Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients

Yamaguti, Wellington Pereira; Paulin, Elaine; Shibao, Simone; Chammas, Maria Cristina; Salge, João Marcos; Ribeiro, Marcelo Leite; Cukier, Alberto; Carvalho, Celso Ricardo Fernandes

doi:10.1111/j.1440-1843.2007.01194.x

Cited by 94 publications

(84 citation statements)

References 32 publications

(36 reference statements)

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“…This analysis was performed based on a previous study, which reported a significant correlation between diaphragmatic mobility and pulmonary function parameters, including FVC. (30) Our results showed that the mobility/FVC (mm/L) ratio was significantly greater in women than in men, indicating that women performed better than did men on all three types of breathing exercises. One group of authors (28) reported that BMI can be considered another factor affecting diaphragmatic mobility in healthy subjects.…”

Section: Discussionmentioning

confidence: 50%

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Yamaguti¹,

Sakamoto

Panazzolo

et al. 2010

J. bras. pneumol.

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Objective: To compare the diaphragmatic mobility of healthy subjects during incentive spirometry with a volumeoriented device, during incentive spirometry with a flow-oriented device, and during diaphragmatic breathing. To compare men and women in terms of diaphragmatic mobility during these three types of breathing exercises. Methods:We evaluated the pulmonary function and diaphragmatic mobility of 17 adult healthy volunteers (9 women and 8 men). Diaphragmatic mobility was measured via ultrasound during diaphragmatic breathing and during the use of the two types of incentive spirometers. Results: Diaphragmatic mobility was significantly greater during the use of the volume-oriented incentive spirometer than during the use of the flow-oriented incentive spirometer (70.16 ± 12.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). Diaphragmatic breathing led to a greater diaphragmatic mobility than did the use of the flow-oriented incentive spirometer (69.62 ± 11.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). During all three types of breathing exercises, the women showed a higher mobility/ FVC ratio than did the men. Conclusions: Incentive spirometry with a volume-oriented device and diaphragmatic breathing promoted greater diaphragmatic mobility than did incentive spirometry with a flow-oriented device. Women performed better on the three types of breathing exercises than did men. ResumoObjetivo: Comparar a mobilidade diafragmática de indivíduos sadios durante a espirometria de incentivo orientada a volume, durante a espirometria de incentivo orientada a fluxo e durante exercícios diafragmáticos. Comparar a mobilidade diafragmática entre homens e mulheres durante esses três tipos de exercícios respiratórios. Métodos: Foram avaliadas a função pulmonar e a mobilidade diafragmática de 17 voluntários sadios adultos (9 mulheres e 8 homens). A avaliação da mobilidade do diafragma foi realizada durante a execução de exercícios diafragmáticos e durante o uso dos dois tipos de espirômetros de incentivo, por meio de um método ultrassonográfico. Resultados: A mobilidade diafragmática avaliada durante a utilização do espirômetro orientado a volume foi significativamente maior que aquela durante o uso do espirômetro orientado a fluxo (70,16 ± 12,83 mm vs. 63,66 ± 10,82 mm; p = 0,02). Os exercícios diafragmáticos promoveram maior mobilidade diafragmática do que o uso do espirômetro orientado a fluxo (69,62 ± 11,83 mm vs. 63,66 ± 10,82 mm; p = 0,02). Durante os três tipos de exercícios respiratórios, a relação mobilidade/CVF foi significativamente maior nas mulheres do que nos homens. Conclusões: A espirometria de incentivo orientada a volume e o exercício diafragmático promoveram maior mobilidade diafragmática do que a espirometria de incentivo orientada a fluxo. As mulheres apresentaram um melhor desempenho nos três tipos de exercícios respiratórios avaliados do que os homens. Original ArticleDiaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device J Bras Pneumol...

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Section: Discussionmentioning

confidence: 50%

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Yamaguti¹,

Sakamoto

Panazzolo

et al. 2010

J. bras. pneumol.

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“…US findings of diaphragm muscle in COPD patients is not concluded yet because of the varying results [3][4][5][6][7].These studies address the structure and the motion of the diaphragm [4]. The impairment of diaphragm is suggested to be an important factor which is associated with alterations in the principal pulmonary function parameters such as FEV1 [8]. In our study, diaphragmatic muscle thickness is measured in COPD patients with B-Mode US to determine the relationship between thickness and clinical and functional parameters.…”

