Source: Annual Congress 2010 - Respiratory and peripheral muscles: From basic mechanisms to altered function
Disease area: Airway diseases

Abstract

COPD patients often show paradoxical movements of the lower rib cage (Aliverti et al, ERJ 33:49-60, 2009), but it is unclear if the configuration of the diaphragm may determine chest wall compartments asynchrony depending on the assumed posture.
12 severe COPD patients (FEV1=29.2±5.6%, FRC=169±30%) and 5 healthy controls (CTRL) were studied during quiet breathing (QB) in the seated and supine positions. Volume variations of chest wall compartments were measured by Opto-Electronic Plethysmography and the cranio-caudal displacement of the zone of apposition margin of the diaphragm (ΔZOM) by ultrasonography. Linear regression between pulmonary (V_RCp), abdominal (V_RCa) rib cage, abdominal (V_AB) volume variations and ΔZOM was calculated and the relative r² was taken as an index of synchrony between these compartments and ΔZOM.
In COPD patients, r² of V_RCa, V_RCp and V_AB versus ΔZOM relationships were respectively 0.72±0.04, 0.50±0.07, 0.76±0.03 in seated, and 0.53±0.07, 0.51±0.07, 0.65±0.05 in supine. In seated both r² between V_RCp versus ΔZOM and V_AB versus ΔZOM were higher (p<0.05) than V_RCa versus ΔZOM. Conversely, in supine no differences were noticed between the different compartments. In the CTRL the r² was not affected by posture (r²=0.73±0.06 for V_RCp, r²=0.80±0.06 for V_RCa and r²=0.82±0.05 for V_AB in seated; r²=0.68±0.06 for V_RCp, r²=0.76±0.05 for V_RCa and r²=0.75±0.05 for V_AB in supine).
In healthy subjects asynchronies between the chest wall and the diaphragm are neither present nor affected by posture. Conversely, the configuration of the diaphragm in COPD patients is influenced by posture, therefore inducing strong thoracic paradoxical movements if seated, which disappear in the supine position.

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R. Priori, A. L. P. de Albuquerque, M. Quaranta, P. M. Calverley, A. Aliverti (Italy; Liverpool, United Kingdom; , Brazil). Relationship between diaphragm and chest wall motion in COPD patients. Eur Respir J 2010; 36: Suppl. 54, 3410

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