Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease

Abstract

Background Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD. Methods Thirty‐eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (TdiTLC), functional residual capacity (TdiFRC) and residual volume (TdiRV) using B‐mode ultrasonography. We calculated the change ratio of TdiTLC and TdiRV (ΔTdi%). We used a one‐way analysis of variance and multiple comparison test for the comparison analysis. Results The TdiTLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the TdiFRC or TdiRV. Conclusions Our results indicate significant differences in TdiTLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use TdiTLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.

Diaphragm Ultrasound is an Imaging Biomarker that Distinguishes Exacerbation Status from Stable Chronic Obstructive Pulmonary Disease

“…DUS findings are well established in many previous studies. 10 , 11 , 16 Patients were placed in a supine position, and the tests were performed at the right hemidiaphragm. A linear ultrasound probe (5–12 MHz) was used to measure the thickness of the diaphragm (DT) by B-mode.…”

“…The thickening fraction of the diaphragm (TF) has been evaluated in many studies. 10 , 11 , 15 It is related to the generation of diaphragm muscle pressure. The TF was calculated with the DT value.…”

“…DUS findings are well established in many previous studies. 10,11,16 Patients were placed in a supine position, and the tests were performed at the right hemidiaphragm.…”

“…13,14 The method of DUS in COPD patients has been well described by previous studies. 10,11 The usefulness of DUS in monitoring the improvement of AECOPD or in detecting the diaphragm dysfunction during AECOPD was well described in previous articles. 17,18 In a recent systematic review, the role of DUS as an imaging biomarker was emphasized.…”

Effects of pulmonary rehabilitation on diaphragm thickness and contractility in patients with chronic obstructive pulmonary disease

“…To date, many studies were conducted to evaluate the diaphragm thickness in patients with COPD using ultrasonography [5,8,9]. In one study, reduced diaphragm thickness compared to healthy adults was shown [5], which was considered as an indicator of diaphragm dysfunction, however, no difference was observed in another study [9]. Pulmonary rehabilitation (PR), a multicomponent intervention based on individually tailored exercise training, education, dietary advice, psychological and behavioral intervention has emerged as arguably the most effective non-pharmacological treatment in improving exercise capacity, dyspnea, and quality of life in patients with COPD 3 3 [10,11].…”