Clinical Utility of Chest Sonography in COPD Patients with a Focus on Diaphragmatic Measurements.

BACKGROUND: There are many methods of evaluating diaphragmatic function, such as trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis, we studied the clinical usefulness of chest ultrasonography in evaluating stable COPD patients and those in exacerbation, we focus on diaphragmatic measurements and their correlation to spirometry and other clinical parameters.

METHODS: In a prospective case control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was done for all included subjects.

RESULTS: Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, the same for B Lines. TUS significantly showed high specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion illustrated a significant negative correlation with BMI and dyspnea scale and a positive correlation with spirometry measures. Patients in GOLD group D showed lower diaphragmatic measurements (thickness and excrusion).

CONCLUSION: The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.