Abstract
Camilo Corbellini
Abstract
COPD causes airway obstruction that is not fully reversible and causes changes in the rib cage structure. These modifications lead to respiratory muscles functional inefficiency that is strongly correlated to lung function loss. Specifically, the diaphragm undergoes a progressive process of muscle fibers shortening, consequence of lung hyperinflation and dead space increase. This results in a chronic mechanical disadvantage that impairs the diaphragm???s mobility. This impairment may worsen in COPD exacerbations, improving after pulmonary rehabilitation. The diaphragmatic mobility (DM) is mostly assessed with techniques that expose the patient to risks. The pathophysiological changes in the diaphragm that occur in chronic obstructive pulmonary disease ( COPD) lead to functional inefficiency which strongly correlates with the loss of lung function. Shorting muscle fiber accompanies lung hyperinflation, leading to a chronic mechanical disadvantage that worsens in COPD exacerbations.Mostly the DM is evaluated using techniques which expose the patient to danger. The ultrasonography on Mmode is simple to use, safe and directly tests the displacement of the diaphragmatic dome. The purpose of the analysis is to assess whether the COPD impairs the DM and to validate progress after an inpatient PR.According to the statements of the American Thoracic Society / European Respiratory Society (ATS / ERS), each COPD patient must have a standard assessment consisting of lung function check, six-minute walk test and arterial blood gas examination. The diaphragm mobility ultrasonographic (US) test will be measured as follows during the second day of recovery: the patients placed in a semirecumbent position (45 degrees). The U.S. probe located between the anterior and mean axillary line, on the central right subcostal, cranial and dorsal region.The US wave on the posterior hemidiaphragm perpendicularly third (it is visualized as the hyperechogenic line behind the liver). Mobility tested by Mmode when the patient breathes at tidal volume (rest breathing) and deep slow breathing (to Functional Residual Capability).Classification and diagnosis of COPD patients will be based on requirements set by the Global Initiative for Chronic Obstructive Lung Disease ( GOLD). During the assessment, each patient must follow the PR as an ATS / ERS pulmonary rehabilitation recommendation. All patients will follow a physical exercise routine which is five days a week.The aerobic cycloergometer training was set at 60 per cent 70 per cent of the average heart rate of 220 minus patient age. The patients should conduct strength exercises on the lower limbs, particularly for quadriceps and hamstring.The patients will receive regular prescribed medication and oxygen therapy during the stay in hospital according to the evaluation of the medical staff, which will be prescribed by the clinician responsible. Patients will also have respiratory physiotherapy with respect to retaining lung secretion and the need to expand unventilated areas. Good volunteers must make up the control group. The volunteers will have their lung function screened. The subjects on the control group will be subjected to the same evaluation protocol about the ultrasonography of the spirometry and the M-mode. The data will be characterized qualitatively with percentages and frequency. The quantitative data defined the symmetrical distributions as means and standard deviation. The Kolmogorov-Smirnov test to determine the mean normality of distributions. A one way variance analysis ( ANOVA) with repeated measurements and the Bonferroni test will be used as a post-hoc method for determining statistical significance. Within group effect sizes are calculated using interpretation of the Cohen d coefficient.The P values below 0.05 will be considered significant for all data from the study. The authors will use the Student T method for independent analysis for quantitative data and for comparisons between the COPD patients and the control group and ANOVA to the COPD group comparisons. The investigators will use the Pearson correlation test to measure the association between the mobility of the diaphragm and the working lung variablesThe ultrasonography in M-mode is easy to use, is safe and measures directly the diaphragmatic dome displacement. The study aimed to determine whether the COPD, according to the subjects??? COPD severity, impairs the DM and to verify DM improvements after an inpatient pulmonary rehabilitation. We performed lung function tests and diaphragmatic M-mode ultrasonography in COPD individuals and healthy subjects. Ultrasonography was performed during rest breathing and deep inspirations. The COPD subjects underwent six-minute walk test and arterial blood gas analysis. After initial screening, 46 COPD patients ended the rehabilitation. The mean characteristics in healthy individuals and COPD subjects: The DM during rest breathing and deep inspirations were correlated to FEV1 decrease (r=0.74; p<0.01 and r=-0.8; p<0.01, respectively). The correlation was also positive between the deep inspiration and the inspiratory capacity (r= 0.64 with p<0.001). After the rehabilitation, the DM increases during deep inspiration from 4.58cm � 1.83cm to 5.45cm � 1.56cm (p<0.01). It could be concluded that M-mode ultrasonography showed DM impairment is correlated to lung function loss in COPD subjects. The patients who completed the rehabilitation improved the diaphragmatic mobility verified during deep inspirations. Recent Publications 1. Corbellini C, Boussuges A, Villafa�e J and Zocchi L (2018) Diaphragmatic Mobility Loss in Subjects With Moderate to Very Severe COPD May Improve After In-Patient Pulmonary Rehabilitation. Resp Care. 63 (10) 1271-1280. 2. Villafa�e J, Corbellini C, Balestri E, Dall???ara S, Bazzochi F, et al. (2017) Functional evaluation of breath: spirometry and body plethysmography comparison in people with cystic fibrosis. J. Phys. Ther. Sci. 29: 799-800. 3. Corbellini C, Boussuges A, Villafa�e J and Zocchi L (2016) Diaphragmatic mobility improves after pulmonary rehabilitation. A study using M-mode ultrasonography. European Respiratory Journal 48:OA3047. 4. Corbellini C, Trevisan C, Villafa�e J, Da Costa A and Vieira S R R (2015) Weaning from mechanical ventilation: a crosssectional study of reference values and the discriminative validity of aging. J. Phys. Ther. Sci. 7:1945???1950.