Decreased and slower diaphragmatic motion during forced breathing in severe COPD patients: Time-resolved quantitative analysis using dynamic chest radiography with a flat panel detector system

Objective: To assess the diaphragmatic motion in chronic obstructive pulmonary disease (COPD) patients during forced breathing by time-resolved quantitative analysis using dynamic chest radiography and to demonstrate the characteristics and the difference from that in normal subjects. Materials and methods: Thirty-one COPD patients and a matched control of 31 normal subjects on age, sex, height, and weight, who underwent chest radiographs during forced breathing using dynamic chest radiography, were included in this study. COPD patients were classified based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (GOLD 1, n = 3; GOLD 2, n = 12; GOLD 3, n = 13; GOLD 4, n = 3). We measured excursions and peak motion speeds of the diaphragms for each participant. We compared the results among GOLD 1/2, GOLD 3/4 groups and normal subjects and investigated associations between the data, and participants' demographics, or pulmonary function. Results: The excursions of bilateral diaphragms were significantly decreased in the GOLD 3/4 group relative to normal subjects (right, 39.8 +/- 15.3 mm vs. 52.7 +/- 15.1 mm, P = 0.030; left, 43.7 +/- 14.0 mm vs. 56.9 +/- 15.5 mm, P = 0.017; mean +/- standard deviation) and the GOLD 1/2 group (right, 39.8 +/- 15.3 mm vs. 54.4 +/- 16.7 mm, P = 0.036; left, 43.7 +/- 14.0 mm vs. 60.5 +/- 13.9 mm, P = 0.008). The peak motion speeds of the left diaphragm in the inspiratory phase were slower in the GOLD 1/2 group than in normal subjects (24.5 +/- 8.0 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.038), and in the GOLD 3/4 group than in normal subjects (25.6 +/- 6.8 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.067). The excursions of the diaphragms showed correlation with VC, %VC, and FEV1, while the peak motion speeds showed no significant correlation with pulmonary function tests. Conclusions: Time-resolved quantitative analysis of diaphragms with dynamic chest radiography indicated differences in diaphragmatic motion between COPD groups and normal subjects during forced breathing. The excursions of the diaphragms during forced breathing were significantly lower in the GOLD 3/4 group than those in the GOLD 1/2 group and normal subjects.