Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 30;11(3):01042-2024.
doi: 10.1183/23120541.01042-2024. eCollection 2025 May.

Utility of diaphragm dome height as a marker of operational lung volume changes, disease burden and exacerbations in patients with mild-to-moderate COPD: an observational study within the CanCOLD cohort

Sarah A Beydoun  1 , Olivia C Iorio  1   2 , Daniel Genkin  3 , Pei Z Li  1 , Dany Doiron  1 , François Maltais  4 , Jean Bourbeau  1   2   5 , Wan Tan  6 , Don D Sin  6 , Shawn D Aaron  7 , Kenneth R Chapman  8 , Paul Hernandez  9 , Darcy D Marciniuk  10 , Denis E O'Donnell  11 , Brandie L Walker  12 , Miranda Kirby  13 , Bryan A Ross  1   2   5
Affiliations

Utility of diaphragm dome height as a marker of operational lung volume changes, disease burden and exacerbations in patients with mild-to-moderate COPD: an observational study within the CanCOLD cohort

Sarah A Beydoun et al. ERJ Open Res. .

Abstract

Background: Dynamic hyperinflation is central to dyspnoea, exercise limitation and exacerbations in COPD. While studied previously in moderate-to-severe COPD, the relevance of diaphragm dome height (DDH) on clinically important outcomes has been under-investigated in mild-to-moderate COPD.

Methods: Canadian Cohort Obstructive Lung Disease (CanCOLD) participants with spirometry-confirmed COPD, symptom-limited incremental cardiopulmonary exercise testing and computed tomography image data were included. Base-to-apex left DDH (LDDH) and right DDH (RDDH) were automatically segmented, with increased height implying less flattening and thus less hyperinflation. Dynamic hyperinflation was defined as ≥150 mL reduction in inspiratory capacity (IC) from rest to peak exercise. Cross-sectional linear regression models were fitted between LDDH and RDDH (predictor variables) with peak IC (ICpeak), peak workload (W peak), forced expiratory volume in 1 s (FEV1) and COPD Assessment Test (CAT) score (outcome variables), and in longitudinal (Anderson-Gill) models with "symptom-based" and "event-based" exacerbations. Results are reported as parameter estimates or hazard ratios (HRs) with 95% confidence intervals per interquartile range dome height increment.

Results: Amongst 304 participants (mean±sd age 64.7±10.3 years, 41.8% female, 44.4% with mild COPD), each LDDH and RDDH increment, respectively, was associated with ICpeak (0.21 (95% CI 0.13-0.29) L and 0.13 (95% CI 0.07-0.19) L), W peak (9.54 (95% CI 5.03-14.04) W and 6.04 (95% CI 2.45-9.62) W), FEV1 (0.17 (95% CI 0.10-0.25) L and 0.08 (95% CI 0.02-0.14) L) and CAT score (-1.36 (95% CI -2.39- -0.33) and -0.82 (95% CI -1.63-0.00)). LDDH alone was associated with both symptom-based (HR 0.82 (95% CI 0.74-0.91)) and event-based (HR 0.83 (95% CI 0.73-0.95)) exacerbations. Of 167 out of 304 participants with confirmed dynamic hyperinflation (ΔIC -0.47±0.25 L), LDDH alone was associated with all outcomes (ICpeak, W peak, FEV1, CAT and symptom-based/event-based exacerbations).

