Background Chronic Obstructive Pulmonary Disease (COPD) impairs the function of the diaphragm by placing it at a mechanical disadvantage, shortening its operating length and changing the mechanical linkage between its various parts. This makes the diaphragm's contraction less effective in raising and expanding the lower rib cage, thereby increasing the work of breathing and reducing the functional capacity. Aim of the Study To compare the effects of diaphragmatic stretch and manual diaphragm release technique on diaphragmatic excursion in patients with COPD. Materials and Methods This randomised crossover trial included 20 clinically stable patients with mild and moderate COPD classified according to the GOLD criteria. The patients were allocated to group A or group B by block randomization done by primary investigator. The information about the technique was concealed in a sealed opaque envelope and revealed to the patients only after allocation of groups. After taking the demographic data and baseline values of the outcome measures (diaphragm mobility by ultrasonography performed by an experienced radiologist and chest expansion by inch tape performed by the therapist), group A subjects underwent the diaphragmatic stretch technique and the group B subjects underwent the manual diaphragm release technique. Both the interventions were performed in 2 sets of 10 deep breaths with 1-minute interval between the sets. The two outcome variables were recorded immediately after the intervention. A wash-out period of 3 hours was maintained to neutralize the effect of given intervention. Later the patients of group A and group B were crossed over to the other group. Results In the diaphragmatic stretch technique, there was a statistically significant improvement in the diaphragmatic excursion before and after the treatment. On the right side, p=0.00 and p=0.003 in the midclavicular line and midaxillary line. On the left side, p=0.004 and p=0.312 in the midclavicular and midaxillary line. In manual diaphragm release technique, there was a statistically significant improvement before and after the treatment. On the right side, p=0.000 and p=0.000 in the midclavicular line and midaxillary line. On the left side, p=0.002 and p=0.000 in the midclavicular line and midaxillary line. There was no statistically significant difference in diaphragmatic excursion in the comparison of the postintervention values of both techniques. Conclusion The diaphragmatic stretch technique and manual diaphragm release technique can be safely recommended for patients with clinically stable COPD to improve diaphragmatic excursion.

IntroductionCOPD presents with an array of extra-pulmonary symptoms of which skeletal muscle dysfunction, particularly of the quadriceps, is well recognized. This contributes to impaired quality of life and increased health care utilization. Work on the quadriceps originated from the observation that a good proportion of COPD patients stop exercise due to the feeling of leg fatigue rather than breathlessness. This study was carried out with the aim of finding the prevalence of quadriceps weakness in a population set and correlate it with severity of COPD.MethodologyThis cross-sectional study was conducted in 75 subjects suffering from COPD aged 45 years or above. COPD severity in the subjects was graded based on the GOLD staging system. A digital hand held dynamometer (HHD) was used to measure quadriceps muscle strength. Descriptive statistics were done, and Pearson’s Correlation Coefficient and ANOVA analysis was used for expressing the results.ResultsNinety two percent of subjects were suffering from quadriceps muscle weakness. Quadriceps weakness was present in significantly high proportions even in those suffering from mild disease and belonging to a younger age group. The mean quadriceps muscle force value decreased with disease severity and this relation was found to be significant (P<0.01).ConclusionMajority of the COPD patients were found to be suffering from quadriceps weakness, which was also present in significant proportions in subjects belonging to younger age groups and suffering from mild disease. These findings indicate that onset of muscle weakness in COPD may precede the onset of symptoms. These findings suggest need for early remedial measure to prevent occurrence of associated systemic diseases.

Background Bronchiectasis is a chronic respiratory condition characterised by chronic sputum production, fatigue, and dyspnoea. These symptoms will lead to reduced exercise capacity and a reduced ability to carry out activities of daily living. Glittre ADL test is a valid and reliable test which evaluates the activities of daily living. Aim To investigate whether the Glittre ADL test can differentiate the functional capacity and cardiorespiratory responses of patients with bronchiectasis from those healthy individuals using the six-minute test as a functional performance standard. Methods This study included 30 subjects: 15 bronchiectasis and 15 age- and gender-matched healthy subjects. The patients and healthy subjects were made to perform the Glittre ADL and six-minute test on two consecutive days. Parameters such as time taken, distance walked, HR, RR, SpO2, and dyspnoea were recorded before and after the tests. Results The performance of bronchiectasis was worse than the healthy group on the Glittre ADL test (4.78 ± 1.33 min, 3.94 ± 0.82 min, p=0.04). Distance walked in the six-minute walk test by the bronchiectasis was 42 meters lesser than the healthy (400.33 ± 77.99, 442 ± 89.21, p=0.18). The Glittre ADL test was correlated with 6MWT when the total sample was analysed (r=−0.41, p=0.05). There was moderate positive correlation between heart rate variation, dyspnoea, respiratory rate, and peripheral saturation (SpO2) between the tests (Glittre heart rate versus six-minute walk test heart rate (r=0.55, p=0.001); Glittre (Borg) versus six-minute walk test (Borg) (r=0.72, p=0.00); Glittre respiratory rate versus six-minute walk test RR (r=0.62, p=0.00); Glittre SpO2 versus six-minute walk test SpO2 (r=0.40, p=0.02)). The bronchiectasis group had a statistically significant higher (p=0.08, p=0.46) increase in dyspnoea and RR than the controls in both the Glittre ADL test and six-minute walk test (p=0.009, p=0.03), with the similar HR variation in both the groups (p > 0.05). There was statistical difference in peripheral oxygen saturation in bronchiectasis in the six-minute walk test (p=0.03). Conclusion The Glittre ADL test induced similar cardiorespiratory responses when compared to the six-minute walk test. So, the Glittre ADL test can be used as an assessment tool besides the six-minute walk test for the more complete evaluation of functional capacity and activities of daily living.