Indian Journal of Respiratory Care

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VOLUME 12 , ISSUE 1 ( January-March, 2023 ) > List of Articles

Original Article

Correlation Between Ultrasonographic Evaluation of Diaphragm Excursion, Thickness and Spirometry in COPD patients: A Case-Control Study

Anjaly K Chandrakumar, Jacob Baby, Elizabeth Sunila Chakkalakkal Xavier, Praveen Valsalan, Rohith Puthanveettil

Keywords : Chronic obstructive pulmonary disease, Diaphragmatic paralysis, Forced expiratory volume 1, Forced vital capacity, Spirometry, Ultrasonography

Citation Information : Chandrakumar AK, Baby J, Xavier ES, Valsalan P, Puthanveettil R. Correlation Between Ultrasonographic Evaluation of Diaphragm Excursion, Thickness and Spirometry in COPD patients: A Case-Control Study. Indian J Respir Care 2023; 12 (1):33-37.

DOI: 10.5005/jp-journals-11010-1027

License: CC BY-NC-SA 4.0

Published Online: 14-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Weakness of the diaphragm is associated with dyspnea and exercise intolerance and affects survival in chronic obstructive pulmonary disease (COPD) patients. The present study aimed to evaluate diaphragm excursion, and thickness using ultrasonography (USG) and spirometry values in patients with COPD, correlate these values and compare them with healthy controls. Methodology: This case-control study was conducted in a tertiary care center in South India for 1 year. A total of 70 patients with COPD and 70 healthy controls were recruited. Data were collected and statistically analyzed. Results: The absolute value of forced expiratory volume 1 (FEV1) and the percentage of predicted FEV1, forced vital capacity (FVC), and FEV1/FVC was significantly lower in COPD patients (p < 0.0001). Diaphragm excursion at normal inspiration, deep inspiration, and while sniffing was significantly lower in COPD patients (p < 0.01). Diaphragm thickness at end-inspiration, end-expiration, and diaphragm thickness fraction (DTF) was significantly lower in COPD patients compared to normal healthy subjects (p < 0.01). Conclusion: A mild positive correlation was found between diaphragm excursion at normal inspiration and FEV1. There was a strong correlation between FEV1 and diaphragm excursion during deep inspiration and sniffing. A linear equation was developed to calculate FEV1. FEV1 = 2.99 – (0.042 × age) + (0.224 × deep inspiration) + (0.015 × sniffing). This could predict risks for any major surgeries, decide on treatment options for COPD patients, and can be used for prognosis and follow-up while the patient is on inhaler therapy.

  1. ICMR Disease Burden Trends in the States of India. Disease Burden Trends in the States of India 1990 to 2016. Indian Council of Medical Research, Public Health Foundation of India, Insitute for Health Metrics and Evaluation. 2017. (accessed on 21st April 2021)
  2. Jindal SK, Aggarwal AN, Gupta D. A review of population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking. Indian J Chest Dis Allied Sci 2001;43(3):139–147. PMID: 11529432.
  3. Amin A, Zedan M. Transthoracic ultrasonographic evaluation of diaphragmatic excursion in patients with chronic obstructive pulmonary disease. Egypt J Bronchol 2018;12(1):27–32. DOI: 10.4103/1687-8426.217411
  4. Scheibe N, Sosnowski N, Pinkhasik A, et al. Sonographic evaluation of diaphragmatic dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10:1925–1930. DOI: 10.2147/COPD.S85659
  5. Wilcox PG, Pardy RL. Diaphragmatic weakness and paralysis. Lung 1989;167(6):323–341. DOI: 10.1007/BF02714961
  6. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012;366(10):932–942. DOI: 10.1056/NEJMra1007236
  7. 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. DOI: 10.1159/000358564
  8. Eryüksel E, Cimşit C, Bekir M, et al. Diaphragmatic thickness fraction in subjects at high-risk for COPD exacerbations. Respir Care 2017;62(12):1565–1570. DOI: 10.4187/respcare.05646
  9. Evrin T, Korkut S, Ozturk Sonmez L, et al. Evaluating stable chronic obstructive pulmonary disease by ultrasound. Emerg Med Int 2019;2019:5361620. DOI: 10.1155/2019/5361620
  10. Venkatesan P. GOLD report: 2022 update. Lancet Respir Med 2022;10(2):e20. DOI: 10.1016/s2213-2600(21)00561-0
  11. Laszlo G. Standardisation of lung function testing: helpful guidance from the ATS/ERS task force. Thorax 2006;61(9):744–746. DOI: 10.1136/thx.2006.061648
  12. Patel AR, Patel AR, Singh S, et al. Global initiative for chronic obstructive lung disease: the changes made. Cureus 2019;11(6):e4985. DOI: 10.7759/cureus.4985
  13. Ribeiro S, Cardoso CS, Valério M, et al. Confirmatory evaluation of the modified medical research council questionnaire for assessment of dyspnea in patients with chronic obstructive pulmonary disease in Portugal. Acta Med Port 2022;35(2):89–93. DOI: 10.20344/amp.15208
  14. Roriz D, Abreu I, Soares PB, et al. Ultrasound in the evaluation of diaphragm. Electron Present Line Syst 2015;1–16. DOI: 10.1594/ecr2015/C-2402
  15. Barba Arce AB, Fernandez-Lobo V, Romero EH, et al. Evaluation of the phrenic nerve dysfunction in patients with lung transplantation. Eur Soc Radiol 2018:C–1671. DOI: 10.1594/ecr2018/C-1671
  16. Topalovic M, Laval S, Aerts JM, et al. Automated interpretation of pulmonary function tests in adults with respiratory complaints. Respiration 2017;93(3):170–178. DOI: 10.1159/000454956
  17. 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. DOI: 10.1111/j.1440-1843.2007.01194.x
  18. De Troyer A. Effect of hyperinflation on the diaphragm. Eur Respir J 1997;10(3):708–713. PMID: 9073010.
  19. Steele RH, Heard BE. Size of the diaphragm in chronic bronchitis. Thorax 1973;28(1):55–60. DOI: 10.1136/thx.28.1.55
  20. Ogan N, Aydemir Y, Evrin T, et al. Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters. Turk J Med Sci 2019;49(4):1073–1078. DOI: 10.3906/sag-1901-164
  21. Baria MR, Shahgholi L, Sorenson EJ, et al. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2014;146(3):680–685. DOI: 10.1378/chest.13-2306
  22. Cimsit C, Bekir M, Karakurt S, et al. Ultrasound assessment of diaphragm thickness in COPD. Med J Marmara 2016;29(1):8. DOI: 10.5472/MMJoa.2901.02
  23. Unal O, Arslan H, Uzun K, et al. Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease. Clin Imaging 2000;24(6):347–350. DOI: 10.1016/s0899-7071(00)00245-x
  24. Kang HW, Kim TO, Lee BR, et al. Influence of diaphragmatic mobility on hypercapnia in patients with chronic obstructive pulmonary disease. J Korean Med Sci 2011;26(9):1209–1213. DOI: 10.3346/jkms.2011.26.9.1209
  25. Gólczewski T, Lubiński W, Chciałowski A. A mathematical reason for FEV1/FVC dependence on age. Respir Res 2012;13(1):57. DOI: 10.11 86/1465-9921-13-57
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