Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

Figures & data

Figure 1 Radiographic image of the area displaced by diaphragm motion during inspiration and expiration for the same chronic obstructive pulmonary disease patient.

Note: The thick horizontal lines of posteroanterior radiographs represent the costal insertion of diaphragm to the same spinal process of vertebral column between full inspiration and full expiration.

Figure 2 Schematic illustration of the area displaced by diaphragm movement during both inspiration (Area I) and expiration (Area E) in patients with chronic obstructive pulmonary disease.

Notes: Horizontal line shows low margin of vertebral body connecting the costal insertion of diaphragm. Vertical brick line shows thoracic vertebral spinous processes. Low curved thick line shows diaphragm shadow.

Table 1 Subject characteristics of chronic obstructive pulmonary disease patients (N=37)

Age, years	65.2±10.1
Sex (male:female)	37:0
Body mass index (kg/m^2)	21.7±2.9
Ex-smokers	32
Current smokers	5
Pack-year	38.3±20.1
Exercise period (months)	6.7±2.8
Comorbidities
Cardiovascular	19
Others	0

Note: Values are expressed as mean ± standard deviation.

Table 2 Anthropometric and pulmonary function data (n=37)

Arterial blood gas analysis
PaO2 (mmHg)	75.7±10.9
PaCO2 (mmHg)	45.6±7.8
Spirometry (pre)
FVC/FEV1 % predicted	46.4±14.8
FVC % predicted	73.4±24.5
FEV1 % predicted	50.1±19.5
FEF25%–75% % predicted	23.7±16.0
GOLD stage (%)
GOLD I	10.8
GOLD II	40.5
GOLD III	35.2
GOLD IV	13.5
Echocardiography
Ejection fraction (%)	57.4±7.4
RVSP (mmHg)	40.4±23.2

Note: Values are expressed as mean ± standard deviation.

Abbreviations: FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; FEF_25%–75%, forced expiratory flow at 25%–75%; GOLD, Global initiative for chronic Obstructive Lung Disease; RVSP, right ventricular systolic pressure; PaCO₂, partial pressure of carbon dioxide; PaO₂, partial pressure of oxygen.

Table 3 Results of pulmonary function test between pre- and postpulmonary rehabilitation in patients with chronic obstructive pulmonary disease (n=37)

	Prepulmonary rehabilitation	Postpulmonary rehabilitation	P-value*
FVC (%) pre-	73.4±4.0	77.4±3.6	0.137
FEV1 (%) pre-	50.1±3.2	51.9±4.2	0.297
FEF25%–75% (%)	23.7±2.7	23.8±3.4	0.921

Notes: Values are expressed as mean ± standard error. Significant difference between pre- and postpulmonary rehabilitation:

* P<0.05 (paired t-test).

Abbreviations: FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; FEF_25%–75%, forced expiratory flow at 25%–75%.

Table 4 Changes of diaphragmatic area between expiratory–inspiratory diaphragm motion with fluoroscopy in patients with chronic obstructive pulmonary disease (n=37)

	Prepulmonary rehabilitation	Postpulmonary rehabilitation	P-value*
Right (mm^2)	2,022.8±1,548.3	3,010.7±1,495.6	0.001
Left (mm^2)	2,382.4±1,475.9	3,315.9±1,883.5	0.019

Notes: Values are expressed as mean ± standard deviation. Significant difference between pre- and postpulmonary rehabilitation:

* P<0.05 (paired t-test).