ObjectivesThe aim of the study was to investigate the role of ultrasound in the evaluation of movement of the diaphragm and its value in predicting successful extubation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients in relation to other weaning parameters. Patients and methodsThe present study was conducted on 50 patients in the respiratory ICU and the Chest Department of Ain Shams University Hospitals. Patients were divided into two groups: group A and group B. Group A consisted of 30 mechanically ventilated COPD patients admitted to the respiratory ICU and group B consisted of 20 COPD patients not mechanically ventilated during attendance at the Chest Department. ResultsDiaphragmatic movement was assessed in the two groups. The mean value of diaphragmatic displacement was higher in group B. In group A this value was higher among those with successful weaning using a cutoff value of 1.1 cm with sensitivity of 86.4%, specificity of 87.5%, and accuracy of 89.5%. There was a significant correlation between diaphragmatic displacement and other weaning parameters, which was better in the group with successful weaning. Conclusion Diaphragmatic displacement measuredby ultrasound is one of the most sensitive, specific, and accurate parameters for weaning of COPD patients from mechanical ventilation, especially in relationship with other weaning parameters.

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Background COPD is characterized by non-remitting airflow limitation and persistent respiratory symptoms which is an enhanced inflammatory response to prolonged exposure to smoking or noxious gases or particles and manifested through chronic cough, effort dyspnea, expectoration and wheezing, symptoms that appears in context of airways hyper-responsiveness and may be partially reversible. Objective Assessment of COPD patients in Gamal Abd El Nasser Hospital during period from January 2017 to June 2017. Subjects and Methods This study was a cross sectional study that included 290 COPD patients recommended for spirometric assessment. The patients were classified into 2 groups: Outpatients and inpatients in the period from January 2017 to June 2017, they were subjected to full medical history, general and local examination, Pre and post bronchodilator spirometric study according to (GOLD,2017) and each patient will be subjected to the following questionnaire [Serial number, Name, Age, Sex, Occupation, Residence, Level of education, Smoking, Smoking index, Family history of COPD, Symptoms, Number and severity of exacerbation attacks in the last year, Number of Hospitalization during the last year, Vaccination status, Spirometry, Treatment prescribed by, Treatment, Inhalation therapy, Regulation of treatment, Non pharmacological therapy, Satisfaction of treatment, co morbidities, Complications, Outcome for inpatient] Results The study included 290 patients, 259 males and 31 females with age range of 29 _ 83 years, the majority of the studied cases were Current smoking but only 22.5% was ex-smoker. Mean FEV1% pred. Post-bronchodilator was 75.9± 16.9 in outpatients and mean FEV1% pred. Post – bronchodilator was 52.9 ± 13.4 in inpatient. The most common co morbidities in COPD patients were hypertension in 25% of cases. More than half of all studied cases had complications and the most frequent complication was Cor-pulmonale and respiratory Failure. In this study, Severity of COPD according to GOLD 2017 was 27.8% in mild stage, 34.2% in moderate stage, 35.8% in severe stage and 2.5% in very severe stage. Conclusion Spirometry had a great role in diagnosis of COPD and its differential diagnosis from asthma. Smoking is the major risk factors in developing COPD and this reflects on the disease occurrence and severity. Some of COPD patients refuse to use inhalers due to fear of addiction and incorrect method in using it. Inhaler steroids were preferred due to fear of systemic complications of steroids. There is great defect in vaccination and trials of quitting smoking as a non-pharmacological treatment for COPD patients.