., Zedan, M. Transthoracic ultrasonographic evaluation of diaphragmatic excursion in patients with chronic obstructive pulmonary disease. Egypt J Bronchol 12, 27–32 (2018). https://doi.org/10.4103/1687-8426.217411

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Key words

  • chronic obstructive pulmonary diseases
  • diaphragmatic excursion
  • transthoracic ultrasonography