Diaphragmatic thickness and excursion by lung ultrasound in pediatric chronic pulmonary diseases

Ishak, Sally Raafat; Sakr, Hossam Moussa

doi:10.1007/s40477-021-00570-2

“…For instance, the diaphragm thickening ratio increased upon inspiratory muscle training in subjects with CF 29 . Recently, an ultrasound study in children with chronic pulmonary disease including CF, demonstrated reduced diaphragm excursion in this group compared to healthy children 30 . As indicated in this study, diaphragm mobility is most likely also impaired in advanced CF lung disease as it is known from COPD.…”

Section: Discussionsupporting

confidence: 49%

“… 29 Recently, an ultrasound study in children with chronic pulmonary disease including CF, demonstrated reduced diaphragm excursion in this group compared to healthy children. 30 As indicated in this study, diaphragm mobility is most likely also impaired in advanced CF lung disease as it is known from COPD. Therefore, ultrasound‐assessed diaphragm excursion seems to be a suitable readout for the monitoring of ACT effects in subjects with CF as we demonstrate in this study.…”

Section: Discussionmentioning

confidence: 60%

Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

Schmidt

¹

,

Toth

²

,

Käppler-Schorn

³

et al. 2022

Health Science Reports

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Background and Aims In cystic fibrosis (CF) airways, impaired airway mucociliary clearance and mucus accumulation due to cystic fibrosis transmembrane conductance regulator defects contribute to inflammation, progressive structural lung damage, and decline of lung function. Physiotherapy is essential to promote mucus mobilization and removal in CF and is a key element of rehabilitation measures, but conventional techniques may be suboptimal to mobilize viscous mucus. This study aimed to test the specific effects of a novel bronchial drainage device (BDD) (Simeox®; PhysioAssist) in subjects with CF and evaluate lung function, diaphragm mobility, and sputum properties. Methods This prospective monocentric clinical cohort study in the setting of outpatient physiotherapy of CF patients ( n = 21) with stable CF lung disease collected pulmonary lung function tests (PFT), diaphragm mobility, and sputum properties before and after two physiotherapy sessions using the novel BDD. PFT was assessed using spirometry and diaphragm mobility using m‐mode ultrasound analysis. Spontaneous sputum samples were collected before and after using the BDD and analyzed for microstructure and DNA concentrations. Results PFT parameters (FEV 1 , FVC, MEF25/50/75) were not affected by the use of the BDD. Ultrasound analysis of diaphragm mobility revealed an increase in maximum diaphragm excursion upon the intervention. Mucus analysis demonstrated altered microstructure and higher DNA concentrations collected after using the BDD compared to samples collected before. Pearson correlation analysis showed significant correlations between changes in mucus properties and DNA levels in respective mucus samples. Conclusion Our results demonstrate that the novel BDD improves diaphragm mobility and alters sputum properties in subjects with CF. The novel BDD with unique properties may be further studied as a device in CF‐specific physiotherapy to facilitate sputum mobilization of CF patients.

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“…Patients with chronic respiratory diseases often have lower diaphragmatic excursions than healthy controls [ 59 – 62 ]. Many of these patients suffer from dyspnea and associated exercise intolerance [ 63 – 66 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of abdominal bracing on respiration during a lifting task: a cross-sectional study

