Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease

The aim was to describe diaphragmatic behavior during postural limb activities and examine the ventilatory and stabilizing functions of the diaphragm. Thirty healthy subjects were examined in the supine position using a dynamic MRI system assessed simultaneously with specialized spirometric readings. The diaphragmatic excursions (DEs) were measured at three diaphragmatic points in the sagittal plane; the diaphragm positions (DPs) as related to a reference horizontal baseline were determined. Measurements were taken during tidal breathing (TB) and isometric flexion of upper or lower extremities against external resistance together with TB. Mean DE in both upper and lower postural limb activities was greater compared with the TB condition (P < 0.05), with the effect greater for lower limb activities. Inspiratory DPs in the upper and lower extremity activities were lower compared with TB alone (P < 0.01). Expiratory DP was lower only for lower extremity activities (P < 0.01). DP was most affected at the apex of the crescent and crural (posterior) portion of the diaphragm. DEs correlated strongly with tidal volume (Vt) in all conditions. Changes in DEs relative to the initial value were minimal for upper and lower extremities but were related to lower values of Vt (P < 0.03). Significant involvement of the diaphragm in the limb postural activities was found. Resulting DEs and DPs differed from the TB conditions, especially in lower extremity activities. The differences between the percent changes of DEs vs. Vt found for lower extremity activities were confirmed by both ventilatory and postural diaphragm recruitment in response to postural demands.

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“…Similar to Suga et al (33) we could not detect the previously reported finding of asymmetric excursions between hemidiaphragms (8,34,36).…”

Section: Discussionsupporting

confidence: 63%

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment

Kolář

Šulc

Kynčl

et al. 2010

Journal of Applied Physiology

107

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“…(4,5) These results, taken together, strengthen the hypothesis that diaphragmatic dysfunction is related to the severity of the pulmonary disease.…”

Section: Discussionsupporting

confidence: 66%

“…(3,4) Studies have shown that the impairment of diaphragm mobility might be associated with alterations in the principal pulmonary function parameters, such as FEV 1 . (2,5) The isolated determination of FEV 1 has been recognized as a useful tool to predict health status, the frequency of exacerbations and the risk of mortality in patients with COPD. (6) However, the systemic manifestations of the disease are not reflected by this parameter.…”

Section: Introductionmentioning

confidence: 99%

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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“…12 The effects of diaphragm movement and physiological changes have been explored in the presence of disease such as chronic obstructive pulmonary disease. 13 However, little research has been conducted on the effects of stretching techniques on the diaphragm.…”

Section: Introductionmentioning

confidence: 99%

Effects of a diaphragm stretching technique on pulmonary function in healthy participants: A randomized-controlled trial

González-Álvarez

Valenza

Cabrera‐Martos

et al. 2015

International Journal of Osteopathic Medicine

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Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease

Cited by 74 publications

References 10 publications

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

Effects of a diaphragm stretching technique on pulmonary function in healthy participants: A randomized-controlled trial

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