Comparison of Ultrasound Measurements for Diaphragmatic Mobility, Diaphragmatic Thickness, and Diaphragm Thickening Fraction with Each Other and with Lung Function in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Purpose: To compare ultrasound measurements of diaphragmatic mobility, diaphragm thickness, and diaphragm thickening fraction with one another and also with lung function parameters in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: We conducted a prospective, observational study from 2015 to 2018. A total of 140 patients were randomly selected for this study. Diaphragmatic thickness was measured at deep expiration and deep inspiration with a linear 10-MHz ultrasound probe. Diaphragm thickening fraction was calculated as the ratio between diaphragm thickness at deep inspiration and end expiratory diaphragm thickness. Diaphragmatic mobility was measured with a 3.5-MHz curved probe. Forced expiratory volume in one second (FEV1), residual lung volume, Pimax, and P0.1max were also measured. Sonographic results were compared to FEV1 and other lung function parameters. Results: There was a significant positive correlation between diaphragmatic mobility and the following measurements: FEV1 (P < 0.01), diaphragm thickening fraction (P = 0.013), and lung function parameters reflecting ventilatory muscle strength such as Pimax (P < 0.017) and P0.1/Pimax (P < 0.01). There was a significant negative correlation between diaphragmatic mobility and both residual volume (P < 0.01) and diaphragmatic thickness (P = 0.022). In contrast, there was no correlation between diaphragmatic thickness and FEV1, Pimax, and P0.1/Pimax. Diaphragm thickening fraction had a significant correlation with FEV1 (P = 0.041). Conclusion: In patients with COPD, diaphragm mobility measured sonographically correlates with different lung function parameters and also with sonographically measured diaphragm thickness (negative correlation) and diaphragm thickening fraction (positive correlation).