Milan University, Italy
Camilo Corbellini is a skilled Respiratory Physiotherapist, with experience in the treatment and research of respiratory diseases, in adult and elderly patients. Graduated in Brazil in 2002, since 2010 living, studying and working in Italy. MSc in Medical Sciences (Brazil) and in Respiratory Physiotherapy (Italy). PhD in Physiology at Milan University. Happy father.
The COPD causes a not fully reversible airway obstruction and also changes in the rib cage structure. Those modifications lead to respiratory muscles functional inefficiency that is strongly correlated to lung function loss. Specifically, the diaphragm undergoes a progressive process of muscle fibers shortening, a consequence of lung hyperinflation and dead space increase. This results in a chronic mechanical disadvantage that impairs diaphragm’s mobility. This impairment may worse in COPD exacerbations, improving after pulmonary rehabilitation. The diaphragmatic mobility (DM) is mostly assessed with techniques that exposes the patient to risks. The ultrasonography in M-mode is easy to use, is safe and measures directly the diaphragmatic dome displacement. The study aimed to determine whether the COPD, according to the subject’s COPD severity, impairs the DM and to verify DM improvements after an inpatient pulmonary rehabilitation. We performed lung function tests and diaphragmatic M-mode ultrasonography in COPD individuals and healthy subjects. Ultrasonography was performed during rest breathing and deep inspirations. The COPD subjects underwent a six-minute walk test and arterial blood gas analyzes. After initial screening, 46 COPD patients ended the rehabilitation. The mean characteristics of healthy individuals and COPD subjects. The DM during Rest Breathing and Deep Inspirations were correlated to FEV1 decrease (r=0.74; p<0.01 and r= - 0.8; p<0.01, respectively). (figure 1). The correlation were also positives between the Deep Inspiration and the Inspiratory Capacity (r= 0.64 with p<0.001). After the rehabilitation the DM increases during deep inspiration from 4.58cm±1.83cm to 5.45cm±1.56cm (p<0.01). We concluded that M-mode ultrasonography showed that DM impairment is correlated to lung function loss in COPD subjects. The patients who completed the rehabilitation improved the diaphragmatic mobility verified during deep inspirations.