The effect of unsupported arm elevations on regional chest wall volumes and thoracoabdominal asynchrony in patients with chronic obstructive pulmonary disease

ABSTRACT

Objective

To compare the effect of unsupported arm elevation (UAE) in different planes on chest wall volumes, thoracoabdominal asynchrony (TAA), ventilatory demands, dyspnea, and arm fatigue in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects.

Methods

Twenty-one patients with COPD and healthy-matched subjects performed UAE in shoulder flexion, scaption, abduction, and resting. Pulmonary total and regional chest wall volumes (V_RCp), abdominal rib cage volume, abdominal volume, TAA, and ventilatory demands during arm positions were measured using optoelectronic plethysmography.

Results

In both groups, V_RCp and TAA were significantly affected during UAEs compared with the resting position. The healthy subjects had significantly decreased V_RCp (L) (p < 0.05) during scaption (0.14 ± 0.07) and abduction (0.15 ± 0.06) than during flexion (0.18 ± 0.07) and no significantly different TAA between UAEs. The COPD group had no significantly different V_RCp between UAEs, had significantly increased TAA (p < 0.05) during scaption (31.1°±9.5°) and abduction (32.3°±9.9°) than during flexion (29.7°±9.1°); and had significantly worse V_RCp (p = 0.007), TAA (p = 0.0001), ventilatory demands (p < 0.05), dyspnea ((p = 0.03), and arm fatigue (p = 0.002).

Conclusions

In patients with COPD, UAE in different planes similarly restricted the upper chest wall volume. Shoulder scaption and abduction significantly impaired TAA, ventilation, dyspnea, and arm fatigue compared with flexion. These results may help to select the appropriate UAE during physical activities.

KEYWORDS:

• Unsupported arm elevation
• chronic obstructive pulmonary disease
• optoelectronic plethysmography
• lung volume
• chest wall kinematics

Acknowledgments

The authors would like to thank all participants for their time and effort to participate in this study and the Central Chest Institute of Thailand for allowing us to recruit the subjects. We would also like to thank Mr. Vasapol Teravanapanth for your assistance with the MATLAB code.

Disclosure of Interest

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the 90^th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) [GCUGR1125613082D] and the Thailand Research Fund [MRG-5980084]