Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters

Ogan, Nalan; Aydemir, Yusuf; Evrın, Togay; Ataç, Gökçe Kaan; Baha, Ayşe; Katipoğlu, Burak; Süzen, Banu; Akpınar, Evrim Eylem

doi:10.3906/sag-1901-164

Cited by 26 publications

(26 citation statements)

References 14 publications

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“…4,39,40 As COPD progresses, respiratory work generally increases, as does anxiety and anorexia, which lead to decreased nutrient intake and impaired lung ventilation. 41,42 Furthermore, malnutrition leads to decreased immune function and inflammatory damage to the normal structure of the bronchoalveoli, which result in decreased lung function and accelerated disease progression. 38,43,44 Therefore, we believe that nutritional support during pulmonary rehabilitation is crucial to end the negative cycle.…”

Section: The Relationship Between Nutrient Levels and Disease Progression In Patients With Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

<p>Exploration of n-6 and n-3 Polyunsaturated Fatty Acids Metabolites Associated with Nutritional Levels in Patients with Severe Stable Chronic Obstructive Pulmonary Disease</p>

Xue¹,

Cai²,

Guan³

et al. 2020

COPD

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Background and Objective Severe chronic obstructive pulmonary disease (COPD) is the terminal stage of the disease characterized by declined lung function, malnutrition, and poor prognosis. Such patients cannot tolerate long-time sports rehabilitation owing to dyspnea and fail to achieve the desired therapeutic effect; therefore, increasing nutritional support will be an important strategy for them. The present study applied metabolomics technology to evaluate the correlation between serum concentrations of polyunsaturated fatty acid (PUFA) metabolites, nutritional status, and lung function in patients with COPD to provide a theoretical basis for accurate nutritional support. Materials and Methods We enrolled 82 patients with stable severe COPD in our hospital. The general characteristics including height, weight, and lung function were recorded. Metabolomics was used to detect the concentrations of serum metabolites of n-3 and n-6 at baseline and at 24 and 52 weeks after enrollment. The correlations between nutrition level and pulmonary function and clinical indicators were evaluated. Results The concentrations of n-3 and n-6 increased over time along with the progression of COPD. Body mass index (BMI) and percent of ideal body weight (IBW%) decreased with disease development, and BMI was found to be significantly correlated with FEV1% predicted and FEV1/FVC. Serum levels of n-6 metabolites such as linoleic acid (LA), γ-linoleic acid (GLA), and arachidonic acid (ARA) (all P < 0.01) and the n-3 metabolites such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (all P < 0.05) showed significant correlations with BMI and were closely correlated with FEV1% predicted and FEV1/FVC of lung function (all P < 0.05). Conclusion This study demonstrates that malnutrition in patients with severe COPD is progressive and is positively correlated with n-3 and n-6 polyunsaturated fatty acids and lung function.

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Section: The Relationship Between Nutrient Levels and Disease Progression In Patients With Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

<p>Exploration of n-6 and n-3 Polyunsaturated Fatty Acids Metabolites Associated with Nutritional Levels in Patients with Severe Stable Chronic Obstructive Pulmonary Disease</p>

Xue¹,

Cai²,

Guan³

et al. 2020

COPD

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“…27 21 37-42 However, some studies found no significant difference in the thickness of the diaphragmatic muscle between patients with COPD and healthy subjects. [44][45][46] Diaphragm muscle atrophy in COPD had been previously described to be mechanistically linked with systemic muscle wasting. This is in the form of chronic loss of type I and type II diaphragm fibres in response to COPD-related physiological changes, such as increased energy expenditure and relative resistance to fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…43 Three studies reported no significant difference in diaphragm thickness between patients with COPD and healthy subjects. [44][45][46] US ASSESSMENT OF MUSCLES AND BONES Lower limb muscles Out of the 14 studies assessing lower limb muscles, the most common muscles of the lower limb that have been assessed with US in COPD are quadriceps (rectus femoris), ankle dorsiflexor (tibialis anterior) and vastus lateralis. Features such as CSA (an assessment of the overall muscle size), echo intensity (assessment of the quality of muscle, whereby high echo intensity equals low muscle quality), thickness and strength have been assessed for diagnosis, prognosis and interventional purposes.…”

