Low back pain and gastroesophageal reflux in patients with COPD: the disease in the breath

Abstract

COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD) and low back pain (LBP) in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient's care, improving the approach to the diaphragm muscle.

Keywords: COPD; GERD; diaphragm; fascia; low back pain.

Figure 1

CT images. Notes: The CT images in the coronal and axial planes allow visualization of the diaphragm as a hyperdense linear band interposed between the chest and the abdominal cavity (A and D, respectively; see arrows). Sagittal images highlight a sort of “corrugated” morphology that shows the orientation of the muscle bundles (B; see arrow), which may appear more or less pronounced in wellness or pathologic conditions, such as COPD. Clearly visible diaphragmatic pillars also appear in both the coronal plane (C) and the axial plane (E) (arrowheads). Abbreviation: CT, computed tomography.