Indian Journal of Public Health Research & Development

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

An Analytical Study on Variation in Diaphragm Position and Shape (Costo-Phrenic Angle) in COPD Patients


Affiliations
1 Department of Cardio Respiratory Physiotherapy, K J Pandya College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Waghodia Taluk, Vadodara, Gujarat, India
2 KJPCP
     

   Subscribe/Renew Journal


Background: Increased airflow resistance, hyperinflation, air trapping are the main pathophysiologic features of COPD. A more rigorous of the normal variation in diaphragm position and shape, based on easily recognised anatomic landmarks, and analysis of factors that might contribute to this variation, such as age and weight, may provide a more reliable basis for this assessment.

Purpose of the study: To find out the variation in diaphragm position and shape (costo-phernic angle) in COPD patients.

Method: 30 COPD subjects were selected randomly from Dhiraj general hospital, Vadodara, Gujarat with 30 counterpart normal subjects with same age group and both sex. Their PA chest radiographs had been taken for the measurement of costo - phernic angle and it was measured. Costo - phernic angle of COPD subjects was compared with normal subjects.

Results: p values were get through analysis of data by using independent sample 't'test with spss version 11.0. the values were p<0.000 for right side and p<0.258 for left side when costo - phernic angle of COPD was compared with normal subjects.

Conclusion: There were variation in position and shape of diaphragm in COPD subjects to normal subjects by means of high level significance in same age group.


Subscription Login to verify subscription
User
Notifications
Font Size


  • Rochester D.F., The diaphragm in COPD: the better than expected, but not good enough,N.Engl.Med, 1991:325: 961-962.

  • Martinez F.J., J.I.Couser and B.R.Celli., Factors influencing ventilatory muscle recruitment in patients with chronic air flow obstruction, Am.Rev.Respir.Dis, 1990:142: 276-282.

  • Rochester.D.F., N.M.T.Braun., Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis, 1985:132: 42-47.

  • Sharp.J.T., P.Lith.,C.Nuchprayoon etal., The thorax in chronic obstructive lung disease. Am.J.Med, 1968:44: 39-46.

  • Braun.N.M.T., D.F.Rochester., Respiratory muscle function in chronic obstructive lung disease (COPD), Am.Rev.Respir,Dis, 1977:115: 91

  • Arora.N.S., D.F.Rochester., Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area, J. Appl. Physiol (Respir, Environ. Exerc. Physiol.), 1982: 52: 64-70.

  • Rochester.D.F., N.M.T.Braun and N.S.Arora, Respiratory muscle strength in chronic obstructive pulmonary disease, Am.Rev.Respir,Dis, 1982:119(2,Pt.2): 151-154.

  • Braun.N.M.T.,N.S.Arora and D.F.Rochester, Force-length relationship of the noraml human diaphragm, J. Appl. Physiol (Respir, Environ. Exerc. Physiol.), 1982: 53: 405-412.

  • Fraser. RS.,Muller.NL.,Colman.n etal, The respiratory muscle and chest wall, Fraser.RS eds. Fraser and Pare’s diagnosis of diseases of the chest,W.B.Saunders, Philadelphia, PA, 1992: 246-268.

  • Armstrong. P., The normal chest, Armstrong. P eds. Imaging of diseasesnof the disease, Mosby, London,UK, 2000: 21-62.

  • Lennon.EA., Simon.g, 1965: The height of the diaphragm in the chest radiograph of normal adults, Br. J. Radiol 38: 937-943.

  • Knott.JMS., Chiriste.RV, Radiological diagnosis of emphysema, Lancet, 1951: 21: 881-883.

  • Edge.JR., Millard.FJC., Reid.L etal, the radiograph appearances of the chest in persons of advanced age, Br. J. Radiol, 1964: 37: 769-774.

  • Nikalus.TM., Stowell.D.,Christiansen.WP etal, The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema, Am. Rev. Respir, Dis, 1966: 93: 889-899.

  • Kastura.S.,Martin.CJ, The roentgenologic diagnosis of anatomic emphysema, Am. Rev. Respir, Dis, 1967: 96: 700-706.

  • Simon.G.,Pride.NB.,Jones.NL etal, Relation between abnormalities in the chest radiograph and changes in pulmonary function in chronic bronchitis and emphysema, Thorax, 1973: 28: 15-23.

  • Michie.I., Radiological changes and their significance in aged men (Chelsea pensioners), Gerontol Clin (Basel), 1972: 14: 310-316.

  • Mori.PA., Anderson. AE., Eckert.P., The radiological spectrum of aging and emphysematous lungs, Radiology, 1964: 83: 48-57.

  • Walsh.JM.,Webber.CL.,Fahey.PJ etal, Structural change of the thorax in chronic obstructive pulmonary disease, J.Appl.Physiol, 1992: 72: 1270-1278.

  • Burki.NK.,Krumpelman.JL., Correlation of pulmonary function with the chest roentgenogram in chronic obstructive pulmonary disease, Am.Rev.Respir,Dis, 1980: 121: 217-223.

  • Rothpearl.A.,Varma.AO.,Goodman.K., Radiographic measures of hyperinflation in clinical emphysema: discrimination of patients from controls and relationship to physiologic and mechanical lung function, Chest, 1988: 94: 907-913.

  • Reich.SB.,Weinshelbaum.A.,Yee.J., Correlation of radiographic measurements and pulmonary function tests in chronic obstructive pulmonary disease, AJR Am J Roentgenol, 1985:144: 695-699.

