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Published ahead of print on September 11, 2002, doi:10.1164/rccm.200111-087OC

Am. J. Respir. Crit. Care Med., Volume 166, Number 11, December 2002, 1461-1469

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Submitted on November 19, 2001
Accepted on September 11, 2002

Diaphragm Length During Tidal Breathing in Patients with Chronic Obstructive Pulmonary Disease

Robert B Gorman1*, David K McKenzie1, Neil B Pride2, Jane F Tolman1, and Simon C Gandevia1

1 Prince of Wales Medical Research Institute, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia, 2 Prince of Wales Medical Research Institute, Sydney, NSW, Australia

* To whom correspondence should be addressed. E-mail: R.Gorman{at}unsw.edu.au.

Diaphragm function is compromised in severe chronic obstructive pulmonary disease by hyperinflation, but its ability to shorten and contribute to tidal volume is uncertain. We estimated coronal diaphragm length by measuring zone of apposition length with ultrasound and ribcage diameters with magnetometers, in 10 male patients with severe chronic obstructive pulmonary disease and 10 age-matched control men. Diaphragm length was 20% shorter in patients at residual volume (patients 413 and controls 536 millimeters) and functional residual capacity (381 and 456 millimeters), but was not different at total lung capacity (312 and 336 millimeters). Zone of apposition length was reduced 50% at residual volume and functional residual capacity in patients, but was larger at a given absolute lung volume than in control subjects. There were no differences in tidal volume (0.8 liters), tidal changes in zone of apposition length (20 millimeters) and diaphragm length (38 and 42 millimeters), and tidal volume displaced by the diaphragm (0.6 liters), even though mean functional residual capacity in patients was similar to predicted total lung capacity. Although the diaphragm is shorter at functional residual capacity in chronic obstructive pulmonary disease patients, its motion and change in length during tidal breathing is similar to control subjects.
Key words: ultrasound, COPD, tidal volume, diaphragm length




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