Conclusions: LDDH appears to be a clinically important marker for operational lung volume changes, lung function, exercise performance, disease burden and exacerbations in mild-to-moderate COPD.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: S.A. Beydoun reports support for the present manuscript from the Respiratory Epidemiology and Clinical Research Unit at McGill University Health Centre (MUHC). D. Genkin reports support for the present manuscript from NSERC-PGS-D grant. P.Z. Li reports constancy fees from VIDA Diagnostics. F. Maltais reports grants from GlaxoSmithKline, AstraZeneca, Sanofi, Novartis and Grifols; consultancy fees from AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from GlaxoSmithKline and AstraZeneca; and stock or stock options with Oxynov. J. Bourbeau reports grants from the Canadian Institutes of Health Research, FRQS Respiratory Health Network, MUHC Foundation, AstraZeneca, GlaxoSmithKline, Novartis and Trudel; and payment or honoraria for lectures, presentations, manuscript writing or educational events from CHEST, Canadian Thoracic Society, L'Association des Pneumologues de la Province de Québec, AstraZeneca, GlaxoSmithKline, Inogen and Roche. W. Tan reports participation on a data safety monitoring board or advisory board with Sanofi. D.D. Sin reports grants from Nextone; payment or honoraria for lectures, presentations, manuscript writing or educational events from GlaxoSmithKline, AstraZeneca and Boehringer Ingelheim; and participation on a data safety monitoring board or advisory board with the National Heart, Lung, and Blood Institute and is Deputy Chief Editor of the European Respiratory Journal. S.D. Aaron reports consultancy fees from GlaxoSmithKline, AstraZeneca, Sanofi and Methapharm; and payment or honoraria for lectures, presentations, manuscript writing or educational events from GlaxoSmithKline, AstraZeneca and Sanofi. K.R. Chapman reports grants from BMS, Bellus, AstraZeneca, GlaxoSmithKline, Sanofi, Regeneron, Takeda and Novartis; consultancy fees from AstraZeneca, GlaxoSmithKline, Inhibrix, Mereo, Regeneron, Sanofi and Takeda; payment or honoraria for lectures, presentations, manuscript writing or educational events from Valeo, Sanofi, Novartis, GlaxoSmithKline and Takeda; participation on a data safety monitoring board with Intellia (ITL-3001-CL-101 DSMB); and a leadership role with AlphaNet Canada. P. Hernandez reports support for the present study from the Canadian Institutes of Health Research; grants from Grifols, Cyclomedica, Boehringer Ingelheim and Wave Life Sciences; payment or honoraria for lectures, presentations, manuscript writing or educational events from the Canadian Thoracic Society, GlaxoSmithKline and AstraZeneca; participation on a data safety monitoring board or advisory board with AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda; and a leadership role with the Canadian Thoracic Society. D.D. Marciniuk reports grants from AstraZeneca, Boehringer Ingelheim, Canadian Institutes of Health Research, GlaxoSmithKline, Grifols, Lung Association of Saskatchewan, Lung Health Institute of Canada, Novartis, Sanofi, Saskatchewan Health Research Foundation and Schering-Plough; support for attending meetings from the University of Saskatchewan; a leadership role with the Saskatchewan Health Research Foundation; and is an employee of the University of Saskatchewan and Deputy Editor of CHEST. B.L. Walker reports payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline and Sanofi. M. Kirby reports consultancy fees from VIDA Diagnostics. B.A. Ross reports support for the present study from the McGill University Health Centre (MUHC) Department of Medicine Contract Academic Staff (CAS) Research Award, and a Respiratory Epidemiology and Clinical Research Unit Summer Studentship Research Award; grants from the Quebec Respiratory Health Network, Ministère de l’Éducation et le Ministère de l'Enseignement Supérieur Innovation and Office of Innovation and Partnerships (I+P) of McGill University (McGill University and Thorasys Inc.), McGill Interdisciplinary Initiative in Infection and Immunity (MI4) Pfizer Early Career Investigator Award (ECA), MUHC Foundation/MCI Respiratory Research Campaign Innovation Grant, MUHC Department of Medicine CAS Research Award, MGH Foundation Research Award, Trudell Medical International Unrestricted Investigator-Initiated Operating Grant, AstraZeneca Unrestricted Investigator-Initiated Operating Grant; payment or honoraria for lectures, presentations, manuscript writing or educational events from GlaxoSmithKline, AstraZeneca, COVIS, Canadian Thoracic Society, McGill University CPD, L'Association des Pneumologues de la Province de Québec, CHEST, Alberta Kinesiology Association and Respiplus; and receipt of equipment, materials, drugs, medical writing, gifts or other services from Amazentis, Thorasys Inc. and Restech. The remaining authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Manual measurement of a representative subject: a 70-year-old male with Global Initiative for Chronic Obstructive Lung Disease 1 COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio 0.67, FEV1 90.8% predicted). a) Left diaphragm dome height (LDDH) and b) right diaphragm dome height (RDDH). Manual measurements yielded 35.1 mm for LDDH and 39.3 mm for RDDH.
FIGURE 2
FIGURE 2
Flow diagram of study participants. CanCOLD: Canadian Cohort Obstructive Lung Disease; V1: visit 1 (baseline visit); BD: bronchodilator; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; LLN: lower limit of normal.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Victor JC, To T, Wilton A, et al. The feasibility of COPD surveillance in Ontario: a population study. Healthc Q 2011; 14: 25–29. doi: 10.12927/hcq.2011.22647 - DOI - PubMed
    1. Leung C, Bourbeau J, Sin DD, et al. The prevalence of chronic obstructive pulmonary disease (COPD) and the heterogeneity of risk factors in the Canadian population: results from the Canadian Obstructive Lung Disease (COLD) Study. Int J Chron Obstruct Pulmon Dis 2021; 16: 305–320. doi: 10.2147/COPD.S285338 - DOI - PMC - PubMed
    1. Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. BMJ 2022; 378: e069679. doi: 10.1136/bmj-2021-069679 - DOI - PMC - PubMed
    1. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400: 921–972. doi: 10.1016/S0140-6736(22)01273-9 - DOI - PMC - PubMed
    1. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med 2019; 381: 1257–1266. doi: 10.1056/NEJMra1900500 - DOI - PubMed

LinkOut - more resources