Section: Open Accessmentioning

confidence: 99%

Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

et al. 2020

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BackgroundClinical and research utility of non-cardiac ultrasound (US) in chronic obstructive pulmonary disease (COPD) has been widely investigated. However, there is no systematic review assessing the clinical values of non-cardiac US techniques in COPD.MethodsWe systematically searched electronic databases from inception to 24 June 2020. Two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extracted data. A narrative synthesis of the results was conducted considering non-cardiac US techniques that looked for diaphragm, muscles and bones in patients with COPD.ResultsIn total, 2573 abstracts were screened, and 94 full-text papers were reviewed. A total of 54 studies met the inclusion criteria. Thirty-five studies assessed the diaphragm, while 19 studies evaluated different muscles, including limb muscles and pulmonary lesions in COPD using US. Of the 54 included studies, 30% (16/54) evaluated the changes in either limb muscles or diaphragmatic features before and after physical interventions; 67% (36/54) assessed the correlations between sonographic features and COPD severity. Indeed, 14/15 and 9/13 studies reported a significant reduction in diaphragm excursion and thickness in COPD compared with healthy subjects, respectively; this was correlated significantly with the severity and prognosis of COPD. Three studies reported links between diaphragm length and COPD, where lower diaphragm length correlated with poorer prognosis and outcomes. Quadriceps (rectus femoris), ankle dorsiflexor (tibialis anterior) and vastus lateralis were the most common muscles in COPD assessed by US. More than 70% (12/17) of the studies reported a significant reduction in the cross-sectional area (CSA) of the rectus femoris, rectus femoris and vastus lateralis thickness in COPD compared with healthy subjects. Quadriceps CSA and thickness correlated positively with COPD prognosis, in which patients with reduced quadriceps CSA and thickness have higher risk of exacerbation, readmission and death.ConclusionUS measurements of diaphragm excursion and thickness, as well as lower limb muscles strength, size and thickness, may provide a safe, portable and effective alternative to radiation-based techniques in diagnosis and prognosis as well as tracking improvement postintervention in patients with COPD.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Güneş¹,

Genç²,

Kurtaiş³

et al. 2021

Turk J Med Sci

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Background: Studies are showing that pulmonary rehabilitation (PR) increases diaphragmatic excursion by decreasing hyperinflation in patients with chronic obstructive pulmonary disease (COPD). However, there is a lack of knowledge about its effects on the diaphragm thickness(dt) and contractility. This study aims to evaluate the dt and contractility before and after PR in patients with COPD. Materials and Methods:All subjects participated in an out-patient PR of 6 weeks and 3 sessions per week prospectively. Dyspnea severity, the disease-specific quality of life (St. Georges Respiratory Questionnaire-SGRQ), pulmonary function tests (PFT), exercise capacity, the dt at the end of the expiration and at maximal inspiration (B-mode ultrasound) was evaluated at baseline and after PR.Results: A total of 34 patients with a mean age and FEV1 61.05 ± 8.22 years and 57.9 ± 20.4% predicted respectively showed improvements in exercise capacity and some items of PFT and SGRQ. Diaphragmatic thickness at the end of the expiration also significantly improved regardless of the disease severity and positively correlated with functional performance. The 6-weeks of PR didn't result in a significant difference in diaphragm contractility. Conclusion:The 6-weeks of PR resulted in a significant increase in dt without a significant difference in diaphragm contractility.

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Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters

Cited by 26 publications

References 14 publications

<p>Exploration of n-6 and n-3 Polyunsaturated Fatty Acids Metabolites Associated with Nutritional Levels in Patients with Severe Stable Chronic Obstructive Pulmonary Disease</p>

<p>Exploration of n-6 and n-3 Polyunsaturated Fatty Acids Metabolites Associated with Nutritional Levels in Patients with Severe Stable Chronic Obstructive Pulmonary Disease</p>

Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

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

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