Section: Introductionmentioning

confidence: 95%

Ultrasound assessment of diaphragm thickness in COPD

Çimşit¹,

Bekir²,

Karakurt³

et al. 2016

MMJ

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Objective: Thickness of the diaphragm was evaluated by B-mode ultrasonography (US) in chronic obstructive pulmonary disease (COPD) to determine the relationship between diaphragm thickness measurement, pulmonary function tests, and symptom scores.Patients and Methods: Fifty-three clinically stable patients with COPD were enrolled in this study for diaphragmatic thickness evaluation with B-mode US. The severity of COPD was determined by spirometric measurements in terms of %FEV1. Patients were also analyzed according to GOLD criteria. Correlation between diaphragm thickness and symptom scores like Medical Research Council (mMRC), COPD Assessment Test (CAT), composite scores and body mass index (BMI) were sought. Results:There was a moderate correlation between diaphragmatic muscle thickness and %FEV1 in mild COPD patients (r=0.62, p=0.017<0.05). No significant difference in diaphragmatic thicknesses of GOLD subgroups was found. There were no correlations between diaphragmatic muscle thickness, symptom scores, BMI, age, and gender. Conclusion:No correlation was found between diaphragmatic thickness in COPD patients and pulmonary function tests except for %FEV1 in mild COPD patients. There were no correlations between diaphragmatic muscle thickness and symptom scores. Further US studies should take place for functional evaluation of the diaphragm in COPD subgroups.Keywords: Diaphragm, Ultrasonography, Chronic obstructive pulmonary disease, Thickness. ÖZAmaç: Kronik obstruktive akciğer hastalığı (KOAH) olan hastaların, diyafram kalınlıklarını ultrasonografi ile ölçerek solunum fonksiyon testleri ve semptom skorları ile ilişkisinin araştırılmasıdır. Gereç ve Yöntem:KOAH nedeniyle takip edilmekte olan, son iki aydır klinik olarak stabil seyirli 53 hasta çalışmamıza dahil edildi. Bronkodilatör sonrası FEV1 değerlerinde %12 artış, çalışmada uygulanan testlerden herhangi birine uyumsuzluk, oksijen bağımlılığı, abdominal ya da torasik cerrahi geçirme hikayeleri çalışmadan dışlanma kriterleri olarak belirlendi. KOAH düzeyi spirometri ölçümlerine ve GOLD kriterlerine göre sınıflandırıldı.Hayat kalitesi değerlendirmesi için mMRC ve CAT semptom skorları testleri ile kompozit KOAH skor ölçümü hesaplanması için alevlenme sayıları sorularak kaydedildi. Bulgular: KOAH düzeyi hafif olan hastalarda FEV1 % ile diyafram kalınlığı arasında anlamlı ilişki bulundu (r=0.62, p=0,017<0,05). Diyafram kalınlığı ile GOLD alt grupları, semptom skorları, BMI , yaş ve cinsiyet gibi parametreler arasında anlamlı ilişki bulunamadı.Sonuç: KOAH hastalarında ultrasonografi ile ölçülen diyafram kalınlığı ile solunum fonksiyon testleri arasında hafif KOAH'lı hasta grubu haricinde anlamlı ilişki gösterilememiştir. Diyafram kalınlığı ile semptom skorları arasında anlamlı ilişki bulunamadı. Ultrasonografi ile planlanacak yeni çalışmalarda, KOAH alt gruplarında diyafram fonksiyonunu yansıtacak diyafram kalınlık oranları irdelenmelidir.

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“…The possible role of ultrasound in the functional evaluation of COPD patients has been suggested by Dos Santos Yamaguti et al [11] showing that diaphragm mobility, measured as a craniocaudal displacement, has a strong correlation with airtrapping.…”

Section: Introductionmentioning

confidence: 98%

Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay

Zanforlin¹,

Smargiassi

Inchingolo

et al. 2014

J Ultrasound

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The ultrasound study of the chest is showing a continuous development. This technique could be helpful in managing several chest diseases, but it is limited to the acoustic windows provided by intercostal spaces and by the inability to study healthy lung parenchyma and all intraparenchymal diseases such as chronic obstructive lung disease (COPD), because the interaction between ventilated lung and ultrasound generates only artifacts. Currently, there are few applications of ultrasound that are useful in COPD, with recent studies providing some innovation potentially useful in clinical practice. The similarity of the trend between the time/volume curve of spirometry and the M-mode representation of diaphragm during forced breath allowed to identify the M-mode Index of Obstruction (MIO), an index obtained from the ratio between forced diaphragmatic excursion in the first second (FEDE1, cm) and the maximal expiratory diaphragmatic excursion (EDEMax, cm). MIO has shown a linear correlation with the ratio between forced expiratory volume in the first second (FEV1) and vital capacity (VC), used in spirometry to identify airways obstruction. The value of MIO seems to be lower in patients affected by airways obstruction as showed by a recent study. The technique is easy to learn and fast to perform and the analysis could be provided with any ultrasound machine equipped with M-mode. In conclusion, these findings, if confirmed by other studies, could suggest a new add-on screening tool for obstructive lung diseases, in particular COPD, that could be performed during a routine abdominal ultrasound exam.Keywords Ultrasound Á Diaphragm Á Chronic obstructive pulmonary disease Á Airway obstruction Riassunto Lo studio ecografico del torace sta conoscendo un crescente sviluppo. Questa tecnica può essere di aiuto nella gestione di svariate patologie del torace, ma è limitata alle finestre acustiche fornite dagli spazi intercostali e dall'incapacità di studiare il parenchima polmonare sano e tutte le patologie intraparenchimali come la Broncopneumopatia Cronica Ostruttiva (BPCO), poiché l'interazione tra il polmone ventilato e gli ultrasuoni genera solo artefatti. Attualmente, ci sono poche applicazioni dell'ecografia fruibili nella BPCO, e alcuni studi recenti forniscono degli spunti innovativi potenzialmente utili nella pratica clinica. La somiglianza dell'andamento della curva spirometrica volume/tempo e della rappresentazione ecografica in M-mode della cinetica diaframmatica durante una manovra di espiro forzato ha consentito di identificare l'Indice di ostruzione in M-mode (MIO), un indice ottenuto dal rapporto tra l'escursione diaframmatica forzata nel primo secondo (FEDE1, cm) e l'escursione diaframmatica espiratoria massimale (EDEMax, cm), mostra una correlazione con il rapporto tra il volume espiratorio forzato nel primo secondo (FEV1) e la capacità vitale (VC), utilizzato nella spirometria per identificare l'ostruzione delle vie aeree. Il valore di MIO sembra essere inferiore nei pazienti affetti da ostruzione d...

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Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients

Abstract: The results of this study suggest that the reduction in diaphragm mobility in COPD patients is mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation.

Cited by 94 publications

References 32 publications

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Ultrasound assessment of diaphragm thickness in COPD

Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay

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