title: Estimation of diaphragm length in patients with severe chronic obstructive pulmonary disease.
abstract: In patients with advanced chronic obstructive pulmonary disease (COPD) diaphragm function may be compromised because of reduced muscle fibre length. Diaphragm length (L(Di)) can be estimated from measurements of transverse diameter of the rib cage (D(Rc)) and the length of the zone of apposition (L(Zapp)) in healthy subjects, but this method has not been validated in patients with COPD. Postero-anterior chest radiographs were obtained at total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV) in nine male patients with severe COPD (mean [S.D.]; FEV(1), 23 [6] %pred.; FRC, 199 [15] %pred.). Radiographs taken at TLC were used to identify the lateral costal insertions of the diaphragm (L(Zapp) assumed to approach zero at TLC). L(Di) was measured directly and also estimated from measurements of L(Zapp) and D(Rc) using a prediction equation derived from healthy subjects. The estimation of L(Di) was highly accurate with an intraclass correlation coefficient of 0.93 and 95% CI of approximately +/-8% of the true value. L(Di) decreased from 426 (64) mm at RV to 305 (31) mm at TLC. As there were only small and variable changes in D(Rc) across the lung volume range, most of the L(Di) changes occurred in the zone of apposition. Additional studies showed that measurements of L(Di) from PA and lateral radiographs performed at different lung volumes were tightly correlated. These results suggest that non-invasive measurements of L(Zapp) in the coronal plane (e.g. using ultrasonography) and D(Rc) (e.g. using magnetometers) can be used to provide an accurate estimate of L(Di) in COPD patients.
authors.affiliation: Department of Respiratory Medicine, Prince of Wales Hospital, Randwick, Sydney 2031, Australia. mckenzied@sesahs.nsw.gov.au
authors.forename: D K
authors.initials: DK
authors.lastname: McKenzie
authors.forename: R B
authors.initials: RB
authors.lastname: Gorman
authors.forename: J
authors.initials: J
authors.lastname: Tolman
authors.forename: N B
authors.initials: NB
authors.lastname: Pride
authors.forename: S C
authors.initials: SC
authors.lastname: Gandevia
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005652:Functional Residual Capacity / Q000502:physiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012115:Residual Volume / Q000502:physiology; D012907:Smoking / Q000009:adverse effects; D014109:Total Lung Capacity / Q000502:physiology