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Diaphragmatic thickness and excursion by lung ultrasound in pediatric chronic pulmonary diseases

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Abstract

Purpose

Many patients with chronic pulmonary diseases, such as interstitial lung disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis, suffer from dyspnea and exercise intolerance. Reduced lung compliance is the main cause of the patients’ dyspnea, but weak respiratory muscles could be an additional factor. The diaphragm is considered the major respiratory muscle. Our study aimed to detect diaphragmatic thickness and excursion by ultrasound in pediatric patients with chronic pulmonary diseases to assess respiratory muscle weakness in these patients.

Methods

A case–control study was conducted on 130 patients with pediatric chronic pulmonary diseases (childhood interstitial lung diseases, cystic fibrosis, and non-cystic fibrosis bronchiectasis) and 100 control subjects. Ultrasound was used to detect diaphragmatic excursion and thickness, which were correlated with the severity of the disease, both clinically and functionally.

Results

The right and left diaphragmatic excursions were significantly lower in the patients (19.469 ± 9.984 and 18.5 ± 10.131, respectively) than in the control subjects (29.6 ± 14.131 and 25.6 ± 12.827, respectively) (p values of 0.002 and 0.019). In contrast, the difference in the right and left diaphragmatic thicknesses between the patients and the controls was statistically insignificant (p values of 0.884 and 0.344). The left diaphragmatic excursion was positively correlated with the patients’ age and weight, while both the right and the left diaphragmatic excursion significantly correlated with the patients’ height, FEV1/FVC ratio, and heart rate.

Conclusion

The diaphragmatic excursion is lower in children and adolescents with chronic pulmonary diseases than in healthy control subjects. The diaphragmatic excursion is positively correlated with patients’ age, weight, height, FEV1/FVC ratio, and heart rate.

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Availability of data and materials

The data that support the results of this research are available upon request from the corresponding author. The data are not publicly available for the privacy of research participants.

Abbreviations

CT:

Computed tomography.

DE:

Diaphragm excursion

FRC:

Functional residual capacity

FVC:

Forced vital capacity

ILD:

Interstitial lung diseases

IPF:

Idiopathic pulmonary fibrosis

LUS:

Lung ultrasound

mMRC:

Modified Medical Research Council

MRI:

Magnetic resonance imaging

TF:

Thickness fraction

TLC:

Total lung capacity

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Funding

This research did not receive any funding.

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Authors and Affiliations

  1. Pediatrics Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, 11591, Egypt

    Sally R. Ishak

  2. Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Hossam M. Sakr

Authors
  1. Sally R. Ishak
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  2. Hossam M. Sakr
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Correspondence to Sally R. Ishak.

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Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

The study was approved by the local ethics committee, Children’s Hospital, Ain Shams University.

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Verbal and written consents were taken from all the caregivers of our patients.

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Ishak, S.R., Sakr, H.M. Diaphragmatic thickness and excursion by lung ultrasound in pediatric chronic pulmonary diseases. J Ultrasound 25, 97–102 (2022). https://doi.org/10.1007/s40477-021-00570-2

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  • DOI: https://doi.org/10.1007/s40477-021-00570-2

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