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Year : 2022  |  Volume : 19  |  Issue : 3  |  Page : 427-433

Diaphragmatic thickness in chronic obstructive pulmonary disease

1 Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
2 Department of Surgery, College of Medicine, Al-Nahrain University, Baghdad, Iraq

Correspondence Address:
Jumana Mahdi Kareem
Department of physiology, College of Medicine, University of Al-Nahrain, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJBL.MJBL_68_22

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Background: Chronic obstructive pulmonary disease, characterized by chronic airway inflammation and progressive airflow limitation, and is considered as common, preventable and treatable disease. The defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating diaphragmatic function in chronic obstructive pulmonary disease patients. Objective: to assess the diaphragmatic structure and function using B-mode ultrasonography studying the diaphragm muscle inspiratory and expiratory thickness and thickening fraction in patients with COPD compared to healthy controls, and to study their sensitivity and specificity as well as their correlation with certain pathophysiologic parameters namely (peripheral capillary oxygen saturation, body mass index and C-reactive protein) to establish possible relation with the pathophysiology of the disease. Materials and Methods: The present study is a case control study was conducted in Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq in the period extended from November 2019 to October 2021. Forty patients with the diagnosis of COPD underwent B-mode ultrasound analysis. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The thickening fraction was calculated as (Tmax-Tmin/Tmin), and each set of values was averaged. Findings were compared with a database of 40 healthy control subjects. Results: Diaphragm thickness and thickening fraction were significantly higher in COPD patients compared to control subjects with the mean of the Rt. inspiratory diaphragmatic thickness equals (3.23 ± 0.68mm versus 2.8 ± 0.55mm; respectively, p=0.006) compared to control, and (2.44 ± 0.71 versus 1.96 ± 0.6; respectively, p=0.004) for the mean Rt. diaphragmatic thickening fraction, while the mean of the Lt. inspiratory diaphragmatic thickness was (3.22 ± 0.63mm versus 2.79 ± 0.51mm; respectively, p=0.003) compared to control, and (2.45 ± 0.63 versus 1.95 ± 0.54; respectively, p=0.003) for the mean Lt. diaphragmatic thickening fraction, ROC analysis shows that the right and left diaphragmatic fractions had the highest sensitivity and specificity parameter for COPD. No correlations were found between body mass index, SpO2 with diaphragmatic parameters. Conclusion: the current study found diaphragmatic ultrasonographic characteristics in patients with COPD show significant increase in inspiratory thickness and thickening fraction compared to control group, yet they were of low diagnostic accuracy.

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