The Influence of Costal and Abdominal Pressure on the Action of the Diaphragm in Normal and Emphysematous Subjects

Abstract

The use of pressure on the abdomen by an abdominal belt has been advocated by Christie (1933) and by Alexander and Kountz (1934) for the treatment of emphysema. Warner and Doidge (1939) have employed a costal belt for the same purpose. Both kinds of treatment were successfully used in some patients only, and as it is the aim of the treatment to influence the range of the diaphragm it seemed useful to examine this influence in a number of normal and emphysematous subjects. METHODThe level of the diaphragm was determined by its distance from the iliac crests (Warner and Doidge, 1939). The details of this method, which we have used previously for the mreasurement of the diaphragmatic level in emphysema, are described elsewhere (Grossmann and Herxheimer, 1948). In the present experiments the highest and the lowefst level that could be reached by the diaphragm in maximum expiration and inspiration, and also the range of movement during quiet breathing, were measured in the sitting and in the supine positions. The same measuremnents were taken during costal and abdominal pressure. The pressure was applied by a canvas belt 12 cm. in width, which was fastened round the chest with its upper margin in the axillae or round the abdomen. In order to produce sufficient compression a pad was placed underneath the abdominal belt. ment of the oxygen used; a horizontal tracing was thus obtained. The vital capacity was recorded three times in each position and the mean of these three values was taken. The subjects had been trained previously to breathe through mouthpiece and valves; subjects_ who could not reproduce consistently the same vital capacity (within an arbitrary range of 150 ml.) were excluded. Eight medical students (six men and two women), who were in normal health, and thirty-four patients were investigated. Of the latter, sixteen suffered from severe and nine from moderate emphysema; nine others were obese asthmatics. The diagnosis " emphysema " was supported in all cases by a typical history of long-standing cough and incre'asing breathlessness on exercise: congestive failure, tuberculosis, and malignant disease of the chest were excluded. In many cases the typical clinical signs of emphysema were present. The differentiation between severe and moderate emphysema was made according to the disability of the patient. Those who showed breathlessness on moderate exertion-walking at normal speed on even ground-were regarded as severe; those who only showed breathlessness, at increased speed or on the up-grade were regarded as moderate. As a rule in the latter the vital capacity was normal or approximately normal, whilst in the former it was much reduced.A further group includes nine obese asthmatic patients. They were in a subacute asthmatic state, b-ut their history of asthma was comparatively short and did not exceed ten years. It was assumed that some degree of emphysema was present. RESULTSMaximum range of diaphragmatic movement.-The average results for each group of patients are given in Fig.'1. In this figure the ...

Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD)

“…Herxheimer [33] studied the effects on the position and excursion of the diaphragm of both an abdominal and a rib-cage belt, in sitting and supine positions, in patients with COPD and asthma, as well as in healthy subjects. During breathing at rest, the application of the abdominal belt resulted in a cranial displacement of the diaphragm, in both patients and healthy subjects.…”

Some Observations on the Co-ordination of Diaphragmatic and Rib Movement in Respiration

“…It is known that pressure on the abdominal wall displaces the diaphragm upwards (Herxheimer, 1948). It was found that at the same time, in spite of this obstacle to the diaphragmatic movement, the vital capacity decreased only very little.…”

The Reserve Air as an Aid in the Diagnosis of Emphysema

“…Grossmann and Herxheimer (1948) have described a radiological method of measuring this level. They found a lowered diaphragm not only in severe but also in moderate emphysema.…”