Diaphragm Ultrasonography as an Alternative to Whole-Body Plethysmography in Pulmonary Function Testing

Scott, Suzie; Fuld, Jonathan; Carter, Roger; McEntegart, Margaret; MacFarlane, Niall G.

doi:10.7863/jum.2006.25.2.225

Cited by 62 publications

(56 citation statements)

References 15 publications

(26 reference statements)

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“…According to some of the authors [18,36] of studies on healthy subjects, no significant relationships were found between the right hemidiaphragmatic excursion and the respiratory function parameters. Others found significant correlations with the degree of air trapping, TLC and FEV 1 /FVC ratio [37], although a different technique was used to establish the excursion.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic Assessment of the Diaphragm in Chronic Obstructive Pulmonary Disease Patients: Relationships with Pulmonary Function and the Influence of Body Composition - A Pilot Study

et al. 2014

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Background: Skeletal muscle weakness with loss of fat-free mass (FFM) is one of the main systemic effects of chronic obstructive pulmonary disease (COPD). The diaphragm is also involved, leading to disadvantageous conditions and poor contractile capacities. Objectives: We measured the thickness of the diaphragm (TD) by ultrasonography to evaluate the relationships between echographic measurements, parameters of respiratory function and body composition data. Methods: Thirty-two patients (23 males) underwent (1) pulmonary function tests, (2) echographic assessment of TD in the zone of apposition at various lung volumes, i.e. TD at residual volume (TDRV), TD at functional residual capacity (TDFRC) and TD at total lung capacity (TDTLC), and (3) bioelectrical body impedance analysis. The BMI and the BODE (BMI-Obstruction-Dyspnea-Exercise) index values were reported. Results: TDRV, TDFRC and TDTLC measured 3.3, 3.6 and 6 mm, respectively, with good intraobserver reproducibility (0.97, 0.97 and 0.96, respectively). All the TDs were found to be related to FFM, with the relationship being greater for TDFRC (r² = 0.39 and p = 0.0002). With regard to lung volumes, inspiratory capacity (IC) was found to be closely related to TDTLC (r² = 0.42 and p = 0.0001). The difference between TDTLC and TDRV, as a thickening value (TDTLCRV), was closely related to FVC (r² = 0.34 and p = 0.0004) and to air-trapping indices (RV/TLC, FRC/TLC and IC/TLC): the degree of lung hyperinflation was greater and the TDTLCRV was less. Finally, we found a progressive reduction of both thicknesses and thickenings as the severity of IC/TLC increased, with a significant p value for the trend in both analyses (p = 0.02). Conclusions: Ultrasonographic assessment of the diaphragm could be a useful tool for studying disease progression in COPD patients, in terms of lung hyperinflation and the loss of FFM.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic Assessment of the Diaphragm in Chronic Obstructive Pulmonary Disease Patients: Relationships with Pulmonary Function and the Influence of Body Composition - A Pilot Study

et al. 2014

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“…A reduction in diaphragm mobility has been identified in patients with COPD and has been associated with a decline in pulmonary function parameters. (21) In a previous study, we demonstrated a relationship between diaphragmatic dysfunction and air trapping.…”

Section: Discussionmentioning

confidence: 77%

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

et al. 2009

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Objective: To determine whether COPD patients with diaphragmatic dysfunction present higher risk of mortality than do those without such dysfunction. Methods: We evaluated pulmonary function, diaphragm mobility and quality of life, as well as determining the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, in 42 COPD patients. The patients were allocated to two groups according to the degree to which diaphragm mobility was impaired: low mobility (LM; mobility ≤ 33.99 mm); and high mobility (HM; mobility ≥ 34.00 mm). The BODE index and the quality of life were quantified in both groups. All patients were followed up prospectively for up to 48 months in order to determine the number of deaths resulting from respiratory complications due to COPD. Results: Of the 42 patients evaluated, 20 were allocated to the LM group, and 22 were allocated to the HM group. There were no significant differences between the groups regarding age, lung hyperinflation or quality of life. However, BODE index values were higher in the LM group than in the HM group (p = 0.01). During the 48-month follow-up period, there were four deaths within the population studied, and all of those deaths occurred in the LM group (15.79%; p = 0.02). Conclusions: These findings suggest that COPD patients with diaphragmatic dysfunction, characterized by low diaphragm mobility, have a higher risk of death than do those without such dysfunction.Keywords: Pulmonary disease, chronic obstructive/mortality; Diaphragm; Exercise tolerance; Quality of life. ResumoObjetivo: Verificar se indivíduos portadores de DPOC com disfunção diafragmática apresentam maior risco de mortalidade quando comparados àqueles sem disfunção diafragmática. Métodos: Foi avaliada a função pulmonar, a mobilidade diafragmática, a qualidade de vida e o índice conhecido como Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) em 42 pacientes portadores de DPOC. Os pacientes foram alocados em dois grupos de acordo com a gravidade do acometimento da mobilidade do diafragma: grupo de baixa mobilidade (BM; mobilidade ≤ 33,99 mm) e grupo de alta mobilidade (AM; mobilidade ≥ 34,00 mm). O índice BODE e a qualidade de vida foram quantificados nos dois grupos. Todos os pacientes foram acompanhados prospectivamente por um período de até 48 meses a fim de identificarmos o número de óbitos decorrentes de complicações respiratórias devido a DPOC. Resultados: Dos 42 pacientes avaliados, 20 foram classificados no grupo BM, e 22 foram alocados no grupo AM. Não houve diferenças significativas quanto à faixa etária, hiperinsuflação pulmonar e fatores relacionados à qualidade de vida entre os grupos. Entretanto, o grupo BM apresentou maior pontuação no índice BODE em relação ao grupo AM (p = 0,01). O acompanhamento dos pacientes ao longo de 48 meses permitiu identificar quatro óbitos na população estudada, sendo todos os casos no grupo BM (15,79%; p = 0,02). Conclusões: Esses resultados sugerem que pacientes portadores de DPOC com disfunção diafrag...

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“…Nevertheless, it was still visible in 72% of patients. Regardless of the approach, the left hemidiaphragm assessment may be more challenging because of gas interference from the stomach and the bowel, which makes it more difficult to visualize [22]. Assessment of the right hemidiaphragm is more feasible because of the diaphragm close contact with the liver surface.…”

Section: Discussionmentioning

confidence: 97%

“…Ultrasound of the diaphragm using B-mode alone [8,11,[13][14][15][16][17][18][19] or combined with M-mode has been described in literature [4,9,[20][21][22]. B-mode is a 2-dimensional imaging, which is used to identify the diaphragm at the interface between the lung and the subphrenic solid organ.…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients—an observational study

Haji

Royse

Tharmaraj

et al. 2015

Journal of Critical Care

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Diaphragm Ultrasonography as an Alternative to Whole-Body Plethysmography in Pulmonary Function Testing

Abstract: These data suggest that dynamic measurements using diaphragm ultrasonography provide a relatively poor measure of pulmonary function in relation to whole-body plethysmography.

Cited by 62 publications

References 15 publications

Ultrasonographic Assessment of the Diaphragm in Chronic Obstructive Pulmonary Disease Patients: Relationships with Pulmonary Function and the Influence of Body Composition - A Pilot Study

Ultrasonographic Assessment of the Diaphragm in Chronic Obstructive Pulmonary Disease Patients: Relationships with Pulmonary Function and the Influence of Body Composition - A Pilot Study

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients—an observational study

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