Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Assessment of diaphragmatic mobility by chest ultrasound in relation to BMI and spirometric parameters

Egyptian Journal of Bronchology volume 13, pages 232–243 (2019)Cite this article

Abstract

Context

Ultrasound of the diaphragm is an evolving diagnostic modality with several techniques and measurements that can be used for structural and functional assessment of the diaphragm. Weight may have effects on pulmonary function tests including its impairment. Assessment of the diaphragm is one of these important measures of function by measuring the diaphragmatic thickness, excursion, and diaphragmatic thickness fraction (DTF).

Aim

Assessing the relation between these sonographic diaphragmatic indices with spirometry and BMI.

Settings and design

This was a prospective clinical study in which 107 normal healthy volunteers with different age, height, and weight were enrolled; most of them were coming for routine preoperative assessment at the Ain Shams University Chest Department Pulmonary Function Unit.

Patients and methods

It included 107 healthy persons who came for routine preoperative lung function assessment or normal volunteers. Full medical and smoking history, BMI, chest radiography spirometry, and diaphragmatic assessment by ultrasound for excursion, thickness, and DTF were done. All persons were divided into obese individuals of BMI more than or equal to 25 and nonobese individuals of BMI less than 25.

Statistical analysis

Statistical package for the social sciences program (SPSS) software version 18.0.

Results

In obese individuals, forced expiratory volume in the first second (FEV1%) and right diaphragmatic excursion show a significant decrease when BMI increases. There was a statistically significant increase in right and left diaphragmatic excursion and DTF in men rather than women. There was a highly significant increase in both right and left diaphragmatic thickness and excursion when forced vital capacity increases. There was a highly significant increase in right diaphragmatic excursion and both right and left diaphragmatic thickness when FEV1 increases. A significant increase in left excursion and DTF was also noticed with increased FEV1. However, there was a significant decrease in DTF with increased percent of forced vital capacity.

Conclusion

Spirometric parameters and right diaphragmatic excursion show a significant decrease when BMI increases. Different relations were found between spirometric parameters and ultrasonographic measurements regardless of the BMI.

References

  1. Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001; 20:597–604.

    Article  CAS  Google Scholar 

  2. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve 2013; 47: 319–329.

    Article  Google Scholar 

  3. Epelman M, Navarro OM, Daneman A, Miller SF. M-mode sonography of diaphragmatic motion:description of technique and experience in 278 pediatric patients. Pediatr Radiol 2005; 35:661–667.

    Article  Google Scholar 

  4. Houston JG, Morris AD, Howie CA, Reid JL, McMillan N. Technical report quantitative assessment of diaphragmatic movement – a reproducible method using ultrasound. Clin Radiol 1992; 46:405–407.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  6. Lerolle N, Guerot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 2009; 135:401–407.

    Article  Google Scholar 

  7. Arora NS, Rochester DF. Effect of body weight and muscularity on human diaphragm muscle mass, thickness, and area. J Appl Physiol 1982; 52:64–70.

    Article  CAS  Google Scholar 

  8. Faintuch J, Souza SAF, Valexi AC, Sant’Anna AF, Gama-Rodrigues JJ. Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity. Rev Hosp Clin Fac Med Sao Paulo 2004; 59:181.

    Article  Google Scholar 

  9. American Thoracic Society/European Respiratory Society Task Force. Standardization Of spirometry. Eur Resp J 2005; 26:319–338.

    Article  Google Scholar 

  10. Eugenio O, Michael C, John P, Kiran J. Ultrasound evaluation of diaphragmatic motion. J Ultrasound Med 2001; 20:597–604.

    Article  Google Scholar 

  11. Maish MS. The diaphragm from a surgical perspective. Surg Clin North Am 2010; 90:955–968.

    Article  Google Scholar 

  12. Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 2013; 39:801–810.

    Article  Google Scholar 

  13. Donald RM. Gender and age differences in the relationship between body mass index and perceived weight:exploring the paradox. Int J Men Health 2002; 1:31–42.

    Article  Google Scholar 

  14. Al-Awadhi N, Al-Kandari N, Al-Hasan T, AlMurjan D, Ali S, Al-Taiar A. Age at menarche and its relationship to body mass index among adolescent girls in Kuwait. BMC Public Health 2013; 13:29.

    Article  Google Scholar 

  15. Yang L, Colditz GA. Prevalence of overweight and obesity in the United States, 2007–2012. JAMA Intern Med 2015;175:1412–1413.

  16. Kuan PX, Ho HL, Shuhaili MS, Siti AA, Gudum HR. Gender differences in body mass index, body weight perception and weight loss strategies among undergraduates in Universiti Malaysia Sarawak. Malays J Nutr 2011; 17:67–75.

