Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound.

Download Full-text

Diaphragmatic dysfunction associates with dyspnoea, fatigue, and hiccup in haemodialysis patients: a cross-sectional study

Scientific Reports ◽

10.1038/s41598-019-56035-4 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Bin Wang ◽

Qing Yin ◽

Ying-yan Wang ◽

Yan Tu ◽

Yuchen Han ◽

...

Keyword(s):

Cross Sectional Study ◽

Deep Breathing ◽

Sectional Study ◽

Quiet Breathing ◽

Diaphragmatic Dysfunction ◽

Cross Sectional ◽

Diaphragm Dysfunction ◽

Mortality And Morbidity ◽

Lung Capacity ◽

Diaphragmatic Function

AbstractMuscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p < 0.01) and thickening fraction (TF) (0.838 ± 0.618 vs. 1.127 ± 0.757; p < 0.01) compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing (3.686 ± 1.567 cm/s vs. 4.410 ± 1.720 cm/s, p < 0.01; 5.290 ± 2.048 cm vs. 7.232 ± 2.365 cm; p < 0.05). Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls (2.608 ± 1.630 vs. 4.628 ± 2.110 cm; p < 0.01). After multivariate adjustment, diaphragmatic excursion during deep breathing was associated with haemoglobin level (regression coefficient = 0.022; p < 0.01). We also found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.

Download Full-text

Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients

Rheumatology ◽

10.1093/rheumatology/keaa621 ◽

2020 ◽

Vol 59 (12) ◽

pp. 3906-3916 ◽

Cited By ~ 1

Author(s):

Carlos Fernández-Díaz ◽

Santos Castañeda ◽

Rafael B Melero-González ◽

Francisco Ortiz-Sanjuán ◽

Antonio Juan-Mas ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Interstitial Pneumonia ◽

Standard Dose ◽

Usual Interstitial Pneumonia ◽

Point Change ◽

Lung Capacity ◽

Sparing Effect ◽

Severe Degree

Abstract Objective To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). Methods This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. Results We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2). Conclusion ABA may be an effective and safe treatment for patients with RA-ILD.

Download Full-text

THE PREVALENCE OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS PATIENTS

10.36106/ijsr/5921305 ◽

2019 ◽

pp. 1-3

Author(s):

Julyan Al Fori

Keyword(s):

Systemic Sclerosis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

High Resolution Computed Tomography ◽

Atypical Chest Pain ◽

Royal Hospital ◽

Lung Capacity ◽

Female Predominance ◽

The Mean ◽

Traction Bronchiectasis

OBJECTIVE: To report the prevalence of interstitial lung disease in Systemic Sclerosis patients at the Royal Hospital and compare our data with the literature. METHODS:All adult Omani patients with Systemic Sclerosis (SSc) who are under regular follow-up at the Royal Hospital were retrospectively enrolled from January 2006 to January 2014. RESULTS: A total of 49 cases of Systemic Sclerosis (SSc) patients were included. The mean age was 44.06 ± 11.9 years. There was a predominance of females (48 cases; 98%). Interstitial lung disease present in 30 cases (61%). The most frequent symptoms were dyspnea 47%, cough 33%, and others (e.g. atypical chest pain) 20%. There was no association with smoking, non-smoker (47 cases, 95.5%) versus ex. smoker (2 cases, 4%). The most high resolution computed tomography (HRCT) finding was traction bronchiectasis (21 cases, 42.9%) followed by honey comb appearance (19 cases, 38.8%). Pulmonary Function Test (PFT) was done in 33 cases. The mean total lung capacity (TLC) was 81. 06 ± 26.2. The mean diffusion lung capacity (DLCO) was 61.8± 28.3. Pulmonary hypertension was found in 10 cases only (20.4%) based on echocardiography. CONCLUSIONS: ILD was present in 30 cases out of 49 cases of SSc (61.2%) with female predominance. The most frequently observed HRCT change was traction bronchiectasis. Similarities and differences were found with respect to the previous reports from other countries

