الفهرس 
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Abstract
Chronic obstructive pulmonary disease (COPD) is regarded as a systemic disease causing structural and functional changes in many organs as well as in the lung. Malnutrition, weight loss and muscle weakness are some of the systemic manifestations of COPD that seriously affect the health related quality of life and exercise capacity of patients.
COPD represents a model of respiratory muscle dysfunction; diaphragm is the main respiratory muscle and its assessment is mandatory in the evaluation of COPD patients.
The aim of this study was to assess the diaphragmatic function in COPD patients using ultrasonographic examination and to study its correlation with pulmonary function tests.
The study included fifty subjects; forty clinically stable COPD patients and ten age and sex matched healthy controls. Patients were divided and classified according to GOLD 2015 into 4 subgroups each consisting of ten patients.
- First group included 10 patients with mild COPD.
- Second group included 10 patients with moderate COPD.
- Third group included 10 patients with severe COPD.
- Forth group included 10 patients with very severe COPD.
- All the cases were subjected to the following:
1. Detailed history taking and clinical examination.
2. Routine laboratory investigations.
3. Radiological examination including plain chest X- ray 4. Pulmonary function tests including spirometry and maximal respiratory pressures (MIP and MEP).
5. Six minute walk test.
6. Diaphragmatic ultrasonography to assess diaphragmatic mobility and thickness.
The results of this study revealed the following:-
- The mean age of COPD patients was (54.3±6.49) years and that of the control group was (51.6 ±6.48) years with a statistically non- significant difference (P-value > 0.05).
- 75% of COPD patients and 80% of controls were males with a statistically non-significant difference. The mean body mass index of COPD patients was (26.4±4.27) kg/m2 and that of the control group was (29.8 ±2.60) kg/m2 with a statistically significant difference (P- value < 0.05).
- 40% of patients were current smokers, 25 % were non-smokers and 35% were ex-smokers while all controls were non-smokers with a statistically highly significant difference (P-value ≤ 0.0001).
- There was a statistically highly significant difference between COPD patients and controls as regards FEV1% of predicted, MVV% of predicted and FEV1/FVC (P-value ≤ 0.001). There was also a statistically significant difference between both groups as regards FVC% of predicted (P-value ≤ 0.05).
- There was a statistically highly significant difference (P-value ≤ 0.001) between patients and controls as regards MIP % of predicted and MEP % of predicted.
- There was a statistically highly significant difference (P-value ≤ 0.001) between COPD patients and controls as regards ultrasonographic measurements of diaphragmatic thickness at different lung volumes; RV, FRC and TLC (TDRV, TDFRC and TDTLC respectively). There was also a statistically highly significant difference (P-value ≤ 0.001) between patients and controls regarding diaphragmatic thickenings (TDTLCRV and TDTLCFRC) and diaphragmatic excursion.
- There was a statistically non-significant difference (P-value > 0.05) among COPD patients with different grades of severity regarding age and sex.
- There was a statistically non- significant difference among COPD patients with different grades of severity as regards smoking prevalence, while there was a statistically highly significant difference (P-value ≤ 0.001) among them regarding smoking index.
- There was a statistically highly significant difference (P-value ≤ 0.001) among different grades of severity of COPD patients regarding BMI.
- There was a statistically highly significant difference (P-value ≤ 0.001) among COPD patients with different grades of severity regarding FEV1% predicted, FEV1/FVC and MVV% predicted. But there was a statistically non-significant difference among them regarding FVC% predicted (P-value > 0.05).
- There was a statistically highly significant difference (P-value ≤ 0.001) among COPD patients with different grades of severity regarding MIP % predicted and MEP% predicted.
- There was a statistically highly significant difference (P-value ≤ 0.001) among different grades of severity of COPD patients regarding BODE index.
- There was a statistically highly significant difference (P-value ≤ 0.001) among COPD patients with different grades of severity as regards diaphragmatic thicknesses at various lung volumes and capacities (TDRV, TDFRC and TDTLC), diaphragmatic thickening (TDTLCFRC) and diaphragmatic excursion. Also there was a statistically significant difference (P-value ≤ 0.05) among COPD patients regarding diaphragmatic thickening (TDTLCRV).
- There was a statistically significant difference (P-value ≤ 0.05) between male and female patients regarding ultrasonographic findings of diaphragmatic thickness (TDFRC and TDTLC) and diaphragmatic thickenings (TDTLCRV and TDTLCFRC). On the other hand, there was a statistically non-significant difference (P-value > 0.05) as regards TDRV and diaphragmatic excursion in COPD patients in relation to gender.
- There was a statistically highly significant positive correlation (P-value ≤ 0.001) between diaphragmatic thickness, thickenings and excursion by ultrasound and both maximum inspiratory and expiratory pressures (MIP and MEP % of predicted).
- There was a statistically highly significant positive correlation (P-value ≤ 0.001) between diaphragmatic thickness, thickenings and excursion by ultrasound and forced expiratory volume in one second (FEVl % of predicted) i.e. negative correlation between ultrasonographic findings and the severity of COPD with the least measurements in very severe COPD.
- There was a statistically highly significant positive correlation (P-value ≤ 0.001) between diaphragmatic ultrasonographic findings and FVC % of predicted, FEV1/ FVC and MVV % of predicted