Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium

Introduction: Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to the diaphragm losing its usual configuration and thus affects its functionality; said functionality seems to improve after administering bronchodilator therapy. Chest ultrasound (CU) has been used to assess chan-ges after the use of short-acting bronchodilators, but there are no studies that assess these changes with the use of long-acting bronchodilators.Material and methods: This work is a prospective interventional study with 3 months of follow-up that assessed diaphragm motion/thickness by means of CU before and after starting treatment with indacaterol/glycopyrronium 85/43 mcg in patients with COPD and moderate to very severe airway obstruction. Results: Thirty patients were included (56.6% men, mean age: 69.4 +/- 6.2 years). Pre-and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 +/- 7.1 mm and 26.4 +/- 8.7 mm (p < 0.0001); 42.5 +/- 14.1 mm and 64.5 +/- 25.9 mm (p < 0.0001); and 36.5 +/- 17.4 mm and 46.7 +/- 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). Conclusions: Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients.(c) 2023 Elsevier Espan similar to a, S.L.U. and Sociedad Espan similar to ola de Medicina Interna (SEMI). All rights reserved.