  • Howatt.WF.,DeMuth.GR, The growth of lung function: II, Configuration of the chest, Pediatrics, 1965: 35: 177-184.

  • Mead.J.,Loring.SH,Smith JC, Volume displacements of the chest wall and their mechanical significance, In: Roussos C,ed. The Thorax: part A, Physiology, Lung biology in health and disease series. New York,NY: Marcel Dekkar, 1995: 85: 565-586.

  • Agostoni.E, Mechanics of th pleural space, Macklem. PT., Mead.J eds. Handbook of physiology, section 3: The respiratory system: mechanics of breathing part 2, American Physiological society, 1986: 531-559.

  • Agostoni.E, Mognoni.P, Deformation of the chest wall during breathing efforts, J.Appl.Physiol, 1966: 21: 1827-1832.

  • D’angelo.E, Cranio-caudal rib cage distortion with increasing inspiratory airflow in man, Respir. Physiol, 1981: 44: 215-237.

  • Mellisinos.CG., Goldman.M., Bruce. E etal, Chest wall shape during forced expiratory maneuvers. J.Appl.Physiol, 1981: 50: 84-93.

  • Paiva.M., Estenne.M., Engel.LA, Lung volume, chest wall configuration, and pattern of breathing in microgravity, J.Appl.Physiol, 1989: 67: 1542-1550.

  • Liu.S., Wilson.TA., Schreiner.K, Gravitational forces on the chest wall. J.Appl.Physiol, 1991: 70: 1506-1510.

  • Donnelly.PM.,Yang.TS.,Peat.JK etal, What factors explain racial differences in lung volumes, Eur.Respir.J, 1991: 4: 829-838.

  • Takahashi.E.,Atusmi.H, Age differences in thoracic form as indicated by thoracic index, Human.Biol, 1955: 27: 65-74.

  • Marshall.R, Relationships between stimulus and work of breathing at different lung volumes, J.Appl.Physiol, 1962: 17: 917-921.

  • Cassart.M.,Pettiaux.N.,Gevenosis.PA etal, Effect of chronic hyperinflation on diaphragm length and surface area, Am. J.Respir.Crit.Care.Med, 1997: 156: 504-508.

  • Lando.Y.,Boiselle.PM.,Shade.D etal, Effect of lung volume reduction surgery on diaphragm length in severe chronic obstructive pulmonary disease, Am. J.Respir.Crit.Care.Med, 1999: 159: 796-805.

  • Cassart.M.,Hamacher.J.,Verbandt.Y etal, Effect of lung volume reduction surgery for emphysema on diaphragm dimensions and configuration, Am. J.Respir.Crit.Care.Med, 2001: 163:1171-1175.

  • Bellemare.F.,Couture.J.,Ccordeau.MP etal, Anatomic landmarks to estimate the length of the diaphragm, fro chest radiographs, Chest, 2001: 120: 1-9.

  • De Troyer.A, Effect of hyperinflation on the diaphragm. Eur.Respir.J, 1997: 10: 708-713.

  • Kleinman.BS.,Frey.K.,Vandrunen.M etal, Motion of the diaphragm in patients with chronic obstructive pulmonary disease while spontaneously breathing versus during positive pressure breathing after anaesthesia and neuromuscular blockade, Anaesthesiology, 2002: 97: 298-305.

  • Sharp.JT.,Danon.J.,Druz.WS etal, Respiratory muscle function in patients with chronic obstructive pulmonary disease: its relationship to disability and to repiratory therapy, Am. Rev.Respir.Dis, 1974: 110: 154-168.

  • Singh.B.,Eastwood.PR.,Finucane.KE etal, Volume displaced by diaphragm motion in emphysema, J.Appl.Physiol, 2001: 91: 1913-1923.

  • Bellemare.F.,Couture.J.,Ccordeau.MP etal, Effects of emphysema and lung volume reduction surgery on trans diaphragmatic pressure and diaphragm length, Chest, 2002: 121: 1898-1910.

  • Suga.K.,Tsukuda.T.,Awaya.H etal, Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J.Magn.Imaging, 1999: 10: 510-520.


Abstract Views: 583

PDF Views: 0




  • An Analytical Study on Variation in Diaphragm Position and Shape (Costo-Phrenic Angle) in COPD Patients

Abstract Views: 583  |  PDF Views: 0

Authors

M Premkumar
Department of Cardio Respiratory Physiotherapy, K J Pandya College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Waghodia Taluk, Vadodara, Gujarat, India
K Manivannan
KJPCP

Abstract


Background: Increased airflow resistance, hyperinflation, air trapping are the main pathophysiologic features of COPD. A more rigorous of the normal variation in diaphragm position and shape, based on easily recognised anatomic landmarks, and analysis of factors that might contribute to this variation, such as age and weight, may provide a more reliable basis for this assessment.

Purpose of the study: To find out the variation in diaphragm position and shape (costo-phernic angle) in COPD patients.

Method: 30 COPD subjects were selected randomly from Dhiraj general hospital, Vadodara, Gujarat with 30 counterpart normal subjects with same age group and both sex. Their PA chest radiographs had been taken for the measurement of costo - phernic angle and it was measured. Costo - phernic angle of COPD subjects was compared with normal subjects.

Results: p values were get through analysis of data by using independent sample 't'test with spss version 11.0. the values were p<0.000 for right side and p<0.258 for left side when costo - phernic angle of COPD was compared with normal subjects.

Conclusion: There were variation in position and shape of diaphragm in COPD subjects to normal subjects by means of high level significance in same age group.


References