Download Full-text

Lung volumes and expiratory flow limitation during exercise in interstitial lung disease

Journal of Applied Physiology ◽

10.1152/jappl.1994.77.2.963 ◽

1994 ◽

Vol 77 (2) ◽

pp. 963-973 ◽

Cited By ~ 54

Author(s):

D. D. Marciniuk ◽

G. Sridhar ◽

R. E. Clemens ◽

T. A. Zintel ◽

C. G. Gallagher

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Lung Volume ◽

Total Lung Capacity ◽

Flow Limitation ◽

Expiratory Flow Limitation ◽

Lung Volumes ◽

Lung Capacity ◽

Ventilatory Capacity ◽

Expiratory Flow

Lung volumes were measured at rest and during exercise by an open-circuit N2-washout technique in patients with interstitial lung disease (ILD). Exercise tidal flow-volume (F-V) curves were also compared with maximal F-V curves to investigate whether these patients demonstrated flow limitation. Seven patients underwent 4 min of constant work rate bicycle ergometer exercise at 40, 70, and 90% of their previously determined maximal work rates. End-expiratory lung volume and total lung capacity were measured at rest and near the end of each period of exercise. There was no significant change in end-expiratory lung volume or total lung capacity when resting measurements were compared with measurements at 40, 70, and 90% work rates. During exercise, expiratory flow limitation was evident in four patients who reported stopping exercise because of dyspnea. In the remaining patients who discontinued exercise because of leg fatigue, no flow limitation was evident. In all patients, the mean ratio of maximal minute ventilation to maximal ventilatory capacity (calculated from maximal F-V curves) was 67%. We conclude that lung volumes during exercise do not significantly differ from those at rest in this population and that patients with ILD may demonstrate expiratory flow limitation during exercise. Furthermore, because most patients with ILD are not breathing near their maximal ventilatory capacity at the end of exercise, we suggest that respiratory mechanics are not the primary cause of their exercise limitation.

Download Full-text

Surfactant Protein D and KL-6 as Serum Biomarkers of Interstitial Lung Disease in Patients with Scleroderma

The Journal of Rheumatology ◽

10.3899/jrheum.080633 ◽

2009 ◽

Vol 36 (4) ◽

pp. 773-780 ◽

Cited By ~ 103

Author(s):

FAYE N. HANT ◽

ANNA LUDWICKA-BRADLEY ◽

HE-JING WANG ◽

NING LI ◽

ROBERT ELASHOFF ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Characteristic Curve ◽

High Sensitivity ◽

Serum Levels ◽

Surfactant Protein ◽

Receiver Operator Characteristic Curve ◽

Surfactant Protein D ◽

High Resolution Computed Tomography ◽

Type Ii Pneumocytes

Objective.To assess whether serum concentrations of surfactant protein D (SP-D) and Krebs von den Lungen-6 (KL-6), glycoproteins expressed by type II pneumocytes, correlate with the presence of “alveolitis” and measures of lung function in patients enrolled in the Scleroderma Lung Study (SLS).Methods.Serum obtained at baseline screening of patients with systemic sclerosis (SSc, scleroderma) in the SLS was assayed. “Alveolitis” was defined by either bronchoalveolar lavage or thoracic high-resolution computed tomography (HRCT) by SLS criteria. SP-D and KL-6 levels were measured by ELISA in 66 SSc patients (44 with “alveolitis,” 22 without “alveolitis”) and in 10 healthy controls. These were compared to clinical measures of lung disease and “alveolitis” in the SLS patients.Results.SP-D levels were 300 ± 214 ng/ml (mean ± SD) in the SSc patients compared to 40 ± 51 ng/ml in controls (p < 0.0001). KL-6 levels were 1225 ± 984 U/ml in the SSc patients and 333 ± 294 U/ml in controls (p < 0.0001). SSc patients with “alveolitis” had higher levels of both SP-D and KL-6 than those without “alveolitis.” The level of SP-D was 353 ± 219 ng/ml in patients with “alveolitis” and 161 ± 143 ng/ml without “alveolitis” (p = 0.0002). The level of KL-6 was 1458 ± 1070 U/ml in patients with “alveolitis” and 640 ± 487 U/ml without “alveolitis” (p = 0.0001). Receiver operator characteristic curve analysis demonstrated high sensitivity and specificity of both SP-D and KL-6 for the determination of “alveolitis.” KL-6 and SP-D were positively correlated with maximum fibrosis scores, but not with maximum ground-glass opacities, on HRCT.Conclusion.Serum levels of SP-D and KL-6 appear to be indicative of “alveolitis” in SSc patients as defined by the SLS, and are significantly higher than in SSc patients without “alveolitis.” Serum SP-D and KL-6 may serve as noninvasive serological means of assessing interstitial lung disease in patients with SSc.

