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CORRESPONDENCE
Year : 2020  |  Volume : 37  |  Issue : 1  |  Page : 84-85  

Ultrasonography in chronic obstructive pulmonary disease: Fact or fiction?


1 UCL Respiratory, University College London, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
2 National Heart and Lung Institute, Imperial College London, London, UK; Department of Respiratory Care, Umm Al-Qura University College of Applied Sciences, Makkah, Saudi Arabia

Date of Submission15-Aug-2019
Date of Acceptance09-Sep-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Jaber S Alqahtani
UCL Respiratory, University College London, London; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_375_19

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How to cite this article:
Alqahtani JS, Alghamdi SM. Ultrasonography in chronic obstructive pulmonary disease: Fact or fiction?. Lung India 2020;37:84-5

How to cite this URL:
Alqahtani JS, Alghamdi SM. Ultrasonography in chronic obstructive pulmonary disease: Fact or fiction?. Lung India [serial online] 2020 [cited 2020 Mar 28];37:84-5. Available from: http://www.lungindia.com/text.asp?2020/37/1/84/274425



Sir,

We read with interest the paper by Jain et al. titled “Study of the diaphragm in chronic obstructive pulmonary disease using ultrasonography.”[1]

This cross-sectional study included 48 chronic obstructive pulmonary disease (COPD) patients with 20 age-matched controls. They showed that the diaphragm thickness, movement, and zone of apposition were significantly reduced in mild-to-moderate COPD but increased in severe COPD.

The use of ultrasound to measure diaphragmatic dysfunction in COPD patients holds exciting promise in COPD management. The value of the findings would be more rigorous if some important variables were reported. Limited demographic and clinical data were available which, therefore make their result difficult to interpret and ultimately make it less generalizable. It was interesting to know the actual pulmonary function results, smoking history, presence of comorbidities, and anthropometric data as these factors can contribute to diaphragm dysfunction in COPD.[2]

The examinations procedure for their study was not presented in the methodology section to show how these measurements were taken, which highlights a major concern. The conflicting results to Corbellini et al., 2018 could be explained by the confounding variables that influence the overall outcome.[3]

In the future, the inclusion of COPD phenotypes could add further understanding to their results. The severity of emphysema can play a major role in the abnormal motion of the diaphragm.[4] Therefore, patients with chronic bronchitis and frequent exacerbator phenotypes could have different responses when compared to emphysematous phenotype, and such differences should be considered in these measurements.[5],[6]

In its current format with thanks to the authors, this paper leaves us with two important unanswered questions. (1) What would be the differences in the diaphragm thickness, movement, and zone of apposition among different COPD phenotypes? (2) Does airflow severity in COPD have a strong correlation to the diaphragmatic dysfunction that independent of emphysematous phenotype?

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Jain S, Nair G, Nuchin A, Uppe A. Study of the diaphragm in chronic obstructive pulmonary disease using ultrasonography. Lung India 2019;36:299-303.  Back to cited text no. 1
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2.
Ottenheijm CA, Heunks LM, Sieck GC, Zhan WZ, Jansen SM, Degens H, et al. Diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:200-5.  Back to cited text no. 2
    
3.
Corbellini C, Boussuges A, Villafañe JH, Zocchi L. Diaphragmatic mobility loss in subjects with moderate to very severe COPD may improve after in-patient pulmonary rehabilitation. Respir Care 2018;63:1271-80.  Back to cited text no. 3
    
4.
Iwasawa T, Takahashi H, Ogura T, Asakura A, Gotoh T, Shibata H, et al. Influence of the distribution of emphysema on diaphragmatic motion in patients with chronic obstructive pulmonary disease. Jpn J Radiol 2011;29:256-64.  Back to cited text no. 4
    
5.
Lahousse L, Seys LJM, Joos GF, Franco OH, Stricker BH, Brusselle GG. Epidemiology and impact of chronic bronchitis in chronic obstructive pulmonary disease. Eur Respir J 2017;50: pii: 1602470.  Back to cited text no. 5
    
6.
Wedzicha JA, Brill SE, Allinson JP, Donaldson GC. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Med 2013;11:181.  Back to cited text no. 6
    




 

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