Sonographic evaluation of the diaphragm muscle before and after pulmonary rehabilitation

Aim: The purpose of this retroactive study was to assess the behavior of diaphragmatic excursion before and after a rehabilitation program in pulmonary diseases. Methods: 234 patients in 2014-15 (COPD=112, OSA=65, neuromuscolar=17, surgical=4, fibrotorax=7, bronchiectasis=7, asthma=5, pneumonia=6, emphysema=4, embolism=7) were investigated with sonographic measurements of the diaphragm motion and compared with 6-minute walk test. The ultrasound machine was a portable one with a 1.3-4 MHz sector phased array transducer with 14x24 mm footprint. The sonography was performed by the same RT therapist at bedside with patient in semirecumber position in anterior subcostal approach. All patients followed a rehabilitation program (the daily average of treatments was of 14 days), based on exercises of mobilization and breathing, retraining through calisthenics exercises, theraband, minibike or cyclette. Results: US diaphragm improved were 76%; WT6 improved 57%; US stationary 20%; WT6 stationary 38%; US worse 4%; WT6 worse 5%. The problems have occurred with critically ill patients for which the wt6 was not effective. Conclusion: Our study suggests that Ultrasound is a safe, reliable modality to set measurement of the diaphragmatic excursion. It can be a strong addition to lung function parameters to control the effects of rehabilitation programs and respiratory muscle training in the evaluation of ventilatory muscle strength.