Download Full-text

Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position

Frontiers in Medicine ◽

10.3389/fmed.2021.742703 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alain Boussuges ◽

Sarah Rives ◽

Julie Finance ◽

Guillaume Chaumet ◽

Nicolas Vallée ◽

...

Keyword(s):

Healthy Volunteers ◽

Normal Values ◽

Deep Breathing ◽

Diaphragm Thickness ◽

Quiet Breathing ◽

Men And Women ◽

Mean Values ◽

Diaphragmatic Function ◽

The Mean ◽

The Right

Background: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position.Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women.Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men.Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction.

Download Full-text

Diagnostic Value of Nanopia® KL-6 in Chinese Patients with Interstitial Lung Disease: A Prospective Multicenter Observational Study

10.21203/rs.3.rs-711023/v1 ◽

2021 ◽

Author(s):

Bingpeng Guo ◽

Qian Han ◽

Wenjie Wang ◽

Ziyi Zhang ◽

Baoqing Sun ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Ground Glass Opacity ◽

Diagnostic Value ◽

High Serum ◽

Chinese Patients ◽

High Resolution Computed Tomography ◽

Multicenter Observational Study ◽

Lung Capacity ◽

Chinese Cohort

Abstract Background: Krebs von den Lungen-6 (KL-6) is considered a sensitive biomarker for diagnosis of interstitial lung disease (ILD). We aimed to evaluate the diagnosis value of Nanopia® KL-6 (SEKISUI MEDICAL CO., LTD., Tokyo, Japan) in a Chinese cohort of patients with ILD.Methods: Totally 451 patients were enrolled in our multicenter study, including 166 (36.8%) ILD patients, 210 (46.6%) non-ILD patients and 75 (16.6%) health controls. All ILD patients underwent high-resolution computed tomography (HRCT) followed by pulmonary function test (PFT). Serum KL-6 concentrations were measured by latex particle enhanced turbidimetric immunoassay (LTIA).Results: KL-6 serum concentrations were significantly higher in ILD patients (911 U/ml, IQR 477-1790) than in non-ILD patients (225 U/ml, IQR 166-323) and health controls (196 U/ml, IQR 153-230, p<0.0001). Serum KL-6 higher than 435.5 U/ml appeared as the optimal cut-off value associated with ILD. KL-6 concentrations were inversely correlated with forced vital capacity (FVC) (rho=-0.515, p<0.001), total lung capacity (TLC) (rho=-0.563, p<0.001) and diffuse lung capacity of carbon monoxide (DLco) (rho=-0.544, p<0.001). ILD patients with more severe characteristics of HRCT including ground glass opacity, reticular pattern or honeycombing had significantly higher serum KL-6 levels. In the subgroup of ILD patients, serum KL-6 concentrations were higher in idiopathic interstitial pneumonia (IIP) patients (1024U/ml, IQR 697-2112.25) than in other ILD patients (743U/ml, IQR 702.75-2058.25, p<10-4). ILD and retained smoking were independent factors associated with higher KL-6 levels in multivariate analysis. Conclusions: Our study confirms that KL-6 is a credible biomarker for the diagnosis of ILD in a Chinese cohort of patients. High serum KL-6 concentration should call attention to physicians to assess ILD with HRCT and PFT.

