Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study

Abstract

Objective:To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods:Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results:A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions:Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

Respiratory muscles in COPD: be aware of the diaphragm

“…Considering the importance and clinical relevance of this topic, although symptoms were not measured in that study, 8 it is clear that TH resulted in lower diaphragmatic mobility in COPD patients and, therefore, has a potential to impair diaphragmatic strength. Future studies exploring the impact of chest wall alterations on diaphragm performance and their clinical implications in COPD patients are of high interest.…”

“…As demonstrated by Gonçalves et al, 8 diaphragmatic dysfunction might be present in COPD patients with TH; however, as demonstrated in the study by Gonçalves et al, 8 this topic has yet to be fully elucidated. First, there is question of the clinical relevance of the findings, given that no association was found between reduced diaphragmatic mobility and reduced maximal inspiratory pressure.…”

“…In an article published in the current issue of the JBP, Gonçalves et al 8 showed that COPD patients with thoracic hyperkyphosis (TH) had lower diaphragmatic mobility when compared with a group of patients with COPD and no TH. Furthermore, the authors showed a negative correlation between diaphragmatic mobility and TH: a greater thoracic kyphosis translates to a lower diaphragmatic mobility.…”

“… 14 Moreover, a recent study has demonstrated that diaphragmatic dysfunction defined by reduced thickening fraction on DUS (< 20%) is related to prognostic implications in acutely exacerbated COPD patients. 15 Lastly, the study by Gonçalves et al 8 is a descriptive study, and, therefore, it is impossible to evaluate the cause-and-effect relationship between TH and reduction of diaphragmatic mobility. Table 1 shows the most common variables studied by means of imaging methods for evaluating the diaphragm, as well as their clinical implications in healthy individuals and in patients with respiratory disorders.…”

The Role of Manual Therapy in Patients with COPD

“…An early study illustrated that reduction in thoracic spine mobility was linked to lower lung function, with decreases in forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ) [30]. More recent examination found that those with thoracic hyperkyphosis and COPD have less diaphragmatic mobility compared to those without with postural change, although the implications for this on respiratory function and symptoms are unclear [31]. In some individuals, postural changes have been associated with musculoskeletal pain [9,10].…”