Assessment function of chest ultrasound in diaphragm evaluation among COPD before and after pulmonary rehabilitation programme at Zagazig University
Background Chronic Obstructive Pulmonary Disease (COPD) is currently the world's fourth leading cause of death. Pulmonary rehabilitation is a well-recognized method in the treatment of persons with COPD aimed at improving the physical and psychosocial conditions of patients. The aim was to assess the function chest ultrasound in diaphragm evaluation among COPD before and after pulmonary rehabilitation programme. MethodsThis study was was cohort study that conducted on 90 stable COPD patients underwent pulmonary rehabilitation programs were included. All participants were subjected to the followings: Spirometric pulmonary function (Before and after rehabilitation). Six minute walking test (Before and after rehabilitation). Assessment of diaphragmatic excursion by ultrasound (Before and after rehabilitation). The patients were lying in the semi recumbent position, with the head of the bed elevated at an angle between 30° and 45°. With the probe fixed on the chest wall during respiration, the ultrasound beam was directed to the hemi diaphragmatic dome at an angle of not less than 70°. During inspiration, the normal diaphragm contracts and moves caudally toward the transducer; this is recorded as an upward motion of the Mmode tracing. The amplitude of excursion was measured on the vertical axis of the tracing from the baseline to the point maximum height of inspiration on the graph.. Assessment of diaphragmatic thickness (Before and after rehabilitation). Patients were undergone rehabilitation program for 12 weeks. Successful or failed rehabilitation: Based on SGRQ the patients classified it to failed and successful groups. The latter was defined as an improvement in quality of life as measured by a decrease of 4 points or more on the SGRQ. Results prevalence of successful pulmonary rehabilitation was 71.1%.Pulmonary Rehabilitation reported significant improvement of respiratory function as well as physical and general quality of life, P < 0.001 for all parameters, hence, considering the dyspnea scale, it was significantly improved after Pulmonary Rehabilitation by 35%. SGRQ was significantly improved by 10%, in addition, regarding the spirometric parameters of patients, it showed significant improvement by 2%. Arterial oxygen saturation improved by 2%. Finally, 6MWD showed significant improvement by 9%. there were significant improvement in diaphragmatic performance (DE and DT) after pulmonary rehabilitation program by 6% and 15% respectively Conclusions Diaphragmatic ultrasound examination of stable COPD patients undergoing pulmonary rehabilitation is accurate and reliable method for assessing diaphragmatic function and improvement. The early Pulmonary Rehabilitation program in stable COPD patients of mild and moderate degrees of severity gives the better outcome than those of severe degree of the disease.