Download Full-text

Diaphragmatic dysfunction evaluated by ultrasound correlates with dyspnea, exercise and quality of life in interstitial lung disease

10.1183/13993003.congress-2016.oa2011 ◽

2016 ◽

Author(s):

Pauliane Santana ◽

Letícia Cardenas ◽

Jeferson Ferreira ◽

Vinicius Iamonti ◽

Ozires Ramos ◽

...

Keyword(s):

Quality Of Life ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Diaphragmatic Dysfunction

Download Full-text

Interstitial lung disease in systemic sclerosis: An HRCT-clinical correlative study

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00058.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 258-264 ◽

Cited By ~ 2

Author(s):

G. C. Ooi ◽

M. Y. Mok ◽

K. W. T. Tsang ◽

Y. Wong ◽

P. L. Khong ◽

...

Keyword(s):

Systemic Sclerosis ◽

Interstitial Lung Disease ◽

Lung Function ◽

Lung Disease ◽

Exercise Tolerance ◽

Forced Expiratory Volume ◽

Diffusion Capacity ◽

Inflammatory Index ◽

Lung Capacity ◽

Hrct Patterns

Purpose: To evaluate high-resolution CT (HRCT) parameters of inflammation and fibrosis in systemic sclerosis (SSc), for correlation with lung function, skin scores and exercise tolerance. Material and Methods: 45 SSc patients (40 women, 48.5±13.4 years), underwent thoracic HRCT, lung function assessment, and modified Rodnan skin scores. Exercise tolerance was also graded. HRCT were scored for extent of 4 HRCT patterns of interstitial lung disease (ILD): ground glass opacification (GGO), reticular, mixed and honeycomb pattern in each lobe. Total HRCT score, inflammation index (GGO and mixed score) and fibrosis index (reticular and honeycomb scores) were correlated with lung function and clinical parameters. Results: ILD was present in 39/45 (86.7%) patients. Abnormal (<80% predicted) forced vital capacity (FVC), total lung capacity (TLC) and carbon monoxide diffusion factor (DLco) were detected in 30%, 22% and 46% of patients. Total HRCT score correlated with FVC ( r=−0.43, p=0.008), FEV1 (forced expiratory volume) ( r=–0.37, p=0.03), TLC ( r=–0.47, p=0.003), and DLCO ( r=–0.43, p=0.008); inflammatory index with DLCO ( r=–0.43, p=0.008) and exercise tolerance ( r=–0.39, p < 0.05); and fibrosis index with FVC ( r=–0.31, p=0.05) and TLC ( r=–0.38, p=0.02). Higher total HRCT score, and inflammation and fibrosis indices were found in patients with abnormal lung function. Conclusion: Qualitative HRCT is able to evaluate inflammation and fibrosis, showing important relationships with diffusion capacity and lung volume, respectively.

Download Full-text

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

ERJ Open Research ◽

10.1183/23120541.00714-2020 ◽

2021 ◽

pp. 00714-2020

Author(s):

Alain Boussuges ◽

Julie Finance ◽

Guillaume Chaumet ◽

Fabienne Brégeon

Keyword(s):

Normal Values ◽

Posterior Part ◽

Deep Breathing ◽

Quiet Breathing ◽

Diaphragmatic Dysfunction ◽

Chest Ultrasonography ◽

Upper Limits ◽

Diaphragmatic Motion ◽

The Right ◽

Lower Limits

BackgroundChest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography.MethodsHealthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing, and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing.ResultsThe study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on gender. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three maneuvers that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e., 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively.ConclusionThe normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction.

Download Full-text