The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ASSESSMENT OF DIAPHRAGMATIC THICKNESS AND EXCURSION IN ASTHMATIC CHILDREN AND ITS CORRELATION WITH ANGIOGENIN LEVEL AND PULMONARY FUNCTIONS.

Eman M. Fouda1, Safaa K. Mohammed3, Ahmed M. El-Kahky2



Objective: The study aimed at assessment of diaphragmatic thickness, excursion and fatigue in asthmatic children with various clinical and functional grading and also to assess the effect of a specific training program for the diaphragm "diaphragm strengthening exercise" on pulmonary functions and diaphragm ultrasonography.

Methods:
It included 45 asthmatic children and 12 healthy children as control group. For all cases, assessment of clinical severity and control according to GINA guidelines (2006) ,spirometric pulmonary functions and serum angiogenin level as an inflammatory marker were done. sEMG was measured before and after maximal voluntary ventilation maneuvers to determine the extent and duration of diaphragm fatigue induced during Maximal voluntary ventilation maneuver. Diaphragm was assessed by ultrasonography for thickness and excursion The patients started a special program of physical therapy for the diaphragm "Diaphragm strengthening exercise" by abdominal weights" for 10-12 weeks, twice per week, then they were re-assessed by spirometric pulmonary functions and diaphragm ultrasonography.

Results:
This study reveled statistical significant decreased thickness of diaphragm in asthmatic children (9.28±1.88mm Vs10.4±1.31 mm in control) and decreased excursion of diaphragm(11.06±3.82 mm Vs 12.05±2.23mm in control) (p<0.05) with marked impairment of diaphragmatic excursion in uncontrolled asthmatics compared to both controlled and partly controlled patients. Serum Angiogenin level was significantly higher in asthmatics and it was inversely correlated to FEV1 and to diaphragmatic excursion and thickness. sEMG recording parameters of diaphragm, including amplitude and frequency , were significantly decreased after maximal voluntary ventilation maneuvers (decrease of 18% and 12% from baseline, respectively), which indicate diaphragmatic fatigue. Reassessment of asthmatic children after short term exercise training for the diaphragm reveled significant increase in spirometric pulmonary functions, significant increase in diaphragmatic thickness and diaphragmatic excursion compared to pre-exercise measurements.

Conclusions:
Diaphragmatic thickness and excursion are affected in asthmatics and it is correlated to pulmonary functions and to inflammatory markers. Diaphragmatic training programs may be of value in improving symptoms and severity of patient with asthma through its effect on diaphragmatic thickness and excursion.