Diaphragmatic Mobility Loss in Subjects With Moderate to Very Severe COPD May Improve After In-Patient Pulmonary Rehabilitation.
BACKGROUND: The diaphragm changes in COPD lead to functional inefficiency correlated to lung function loss. Muscle-fiber shortening follows lung hyperinflation, which results in a chronic mechanical disadvantage that impairs diaphragmatic mobility that worsens in COPD exacerbations. OBJECTIVES: To c...
| Publicado en: | Respiratory Care Vol. 63; no. 10; pp. 1271 - 1281 |
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| Autores principales: | , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131898394&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131898394 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2018 vid: 63 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 131898394 131898394 131898394 10.4187/respcare.06101 131898394 ppf: 1271 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Diaphragmatic Mobility Loss in Subjects With Moderate to Very Severe COPD May Improve After In-Patient Pulmonary Rehabilitation. aug: au: Corbellini, Camilo Boussuges, Alain Villafañe, Jorge Hugo Zocchi, Luciano affil: Department of Pulmonary Rehabilitation, Casa di Cura Villa Serena, SpA, Piossasco, Italy sug: subj: Pulmonary Disease, Chronic Obstructive Rehabilitation, Pulmonary Diaphragm Physiology Severity of Illness Disease Exacerbation Diaphragm Ultrasonography Human Respiratory Function Tests Blood Gas Analysis Clinical Assessment Tools Descriptive Statistics P-Value Italy Effect Size T-Tests Pearson's Correlation Coefficient Data Analysis Software Female Adult Middle Age Aged Prospective Studies Male Post Hoc Analysis Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Female Male ab: BACKGROUND: The diaphragm changes in COPD lead to functional inefficiency correlated to lung function loss. Muscle-fiber shortening follows lung hyperinflation, which results in a chronic mechanical disadvantage that impairs diaphragmatic mobility that worsens in COPD exacerbations. OBJECTIVES: To correlate the diaphragmatic mobility loss to COPD severity by using M-mode ultrasonography and to verify if the diaphragmatic mobility can improve after in-patient pulmonary rehabilitation. METHODS: We used M-mode ultrasonography to access diaphragmatic mobility during normal breathing or breathing at rest and deep inspiration in 52 subjects with moderate to very severe COPD who underwent pulmonary rehabilitation and 16 healthy subjects. Lung function test, arterial blood gas analysis, and a 6-min walk test were also performed. The measurements were performed at rehabilitation admission and discharge. RESULTS: We screened 30 subjects with severe to very severe COPD who had completed pulmonary rehabilitation. At discharge, inspiratory capacity improved, from 1.58 ± 0.5L to 1.7 ± 0.6 L(P = .04). Diaphragmatic mobility during deep inspirations increased from (mean ± SD) 4.58 ± 1.83 cm to 5.45 ± 1.56 cm (P = .05) after pulmonary rehabilitation. The diaphragmatic mobility during rest breathing was higher in the subjects with COPD (2.25 ± 0.83 cm) than in the healthy subjects (1.27 ± 0.3 cm) (P = .01). The diaphragmatic mobility for the rest breathing and deep inspirations were correlated to an FEV1 decrease (r = -0.74, P < .001; and r = 0.8, P < .001, respectively). CONCLUSIONS: Our findings demonstrated diaphragmatic mobility loss in the subjects with moderate to very severe COPD. These changes were correlated with COPD severity, and diaphragmatic mobility loss improved after in-patient pulmonary rehabilitation. (ClinicalTrial.gov registration NCT02838953.) pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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