Prevalence of diaphragm dysfunction in patients with interstitial lung disease (ILD): The role of diaphragmatic ultrasound

Nicol Bernardinello; Elisabetta Cocconcelli; Annalisa Boscolo; Gioele Castelli; Nicolò Sella; Chiara Giraudo; Elisabetta Zanatta; Federico Rea; Marina Saetta; Paolo Navalesi; Paolo Spagnolo; Elisabetta Balestro

doi:10.1016/j.rmed.2023.107293

Prevalence of diaphragm dysfunction in patients with interstitial lung disease (ILD): The role of diaphragmatic ultrasound

Respir Med. 2023 Sep:216:107293. doi: 10.1016/j.rmed.2023.107293. Epub 2023 Jun 3.

Affiliations

¹ Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences, And Public Health, University of Padova and Padova City Hospital, Padova, Italy.
² Institute of Anesthesia and Intensive Care, Padua University Hospital, Italy; Department of Medicine (DIMED), University of Padua, Italy.
³ Institute of Anesthesia and Intensive Care, Padua University Hospital, Italy.
⁴ Department of Medicine (DIMED), University of Padua, Italy.
⁵ Rheumatology Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
⁶ Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
⁷ Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences, And Public Health, University of Padova and Padova City Hospital, Padova, Italy. Electronic address: elisabetta.balestro@aopd.veneto.it.

PMID: 37271302
DOI: 10.1016/j.rmed.2023.107293

Abstract

Background: Diaphragm ultrasound (DUS) has been extensively used in critically ill patients while data on outpatients with interstitial lung disease (ILD) are limited. We hypothesized that diaphragm function, assessed by ultrasound, could be impaired in patients with ILD, considering both Idiopathic Pulmonary Fibrosis (IPF) and Connective Tissue Disease (CTD-ILD), compared to healthy subjects. Moreover, this impairment could impact clinical and functional parameters.

Methods: All consecutive CTD-ILD and IPF patients followed in our center (March-October 2020) were screened. Diaphragm displacement (DD), inspiratory thickness (Ti), expiratory thickness (Te), thickening fraction (TF), and respiratory functional parameters were collected. The prevalence of diaphragmatic dysfunction (TF <30%) was then recorded.

Results: Eighty-two consecutive patients (41 CTD-ILD, 41 IPF) and 15 age- and sex-matched controls were enrolled. In the overall population, 24 out of 82 (29%) presented diaphragmatic dysfunction. In CTD-ILD, DD and Ti were lower as compared to IPF (p = 0.021 and p = 0.036, respectively); while diaphragmatic dysfunction was more prevalent compared to controls (37% vs 7%, p = 0.043). TF positively correlated to patients' functional parameters in the CTD-ILD group (FVC%pred: p = 0.003; r = 0.45), while not in the IPF group. Diaphragmatic dysfunction was associated with moderate/severe dyspnea in both CTD-ILD and IPF (p = 0.021).

Conclusion: The prevalence of diaphragmatic dysfunction was 29% in patients with ILD and was associated with moderate/severe dyspnea. CTD-ILD presented lower DD compared with IPF and a higher prevalence of diaphragmatic dysfunction (TF<30%) compared with controls. TF was associated with lung function only in CTD-ILD patients, suggesting its potential role in the comprehensive patient assessment.

Keywords: Connective tissue disease; Diaphragm ultrasound; Idiopathic pulmonary fibrosis; Interstitial lung disease.

MeSH terms

Connective Tissue Diseases* / complications
Diaphragm / diagnostic imaging
Dyspnea / complications
Dyspnea / etiology
Humans
Idiopathic Pulmonary Fibrosis* / complications
Idiopathic Pulmonary Fibrosis* / diagnostic imaging
Idiopathic Pulmonary Fibrosis* / epidemiology
Lung Diseases, Interstitial* / complications
Lung Diseases, Interstitial* / diagnostic imaging
Lung Diseases, Interstitial* / epidemiology
Prevalence