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Endoscopic Lung Volume Reduction Results in Improvement of Diaphragm Mobility as Measured by Sonography

Authors Boyko M, Vonderbank S, Gürleyen H, Gibis N, Schulz A, Erbuth A, Bastian A

Received 28 January 2020

Accepted for publication 24 May 2020

Published 22 June 2020 Volume 2020:15 Pages 1465—1470

DOI https://doi.org/10.2147/COPD.S247526

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Mariya Boyko, Sandy Vonderbank, Hakan Gürleyen, Natalie Gibis, Alina Schulz, Annika Erbuth, Andreas Bastian

Marienkrankenhaus Kassel, Kassel 34127, Germany

Correspondence: Andreas Bastian
Marienkrankenhaus Kassel, Marburger Strasse 85, Kassel 34127, Germany
Email a.bastian@marienkrankenhaus-kassel.de

Background: Hyperinflation in patients with pulmonary emphysema is an important cause of reduced diaphragm mobility. We investigated whether endoscopic lung volume reduction (ELVR) could improve diaphragm mobility.
Methods: Diaphragm mobility data obtained by sonography from 44 patients were compared before and 3– 6 months after ELVR therapy with a Spiration™ valve system. These patients were asked whether they wanted this procedure again after they had learned of their treatment outcome; this was a subjective indicator of outcome. Lung function parameters and blood gases were also measured.
Results: After ELVR, 30 patients (82%) developed atelectasis of ≥ 50% of the targeted lung lobe. These patients had a diaphragm mobility increase of 28.97 ± 15.93 mm, while the remaining patients experienced an improvement in diaphragm mobility of 16.07 ± 21.17 mm; this difference was significant (p = 0.030). All 30 patients with atelectasis and additional 6 patients without radiologically demonstrated atelectasis perceived an improved outcome after ELVR. Their diaphragm mobility increased by 28.89 ± 17.26 mm. Conversely, the patients with no perceived improvement in outcome had a diaphragm mobility increase of 6.75 ± 12.76 mm; this difference was significant (p = 0.001).
Conclusion: ELVR can improve diaphragm mobility, and this improvement is correlated with a perceived positive outcome in patients.

Keywords: COPD, emphysema, diaphragm mobility, endoscopic lung volume reduction, ultrasound, outcome

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