    CAS  PubMed  Google Scholar 

  17. Banerjee J, Roy A, Singhamahapatra A, Dey PK, Ghosal A, Das A. Association of body mass index (BMI) with lung function parameters in non-asthmatics identified by spirometric protocols. J Clin Diagn Res 2014; 8:12–14.

    PubMed  PubMed Central  Google Scholar 

  18. Wang S, Sun X, Hsia TC, Lin X, Li M. The effects of body mass index on spirometry tests among adults in Xi’an, China. Medicine (Baltimore) 2017; 96:e6596.

  19. Jain S, Golmohamed A. Assessing the impact of body mass index on FEV1% and quality of life in asthma patients. Eur Respir J 2013; 42:P816.

  20. Xugui S, Chen X. The relationship between obesity and forced vital capacity among university students. Nutr Hosp 2015; 31:2202–2204.

    Google Scholar 

  21. Tantisira KG, Litonjua AA, Weiss ST, Fuhlbrigge AL. Association of body mass with pulmonary function in the Childhood Asthma Management Program. Thorax 2003; 58:1036–1041.

    Article  CAS  Google Scholar 

  22. Brooks LJ, Strohl KP. Size and mechanical properties of the pharynx in healthy men and women. Am Rev Respir Dis 1992; 146: 1394–1397.

    Article  CAS  Google Scholar 

  23. Carrillo-Esper R, Pérez-Calatayud AA, Arch-Tirado E, Díaz-Carrillo MA. Standardization of sonographic diaphragm thickness evaluations in healthy volunteers. Respir Care 2016; 61:920–924.

    Article  Google Scholar 

  24. Boon AJ, Alsharif KI, Harper CM, Smith J. Ultrasound-guided needle EMG of the diaphragm:Technique description and case report. Muscle Nerve 2008; 38:1623–1626.

    Article  Google Scholar 

  25. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F, et al. Normal diaphragmatic motion and the effects of body composition:determination with M-mode sonography. J Ultrasound Med 2004; 23:255–260.

    Article  Google Scholar 

  26. Harper CJ, Shahgholi L, Cieslak K, Hellyer NJ, Strommen JA, Boon AJ. Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sports Phys Ther 2013; 43: 927–931.

    Article  Google Scholar 

  27. Youssufa HAA, Abdelnabia EA, Abd El Hafeeza AM, Fathallahb WF, Ismail JH. Role of transthoracic ultrasound in evaluating patients with chronic obstructive pulmonary disease. Egypt J Bronchol 2016; 10:274–282.

    Article  Google Scholar 

  28. Eman MF, Mahitab M, Safaa KM, El-Kahky AM, Al Azziz MA. Ultrasonography assessment of diaphragm in asthmatic children and effects of diaphragm strengthening exercise on angiogenin level and pulmonary functions. Int J Pul Res Sci 2017; 1:555574.

    Google Scholar 

  29. Fantini R, Manderioli J, Zona S, Antenora F, Iattoni A, Monelli M. Ultrasound assessment of diaphragmatic function in patients with amyotrophic lateral sclerosis. Asian Pac Soc Respir 2016; 21:932–938.

    Google Scholar 

  30. Santana PV, Prina E, Albuquerque ALP, Carvalho CRR, Caruso P. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease:the utility of ultrasound imaging. J Bras Pneumol. 2016; 42:88–94.

    Article  Google Scholar 

  31. Ali ER, Mohamad AM. Diaphragm ultrasound as a new functional and morphological index of outcome, prognosis and discontinuation from mechanical ventilation in critically ill patients and evaluating the possible protective indices against VIDD. Egypt J Chest Dis Tuberc 2017; 66:339–351.

    Article  Google Scholar 

  32. Osman AM, Hashim RM. Diaphragmatic and lung ultrasound application as new predictive indices for the weaning process in ICU patients. Egypt J Radiol Nucl Med Respirol 2016; 21:932–938.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chest Department, Faculty of Medicine, Ain Shams University, 3 Ali Elabbady Streat, Ain Shams, Cairo, Egypt

    Saeed M. Adel, Ezzelregal G. Hieba MD & Sayed H. Hossam

Authors
  1. Saeed M. Adel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ezzelregal G. Hieba MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sayed H. Hossam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ezzelregal G. Hieba MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adel, S.M., Hieba, E.G. & Hossam, S.H. Assessment of diaphragmatic mobility by chest ultrasound in relation to BMI and spirometric parameters. Egypt J Bronchol 13, 232–243 (2019). https://doi.org/10.4103/ejb.ejb_73_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_73_18

Keywords