Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

Abstract

This review summarizes the characteristics, assessment methods, and targeted rehabilitation therapies of diaphragm dysfunction in patients with chronic obstructive pulmonary disease (COPD). Methods: Extensive literature was searched in PubMed, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure Database, Wanfang, and SinoMed. Results: Under the influence of oxidative stress, inflammation, and other factors, the diaphragm function of patients with COPD changes in mobility, muscle strength, thickness, and thickening. In patients with COPD, diaphragm mobility can be assessed using ultrasound, X-ray fluoroscopy, and magnetic resonance imaging. Diaphragmatic strength can be measured by transdiaphragmatic pressure and maximal inspiratory pressure. Diaphragmatic thickness and thickening can be assessed using ultrasound. Rehabilitation therapies targeting the diaphragm include diaphragmatic breathing, diaphragm-related manual therapy, and phrenic nerve electrical stimulation. Diaphragmatic breathing is safe, simple, and not limited by places. Diaphragmatic manual therapies, which require patient cooperation and one-on-one operation by a professional therapist, are effective. Phrenic nerve electrical stimulation is suitable for patients with severe conditions. These therapies improve the diaphragmatic function, lung function, dyspnea, and exercise capacity of patients with COPD. Conclusion:The diaphragmatic function is commonly assessed in terms of mobility, strength, thickness, and thickening. Diaphragmatic targeted rehabilitation therapies have proven to be efficient, which are recommended to be included in the pulmonary rehabilitation strategy for patients with COPD.

Effects of external diaphragm pacing combined with conventional rehabilitation therapies in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Targeted rehabilitation methods for diaphragmatic dysfunction in COPD patients mainly include diaphragmatic breathing, manual therapy, and phrenic nerve stimulation, which have been shown to improve diaphragm function, pulmonary ventilation function, dyspnea, and exercise capacity. 8 However, for those COPD patients who are limited by the effects of reduced exercise capacity and fatigue-prone respiratory muscles, the implementation of diaphragmatic breathing and manual therapy is greatly limited; meanwhile, the disadvantage of these rehabilitation training is that they are slow to be effective and not easily adhered to by patients, resulting in reduced patient compliance and clinical effects. 9 , 24 Non-invasive phrenic nerve stimulation, which is passive, safe, and easy to perform, can provide a valuable complementary method to improve diaphragm dysfunction.…”

“…For rehabilitation of diaphragm function, many conventional rehabilitation therapies (CRTs) such as diaphragmatic breathing, and diaphragm-related manual therapy, are used to improve diaphragm dysfunction of COPD patients. 8 Nevertheless, limited by the specific physiological structure location and the pathological changes that predispose the diaphragm to fatigue, some CRTs find it hard to stimulate the diaphragm directly and to engage COPD patients actively and consistently in pulmonary rehabilitation training. 9 As a complement to CRTs, diaphragm electrical stimulation has been used in recent years as an emerging and promising treatment for diaphragmatic dysfunction that can effectively improve the therapeutic effect of COPD patients, which includes internal diaphragm pacing (IDP) and external diaphragm pacing (EDP).…”

“…9 As a complement to CRTs, diaphragm electrical stimulation has been used in recent years as an emerging and promising treatment for diaphragmatic dysfunction that can effectively improve the therapeutic effect of COPD patients, which includes internal diaphragm pacing (IDP) and external diaphragm pacing (EDP). 8 IDP necessitates an invasive operation with several potential risks, for example, the phrenic nerve can be damaged by surgery or chemical stimulation, so it is rarely used clinically. Contrary to IDP, EDP stimulates the phrenic nerve via surface electrodes, causing the diaphragm to contract, and it is simple to perform, safe, non-invasive, and easily accepted by patients ( Figure 1 ).…”

Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group

“…Diaphragm performance depends not only on produced tension but also on its resting length, shortening capacity and volume displacement during breathing [20]. Clinical manifestations of diaphragmatic dysfunction are weakness and motion restriction [21].Chronic shortening and weakness of the diaphragm is associated with ber loss, especially in the zone of apposition, leading to a reduction in force production and mechanical fault of the diaphragm [22,23].…”

Two-dimensional shear wave elastography: a new tool for evaluating respiratory muscle stiffness in chronic obstructive pulmonary disease patients

“…Diaphragmatic dysfunction is associated with an increased risk of hospitalization caused by acute COPD aggravation, which significantly reduces the quality of daily life and increases the difficulty of treatment during the acute exacerbation period. The evaluation of diaphragm impairment plays an important role in disease assessments, targeted rehabilitation therapy and pulmonary physiotherapy [ 6 , 7 ]. The diaphragm function of COPD patients is closely related to lung function; therefore, the identification of a simpler method of evaluating the diaphragm function of COPD patients has important clinical significance.…”