Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1654-1659

Diaphragm Injury in Individuals with Airflow Obstruction

NORI A. MACGOWAN, KENNETH G. EVANS, JEREMY D. ROAD, and W. DARLENE REID

School of Rehabilitation Sciences, Department of Medicine, and McDonald Research Laboratory, University of British Columbia, Vancouver, British Columbia, Canada

The purpose of this study was to describe the nature of diaphragm injury, to quantify the injury and number of macrophages at the light microscopic level, and to determine their association with airflow obstruction in humans. Partial-thickness diaphragm biopsies were obtained from 21 subjects going for thoracotomy surgery (FEV₁: 74 ± 34% predicted; range: 16 to 122% predicted). Cross sections cut from frozen diaphragm were processed with H&E or processed for immunohistochemistry using the monoclonal antibody Ber-MAC3 (DAKO Corp., Carpinteria, CA) to label macrophages. Area fractions (A_A) or the proportions of the cross- sectional area were determined by point counting all viable fields of H&E-stained diaphragm cross sections. A_A were 66.2 ± 9.0% for normal muscle, 17.6 ± 7.2% for abnormal muscle, and 16.3 ± 4.2% for connective tissue. Percent predicted FEV₁ was inversely related to the A_A of abnormal muscle (r = 0.53, p < 0.01) and directly related to the A_A of normal muscle (r = 0.37, p < 0.05). The number of macrophages was not related to % predicted FEV₁ (mean ± SD: 0.41 ± 0.18/fiber; 52 ± 19/mm²). We conclude that increasing severity of airflow obstruction is associated with an increased A_A of abnormal diaphragm and a decreased A_A of normal diaphragm.

This article has been cited by other articles:

				M. J. Tobin, F. Laghi, and L. Brochard Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure J Appl Physiol, September 1, 2009; 107(3): 962 - 970. [Abstract] [Full Text] [PDF]

				A. K. Stubbings, A. J. Moore, M. Dusmet, P. Goldstraw, T. G. West, M. I. Polkey, and M. A. Ferenczi Physiological properties of human diaphragm muscle fibres and the effect of chronic obstructive pulmonary disease J. Physiol., May 15, 2008; 586(10): 2637 - 2650. [Abstract] [Full Text] [PDF]

				C. A. C. Ottenheijm, G. J. Jenniskens, M. C. P. Geraedts, T. Hafmans, L. M. A. Heunks, T. H. van Kuppevelt, and P. N. R. Dekhuijzen Diaphragm dysfunction in chronic obstructive pulmonary disease: a role for heparan sulphate? Eur. Respir. J., July 1, 2007; 30(1): 80 - 89. [Abstract] [Full Text] [PDF]

				C. A. C. Ottenheijm, L. M. A. Heunks, and P. N. R. Dekhuijzen Diaphragm Muscle Fiber Dysfunction in Chronic Obstructive Pulmonary Disease: Toward a Pathophysiological Concept Am. J. Respir. Crit. Care Med., June 15, 2007; 175(12): 1233 - 1240. [Abstract] [Full Text] [PDF]

				X. Wang, T-X. Jiang, J. D. Road, D. M. Redenbach, and W. D. Reid Granulocytosis and increased adhesion molecules after resistive loading of the diaphragm Eur. Respir. J., November 1, 2005; 26(5): 786 - 794. [Abstract] [Full Text] [PDF]

				S. N. Mehiri, E. Barreiro, M. Hayot, M. Voyer, A. S. Comtois, A. E. Grassino, and G. Czaika Time-based gene expression programme following diaphragm injury in a rat model Eur. Respir. J., March 1, 2005; 25(3): 422 - 430. [Abstract] [Full Text] [PDF]

				M. I. Lewis, M. Fournier, X. Da, H. Li, Z. Mosenifar, R. J. McKenna Jr, and A. H. Cohen Short-term Influences of Lung Volume Reduction Surgery on the Diaphragm in Emphysematous Hamsters Am. J. Respir. Crit. Care Med., October 1, 2004; 170(7): 753 - 759. [Abstract] [Full Text] [PDF]

				J. A. Simpson, J. Van Eyk, and S. Iscoe Respiratory muscle injury, fatigue and serum skeletal troponin I in rat J. Physiol., February 1, 2004; 554(3): 891 - 903. [Abstract] [Full Text] [PDF]

				M. Orozco-Levi Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation? Eur. Respir. J., November 2, 2003; 22(46_suppl): 41s - 51s. [Abstract] [Full Text] [PDF]

				F. Laghi and M. J. Tobin Disorders of the Respiratory Muscles Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 10 - 48. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Sleep-Disordered Breathing, Control of Breathing, Respiratory Muscles, and Pulmonary Function Testing in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 584 - 597. [Full Text] [PDF]

				M. J. TOBIN Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 642 - 662. [Full Text] [PDF]

				M. OROZCO-LEVI, J. LLORETA, J. MINGUELLA, S. SERRANO, J. M. BROQUETAS, and J. GEA Injury of the Human Diaphragm Associated with Exertion and Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., November 1, 2001; 164(9): 1734 - 1739. [Abstract] [Full Text] [PDF]