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. 2022 Jan 4:17:3-12.
doi: 10.2147/COPD.S341484. eCollection 2022.

Diaphragm Ultrasound is an Imaging Biomarker that Distinguishes Exacerbation Status from Stable Chronic Obstructive Pulmonary Disease

Tai Joon An  1 , Yeun Jie Yoo  2 , Jeong Uk Lim  1 , Wan Seo  3 , Chan Kwon Park  1 , Chin Kook Rhee  4 , Hyoung Kyu Yoon  1
Affiliations

Diaphragm Ultrasound is an Imaging Biomarker that Distinguishes Exacerbation Status from Stable Chronic Obstructive Pulmonary Disease

Tai Joon An et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Evaluating the diaphragm muscle in chronic obstructive pulmonary disease (COPD) is important. However, the role of diaphragm ultrasound (DUS) in distinguishing the exacerbation status of COPD (AECOPD) is not fully understood. We set this study to evaluate the role of DUS as a biomarker for distinguishing the AECOPD.

Methods: COPD patients who underwent DUS were enrolled between March 2020 and November 2020. The diaphragm thickening fraction (TFmax) and diaphragm excursion (DEmax) during maximal deep breathing were measured. Patients were divided into exacerbation and stable groups. Demographics, lung function, and DUS findings were compared between the two groups. Receiver operating characteristic curve and univariate/multivariate logistic regression analyses were performed.

Results: Fifty-five patients were enrolled. The exacerbation group had a lower body mass index (BMI) (20.9 vs 24.2, p = 0.003), lower TFmax (94.8 ± 8.2% vs 158.4 ± 83.5%, p = 0.010), and lower DEmax (30.8 ± 11.1 mm vs 40.5 ± 12.5 mm, p = 0.007) compared to stable group. The areas under the TFmax (0.745) and DEmax (0.721) curves indicated fair results for distinguishing AECOPD. The patients were divided into low and high TFmax and DEmax groups based on calculated cut-off values. Low TFmax (odds ratio [OR] 8.40; 95% confidence interval [CI] 1.55-45.56) and low DEmax (OR 11.51; 95% CI 1.15-115.56) were associated with AECOPD after adjusting for age, sex, BMI, and lung functions.

Conclusion: DUS showed the possibility of an imaging biomarker distinguishing AECOPD from stable status.

Keywords: COPD; biomarker; diaphragm; exacerbation; ultrasound.

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Conflict of interest statement

Prof. Dr. Chin Kook Rhee reports personal fees from MSD, personal fees from AstraZeneca, personal fees from GSK, personal fees from Novartis, personal fees from Takeda, personal fees from Mundipharma, personal fees from Boehringer-Ingelheim, personal fees from Teva, personal fees from Sanofi, personal fees from Bayer, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curve analysis for determining chronic obstructive pulmonary disease exacerbation status using diaphragm ultrasound findings. The ROC curve for distinguishing exacerbation from a stable status indicated that the outcomes were fair. The area under the curve (AUC) of the thickening fraction during maximal deep breathing (TFmax) was 0.745. The AUC of diaphragm excursion during maximal deep breathing (DEmax) was 0.721. No significant difference was observed between TFmax and DEmax for distinguishing exacerbation status (p = 0.608).
Figure 2
Figure 2
Multiple comparative analysis of the receiver operating characteristic (ROC) curve between diaphragm thickening, diaphragm excursion, lung function, and body mass index (BMI). The ROC curve of thickening fraction of diaphragm during maximal breathing (TFmax) (A) and diaphragm excursion during maximal breathing (DEmax) (B) showed in Figure 2. (C) There was no significant difference for distinguishing exacerbation both in TFmax and DEmax compared to those of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and BMI in multiple comparative analysis of the ROC curve analysis.
See this image and copyright information in PMC

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