Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

Abstract

BackgroundClinical and research utility of non-cardiac ultrasound (US) in chronic obstructive pulmonary disease (COPD) has been widely investigated. However, there is no systematic review assessing the clinical values of non-cardiac US techniques in COPD.MethodsWe systematically searched electronic databases from inception to 24 June 2020. Two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extracted data. A narrative synthesis of the results was conducted considering non-cardiac US techniques that looked for diaphragm, muscles and bones in patients with COPD.ResultsIn total, 2573 abstracts were screened, and 94 full-text papers were reviewed. A total of 54 studies met the inclusion criteria. Thirty-five studies assessed the diaphragm, while 19 studies evaluated different muscles, including limb muscles and pulmonary lesions in COPD using US. Of the 54 included studies, 30% (16/54) evaluated the changes in either limb muscles or diaphragmatic features before and after physical interventions; 67% (36/54) assessed the correlations between sonographic features and COPD severity. Indeed, 14/15 and 9/13 studies reported a significant reduction in diaphragm excursion and thickness in COPD compared with healthy subjects, respectively; this was correlated significantly with the severity and prognosis of COPD. Three studies reported links between diaphragm length and COPD, where lower diaphragm length correlated with poorer prognosis and outcomes. Quadriceps (rectus femoris), ankle dorsiflexor (tibialis anterior) and vastus lateralis were the most common muscles in COPD assessed by US. More than 70% (12/17) of the studies reported a significant reduction in the cross-sectional area (CSA) of the rectus femoris, rectus femoris and vastus lateralis thickness in COPD compared with healthy subjects. Quadriceps CSA and thickness correlated positively with COPD prognosis, in which patients with reduced quadriceps CSA and thickness have higher risk of exacerbation, readmission and death.ConclusionUS measurements of diaphragm excursion and thickness, as well as lower limb muscles strength, size and thickness, may provide a safe, portable and effective alternative to radiation-based techniques in diagnosis and prognosis as well as tracking improvement postintervention in patients with COPD.

Pulmonary rehabilitation for COPD: A narrative review and call for further implementation in Saudi Arabia

“…[ 18 ] PR significantly improves exercise capacity, muscle strength and endurance, emotional function, health-related quality of life, exercise capacity, disease self-management, nutritional status, and likelihood of improving physical activities in people with COPD. [ 10 16 19 20 21 22 ]…”

Thoracic imaging outcomes in COVID-19 survivors

“…LUS is also relatively more accessible because of the inherent portability and bedside availability, making it a technique of choice where timely assessment of lung complications is needed, especially in COVID-19 patients with severe or unstable health conditions[ 36 ]. Further, the ability to delineate alterations in superficial lung tissue through the air and tissue ratio (using A- and B-lines) makes LUS unique and more sensitive in characterizing the nature, topography, and size of lung tissue lesions[ 37 , 38 ]. In general, irregular thickening of the pleural line, heterogeneous B-lines and consolidations, pleural effusions, and recovery-phase A-lines in the lung image have been detected in COVID-19 patients using ultrasonography[ 39 - 41 ].…”

Key toolkits of non-pharmacological management in COPD: during and beyond COVID-19

“…PR has been shown to be effective in reducing exacerbation, hospitalisation, emergency department visits, symptoms of dyspnoea, anxiety and depression, leg discomfort, and healthcare costs [34][35][36][37][38]. PR also improves exercise capacity, emotional function, muscle strength and endurance, health-related quality of life, nutritional status, and disease self-management in stable COPD patients [39][40][41]. The benefits of PR can be obtained despite the patient's gender, age, smoking status, disease severity, as well as it can be maintained for 12 months in those who have attended PR before [34][35][36][37][38]42].…”