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Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients

Masashi Shiraishi, Yuji Higashimoto, Ryuji Sugiya, Hiroki Mizusawa, Yu Takeda, Shuhei Hujita, Osamu Nishiyama, Shintarou Kudo, Tamotsu Kimura, Yasutaka Chiba, Kanji Fukuda, Yuji Tohda
ERJ Open Research 2020; DOI: 10.1183/23120541.00589-2020
Masashi Shiraishi
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
2Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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  • For correspondence: masashi-shiraishi@med.kindai.ac.jp
Yuji Higashimoto
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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  • ORCID record for Yuji Higashimoto
Ryuji Sugiya
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Hiroki Mizusawa
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Yu Takeda
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Shuhei Hujita
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Osamu Nishiyama
2Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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Shintarou Kudo
3Graduate School of Health Sciences, Morinomiya University of Health Sciences, Osaka, Japan
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  • ORCID record for Shintarou Kudo
Tamotsu Kimura
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Yasutaka Chiba
4Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
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Kanji Fukuda
1Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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Yuji Tohda
2Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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Abstract

Background Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD.

Methods Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmax and the ventilation parameters.

Results The DEmax of patients with COPD was significantly lower than that of the controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmax in patients with COPD. During CPET, oxygen uptake/weight (VO2/W) and minute ventilation (VE) were significantly positively correlated with DEmax, while VE/VO2 and VE/carbon dioxide output (VCO2) were significantly negatively correlated with DEmax in patients with COPD. DEmax was also significantly positively correlated with ΔIC, reflecting DLH, and with VO2/W, reflecting exercise capacity.

Conclusion Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Shiraishi has nothing to disclose.

Conflict of interest: Dr. Higashimoto has nothing to disclose.

Conflict of interest: Dr. Sugiya has nothing to disclose.

Conflict of interest: Dr. Mizusawa has nothing to disclose.

Conflict of interest: Dr. Takeda has nothing to disclose.

Conflict of interest: Dr. Hujita has nothing to disclose.

Conflict of interest: Dr. Nishiyama has nothing to disclose.

Conflict of interest: Dr. Kudo has nothing to disclose.

Conflict of interest: Dr. Kimura has nothing to disclose.

Conflict of interest: Dr. Chiba has nothing to disclose.

Conflict of interest: Dr. Fukuda has nothing to disclose.

Conflict of interest: Dr. Tohda reports grants from Kyorin pharmaceutical, grants from MeijiSeika pharma, grants from Boellringer Ingelheim, grants from Teijin pharma, grants from DaiichiSankyo, grants from Astellas,Pearl, outside the submitted work;.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received April 27, 2020.
  • Accepted September 18, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients
Masashi Shiraishi, Yuji Higashimoto, Ryuji Sugiya, Hiroki Mizusawa, Yu Takeda, Shuhei Hujita, Osamu Nishiyama, Shintarou Kudo, Tamotsu Kimura, Yasutaka Chiba, Kanji Fukuda, Yuji Tohda
ERJ Open Research Jan 2020, 00589-2020; DOI: 10.1183/23120541.00589-2020

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Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients
Masashi Shiraishi, Yuji Higashimoto, Ryuji Sugiya, Hiroki Mizusawa, Yu Takeda, Shuhei Hujita, Osamu Nishiyama, Shintarou Kudo, Tamotsu Kimura, Yasutaka Chiba, Kanji Fukuda, Yuji Tohda
ERJ Open Research Jan 2020, 00589-2020; DOI: 10.1183/23120541.00589-2020
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