Abnormalities of chest wall motion in patients with chronic airflow obstruction.

Abstract

Forty patients with severe chronic stable airflow obstruction and hyperinflation were studied to assess patterns of abnormal chest wall motion and their frequency. Dimensional changes were measured during tidal breathing, four pairs of magnetometers being used to record anteroposterior diameters of ribcage and abdomen and two lateral diameters of the ribcage. Chest wall movements were qualitatively normal in only five patients. Three main types of abnormality were found and 13 subjects had two or more abnormal patterns. Lateral ribcage paradox was present in 31 of the 40 patients and was recognised clinically in all except one. Inspiratory indrawing of the lower sternum was recorded in 12 patients, paradoxical inspiratory motion of the abdomen was present in four patients and in six there was a biphasic expiratory pattern of abdominal movement. Analysis of variance showed no significant group differences in severity of airflow obstruction or hyperinflation between the patients with qualitatively normal motion and those with different types of abnormal motion. Relationships between the tidal displacement of each dimension and severity of airflow obstruction and hyperinflation were examined. In general, patients with more severe hyperinflation showed less abdominal movement and those with more severe airflow obstruction had less lateral expansion of the ribcage, but the correlations were weak. It is concluded that abnormal motion of the chest wall is very common in patients with airflow obstruction and hyperinflation, that clinical recognition of abnormal motion other than lateral ribcage paradox is easily overlooked, and that quantitative relationships between abnormal motion and disease severity are weak.In the normal person during tidal breathing the chest wall expands by displacement of the ribcage and abdomen and this motion is closely related to change in lung volume. In patients with chronic airflow obstruction and hyperinflation various abnormalities of chest wall motion have been reported; the most familiar is paradoxical inspiratory indrawing of the lateral rib margin, which is a well established physical sign of airways obstruction.' 2 Other abnormalities which have been described include paradoxical or incoordinate abdominal motion34 and paradoxical inspiratory indrawing of the ribcage in the anteroposterior dimension;5 these latter abnormalities have been

Diaphragm curvature modulates the relationship between muscle shortening and volume displacement

“…Maximal phrenic nerve stimulation maximally activates the diaphragm, allowing for increased muscle shortening and dome descent with a reduced diaphragm load given that the active muscles of the rib cage are silent. This condition is similar to those during chronic obstructive pulmonary disease (COPD) where diaphragm load is decreased and the rib cage is expanded (8,18). In this study, we demonstrated that during bilateral phrenic nerve stimulation, the percentage of diaphragm muscle shortening, abdominal VD, and total VD values were two-to three-fold greater than those that occurred during submaximal diaphragm activation.…”

Pulmonary hyperinflation a clinical overview

“…The best recognized distortion is lateral inspiratory paradox of the rib margin, otherwise known as Hoover's sign [10]. In one study [5], this was detectable in as many as 31 of 40 otherwise unselected patients with COPD. Paradoxical lateral motion typically develops with the onset of inspiration, continuing to late inspiration, sometimes with an increase in the dimension in the terminal part of inspiration.…”

“…They suggested that the impression of increased AP diameter of the chest was actually the result of a reduced AP diameter of the abdomen, due to wasting. On the other hand, GILMARTIN and GIBSON [5] measured the dimensions of the rib cage at FRC and showed an increase in the ratio of AP to lateral diameters, i.e. the rib cage was more circular in cross-section than in normal subjects.…”

“…In addition, distortions of chest wall motion are frequently present. In general, the greater the FRC the less the AP motion of the abdomen during tidal inspiration [5]. Although AP motion of the upper rib cage is generally preserved and may even be increased [9], presumably due to greater use of intercostal and accessory muscles, AP motion at the lower sternum and lateral motion of the rib cage are often distorted.…”

The Feasibility of Recording Speech Breathing Patterns before and after Pulmonary Rehabilitation in an Out-Patient Environment

“…Breathing is often the first vital sign to alter in an acutely deteriorating patient, because changes in breathing pattern accompany many respiratory [1][2][3] and non-respiratory disorders [4]. Abnormal breathing patterns have also been observed in patients with chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) [5], bronchiectasis [6] and asthma [7].…”