The frequency of diaphragm dysfunction and its effect on prognosis in patients with copd acute exacerbation

The Frequency of Diaphragm Dysfunction and Its Effect on Prognosis in Patients with COPD Acute Exacerbation Objective: Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of mortality and morbidity, which is increasing in the society and progressing with exacerbations. Diaphragm dysfunction developing during exacerbations negatively affects disease prognosis. Diaphragm dysfunction can be measured at the bedside with ultrasound method. In our single-center prospective study, we aimed to determine the frequency of diaphragm dysfunction and prognosis of diaphragm dysfunction in patients with COPD acute exacerbation. Additionally, it was aimed to investigate the relationship between diaphragm dysfunction and Non-Invasive Mechanical Ventilation (NIMV) success in patients who need NIMV due to respiratory failure. Material and method: Fifty patients admitted to the Cukurova University Faculty of Medicine Balcali Hospital Chest Diseases clinic with COPD acute exacerbation were included in the study. On the day of hospitalization and discharge, diaphragm ultrasonography was performed. Discharged patients were followed up for a six-month period. The demographic data, laboratory tests, NIMV requirement and success status, six-month mortality, and the number of emergency department visits and hospitalizations during this period were recorded. Statistical analysis of these data was performed between groups with and without diaphragm dysfunction. Results: Diaphragm dysfunction (DD) was detected in 10 (% 20) of patients. While the six-month mortality was higher in the DD (+) group (p<0.01), the number of emergency department visits and hospitalizations were not statistically significant (p>0.05). NIMV success was higher in DD (-) group (p<0.01). Diaphragm dysfunction was detected more frequently in patients with high mMRC score, in the presence of comorbidity, in patients who needed NIMV at the time of admission to the hospital and in patients with respiratory failure(p<0.05). Conclusion: In-hospital mortality and 6-month follow-up mortality are higher in patients with diaphragmatic dysfunction who present with COPD exacerbation, and NIMV failure is also more common. There was no significant difference between the number of admissions to the emergency service, the number of hospitalizations and the number of hospitalizations in the intensive care unit. The diaphragm ultrasonography is a fast, non invasive and easy tool to detect DD and predict progress in patients with COPD acute exacerbation. Key Words: Diaphragm, Dysfunction, COPD, Acute Exacerbation, Prognosis