The relationship of diaphragmatic mobility evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Min ,  PIAN Linping

Department of Ultrasound, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, P. R. China;

Corresponding author：

PIAN Linping, Email: hydlm@163.com

Keywords：

Chronic obstructive pulmonary disease; Diaphragmatic motion; M-type ultrasound

DOI：

10.7507/1671-6205.201804041

Video：

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ObjectiveTo investigate the relationship of diaphragmatic mobility (ΔM) evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease (COPD) , and analyze the factors those affect the diaphragmatic mobility.MethodsA total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction (FEV₁%pred), and exercise capacity (6MWD) were measured. The quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ).ResultsThe minimum value of ΔM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between ΔM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of –0.474, –0.416, –0.432, –0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing ΔM were height (β=0.407, P=0.021) and FEV₁%pred (β=–0.391, P=0.035).ConclusionsDiaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV₁%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.

Citation： LIU Min, PIAN Linping. The relationship of diaphragmatic mobility evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 548-551. doi: 10.7507/1671-6205.201804041 Copy

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13.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
14.	Jung KJ, Park JY, Hwang DW, et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med, 2014, 38(1): 29-37.
15.	Dal Negro RW, Celli BR. Patient related outcomes-BODE (PRO-BODE): a composite index incorporating health utilization resources predicts mortality and economic cost of COPD in real life. Respir Med, 2017, 131(10): 175-178.
16.	Chun EM, Han SJ, Modi HN. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2015, 27(1): 193-199.
17.	Orozco-Levi M, Gea J, Lloreta JL, et al. Subcellular adaptation of the human diaphragm in chronic obstructive pulmonary disease. Eur Respir J, 1999, 13(2): 371-378.
18.	Baldi BG, Salge JM. Respiratory muscles in interstitial lung disease: poorly explored and poorly understood. J Bras Pneumol, 2016, 42(2): 82-83.
19.	Iwasawa T, Takahashi H, Ogura T, et al. Influence of the distribution of emphysema on diaphragmatic motion in patients with chronic obstructive pulmonary disease. Jpn J Radiol, 2011, 29(5): 256-264.
20.	Paulin E, Yamaguti WP, Chammas MC, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med, 2007, 101(10): 2113-2118.
21.	Dos Santos Yamaguti WP, Paulin E, Shibao S, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology, 2008, 13(1): 138-144.
22.	Charususin N, Dacha S, Gosselink R, et al. Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert Rev Respir Med, 2018, 12(1): 67-79.
23.	Bisca GW, Camillo CA, Cavalheri V, et al. Peripheral muscle training in patients with chronic obstructive pulmonary disease: novel approaches and recent advances. Expert Rev Respir Med, 2017, 11(5): 413-423.

1. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 10(8): 1603-1658.
2. Putcha N, Drummond MB, Wise RA, et al. Comorbidities and chronic obstructive pulmonary disease: prevalence, influence on outcomes, and management. Semin Respir Crit Care Med, 2015, 36(4): 575-591.
3. Tomasic I, Tomasic N, Trobec R, et al. Continuous remote monitoring of COPD patients--justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput, 2018, 56(4): 547-569.
4. Polverino F, Laucho-Contreras ME, Petersen H, et al. A pilot study linking endothelial injury in lungs and kidneys in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2017, 195(11): 1464-1476.
5. Hamacher J, Hadizamani Y, Borgmann M, et al. Cytokine-ion channel interactions in pulmonary inflammation. Front Immunol, 2018, 8: 1644.
6. Gea J, Pascual S, Casadevall C, et al. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. J Thorac Dis, 2015, 7(10): E418-E438.
7. Barreiro E, Gea J. Molecular and biological pathways of skeletal muscle dysfunction in chronic obstructive pulmonary disease. Chron Respir Dis, 2016, 13(3): 297-311.
8. Suga K, Tsukuda T, Awaya H, et al. Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Reson Imaging, 1999, 10(4): 510-520.
9. Smargiassi A, Inchingolo R, Tagliaboschi L, et al. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration, 2014, 87(5): 364-371.
10. Cancelliero-Gaiad KM, Ike D, Pantoni CB, et al. Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Braz J Phys Ther, 2014, 18(4): 291-299.
11. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
12. 雷玲, 钟小宁, 何志义. 慢性阻塞性肺疾病患者 BODE 指数与生活质量的相关性研究. 中国呼吸与危重监护杂志, 2007, 6(4): 261-264.
13. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
14. Jung KJ, Park JY, Hwang DW, et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med, 2014, 38(1): 29-37.
15. Dal Negro RW, Celli BR. Patient related outcomes-BODE (PRO-BODE): a composite index incorporating health utilization resources predicts mortality and economic cost of COPD in real life. Respir Med, 2017, 131(10): 175-178.
16. Chun EM, Han SJ, Modi HN. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2015, 27(1): 193-199.
17. Orozco-Levi M, Gea J, Lloreta JL, et al. Subcellular adaptation of the human diaphragm in chronic obstructive pulmonary disease. Eur Respir J, 1999, 13(2): 371-378.
18. Baldi BG, Salge JM. Respiratory muscles in interstitial lung disease: poorly explored and poorly understood. J Bras Pneumol, 2016, 42(2): 82-83.
19. Iwasawa T, Takahashi H, Ogura T, et al. Influence of the distribution of emphysema on diaphragmatic motion in patients with chronic obstructive pulmonary disease. Jpn J Radiol, 2011, 29(5): 256-264.
20. Paulin E, Yamaguti WP, Chammas MC, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med, 2007, 101(10): 2113-2118.
21. Dos Santos Yamaguti WP, Paulin E, Shibao S, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology, 2008, 13(1): 138-144.
22. Charususin N, Dacha S, Gosselink R, et al. Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert Rev Respir Med, 2018, 12(1): 67-79.
23. Bisca GW, Camillo CA, Cavalheri V, et al. Peripheral muscle training in patients with chronic obstructive pulmonary disease: novel approaches and recent advances. Expert Rev Respir Med, 2017, 11(5): 413-423.

Chinese Journal of Respiratory and Critical Care Medicine

The relationship of diaphragmatic mobility evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease

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