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. 2019 Jul-Aug;36(4):299-303.
doi: 10.4103/lungindia.lungindia_466_18.

Study of the diaphragm in chronic obstructive pulmonary disease using ultrasonography

Sanket Jain  1 , Girija Nair  1 , Abhishek Nuchin  1 , Abhay Uppe  1
Affiliations

Study of the diaphragm in chronic obstructive pulmonary disease using ultrasonography

Sanket Jain et al. Lung India. 2019 Jul-Aug.

Abstract

Aims and objectives: The study aims to compare the changes in the diaphragm in chronic obstructive pulmonary disease (COPD) patients in Indian population with the help of ultrasound-guided examination. (1) Changes in thickness of the diaphragm during respiration( to rule out diaphragm muscle atrophy). (2) The movement of the diaphragm(correlates with strength and endurance of diaphragm fibres) . (3) Zone of apposition(gives mechanical advantage to diaphragm). (4) Correlation with COPD severity by global initiative for chronic obstructive lung disease (GOLD) staging.

Subjects and methods: Forty-eight COPD patients attending OPD of DY Patil Hospital were recruited in the study and twenty age-matched controls were taken. Detailed history, pulmonary function test examination, and diaphragm study under ultrasonography was done.

Results: The movement of diaphragm was reduced in mild to moderate COPD (A and B) but increased in COPD with Grade C. Movement of diaphragm was significantly more in cases with COPD Grade B (2.329 cm) and C (2.269 cm) as compared to controls (1.891 cm). Mean diaphragmatic thickness during inspiration and expiration, change in thickness, and zone of apposition were significantly higher in patients with COPD score Grade C as compared to Grade A or B. Zone of apposition was significantly decreased in Grade A (3.257 cm) and B (3.429 cm) compared to control (4.268 cm), while it was significantly increased in cases with Grade C (5.138 cm).

Conclusion: The diaphragm is the main muscle of respiration, and study of diaphragm is very important in COPD. The diaphragm thickness, movement, and zone of apposition were significantly reduced in mild to moderate COPD but increased in severe COPD. This cannot be explained by physiotherapy or collagen accumulation. Hence, diaphragm muscle biopsy and electromyogram study in COPD patients will be required to get a better understanding of this muscle in COPD.

Keywords: Chronic obstructive pulmonary disease; diaphragm; movement; thickness.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Pulmonary function test versus diaphragm
Figure 2
Figure 2
Modified medical research council grading versus diaphragm changes
Figure 3
Figure 3
Chronic obstructive pulmonary disease grade versus diaphragm parameters
See this image and copyright information in PMC

References

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