Sembera,

Busch,

Kobesova

et al. 2023

BMC Sports Sci Med Rehabil

0

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Background Abdominal bracing is a maneuver widely used by rehabilitation specialists and sports trainers to improve spinal stability. This study aimed to investigate how lifting tasks with and without abdominal bracing affect the respiratory function of the diaphragm. Methods M-mode ultrasonographic assessment of diaphragmatic motion combined with spirometry was performed on 31 healthy adults. Participants were asked to breathe continuously whilst lifting a load with spontaneous abdominal muscle contraction (natural loaded breathing) and abdominal bracing (AB loaded breathing). Results Pearson’s correlations revealed strong correlations between ultrasonography and spirometry measures (p < 0.001) for all types of breathing: tidal breathing (r = 0.709, r2 = 0.503), natural loaded breathing (r = 0.731, r2 = 0.534) and AB loaded breathing (r = 0.795, r2 = 0.632). Using paired-samples t-tests, the natural loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p < 0.001) but not during expiration (p = .101). Spirometry demonstrated lower lung volumes (L) at the end of inspiration and expiration (p < 0.001), with no changes in total lung volume (p = 0.06). The AB loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p = 0.002) but not during expiration (p = 0.05). Spirometry demonstrated lower lung volumes at the end of inspiration (p < 0.001), expiration (p = 0.002), and total lung volumes (p = 0.019). Conclusion This study demonstrated that abdominal bracing performed during a lifting task reduces lung volume despite an increase in diaphragmatic motion. Diaphragm excursions strongly correlate with lung volumes even under postural loading. Trial registration The study was prospectively registered on 8 April 2021 at ClinicalTrials.gov with identification number NCT04841109.

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“…Subsequently, we chose a measurement line to make the ultrasound beam perpendicular to the diaphragm under M-mode ultrasound which could evidently reveal the diaphragm excursion, moving the probe downward when inhalation, and the opposite when exhalation. Te vertical distance between the highest plane and the lowest plane of the curve was the degree of diaphragm excursion [29,30] (Figure 2(b)).…”

Section: Instruments and Measuresmentioning

confidence: 99%

Ultrasonography Comparison of Diaphragm Morphological Structure and Function in Young and Middle-Aged Subjects with and without Non-Specific Chronic Low Back Pain: A Case-Control Study

Xiao

¹

,

Zheng

²

,

Dong

³

et al. 2022

Pain Research and Management

1

0

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Background. It is reported that impaired postural control in patients with non-specific chronic low back pain (NCLBP) was associated with “core” trunk muscle incoordination. However, as the diaphragm is an important component of the “core” deep trunk muscle group, we still know little about the potential relationship between diaphragm dysfunction and NCLBP. Objectives. This case-control study is intended to investigate the changes of diaphragm morphological structure and function in young and middle-aged subjects with and without NCLBP by ultrasound evaluation and its possible validity in predicating the occurrence of NCLBP. Methods. 31 subjects with NCLBP (NCLBP group) and 32 matched healthy controls (HC group) were enrolled in this study. The diaphragm thickness at the end of inspiration (Tins) or expiration (Texp) during deep breathing was measured through B-mode ultrasound, and the diaphragm excursion (Texc) was estimated at deep breathing through M-mode ultrasound. The diaphragm thickness change rate (Trate) was calculated by the formula: T r a t e = T i n s − T exp / T exp × 100 % . Results. Compared with the HC group, the NCLBP group had a significant smaller degree of Tins (t = −3.90, P < 0.001 ), Texp (Z = −2.79, P = 0.005 ), and Trate (t = −2.03, P = 0.047 ). However, there was no statistical difference in Texc between the two groups (t = −1.42, P = 0.161 ). The binary logistic regression analysis indicated that Trate (OR = 16.038, P = 0.014 ) and Texp (OR = 7.714, P = 0.004 ) were potential risk factors for the occurrence of NCLBP. Conclusions. The diaphragm morphological structure and function were changed in young and middle-aged subjects with NCLBP, while the diaphragm thickness change rate (Trate) and diaphragm thickness at the end of expiration (Texp) may be conductive to the occurrence of NCLBP. Furthermore, these findings may suggest that abnormal diaphragm reeducation is necessary for the rehabilitation of patients with NCLBP.

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Diaphragmatic thickness and excursion by lung ultrasound in pediatric chronic pulmonary diseases

Cited by 5 publications

References 25 publications

Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

The effect of abdominal bracing on respiration during a lifting task: a cross-sectional study

Ultrasonography Comparison of Diaphragm Morphological Structure and Function in Young and Middle-Aged Subjects with and without Non-Specific Chronic Low Back Pain: A Case-Control Study

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