Reduction of COPD Hyperinflation by Endobronchial Valves Improves Intercostal Muscle Morphology on Ultrasound

Peter Wallbridge, Mark Hew, Selina M Parry, Louis Irving, Daniel Steinfort, Peter Wallbridge, Mark Hew, Selina M Parry, Louis Irving, Daniel Steinfort

Abstract

Background and objectives: Parasternal intercostal ultrasound morphology reflects spirometric COPD severity. Whether this relates to the systemic nature of COPD or occurs in response to hyperinflation is unknown. We aimed to assess changes in ultrasound parasternal intercostal muscle quantity and quality (echogenicity) in response to relief of hyperinflation. We hypothesised that reduction in hyperinflation following endobronchial valve (EBV) insertion would increase ultrasound parasternal thickness and decrease echogenicity.

Methods: In this prospective cohort study, eight patients with severe COPD underwent evaluation of health-related quality of life, lung function, and sonographic thickness of 2nd parasternal intercostal muscles and diaphragm thickness, both before and after EBV insertion. Relationships between physiological and radiographic lung volumes, quality of life and ultrasound parameters were determined.

Results: Baseline FEV1 was 1.02L (SD 0.37) and residual volume (RV) was 202% predicted (SD 41%). Median SGRQ was 63.26 (range 20-70.6). Change in RV (-0.51 ± 0.9L) following EBV-insertion showed a strong negative correlation with change in parasternal thickness (r = -0.883) ipsilateral to EBV insertion, as did change in target lobe volume (-0.89 ± 0.6L) (r = -0.771). Parasternal muscle echogenicity, diaphragm thickness and diaphragm excursion did not significantly change.

Conclusions: Dynamic changes in intercostal muscle thickness on ultrasound measurement occur in response to relief of hyperinflation. We demonstrate linear relationships between intercostal thickness and change in hyperinflation following endobronchial valve insertion. This demonstrates the deleterious effect of hyperinflation on intrinsic inspiratory muscles and provides an additional mechanism for symptomatic response to EBVs.

Keywords: COPD; endobronchial valve; measurement; respiratory muscle; ultrasound.

Conflict of interest statement

Dr Selina M Parry reports grants from NHMRC Early Career Fellowship, outside the submitted work. The authors report no other conflicts of interest in this work.

© 2020 Wallbridge et al.

Figures

Figure 1
Figure 1
Parasternal intercostal muscle ultrasound.
Figure 2
Figure 2
Relationship between change in residual volume, CT-target lobe volume and change in parasternal thickness following endobronchial valve insertion.

References

    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Respirology. 2017;22(3):575–601.
    1. Ofir D, Laveneziana P, Webb KA, Lam YM, O’Donnell DE. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;177(6):622–629. doi:10.1164/rccm.200707-1064OC
    1. Guenette JA, Webb KA, O’Donnell DE. Does dynamic hyperinflation contribute to dyspnoea during exercise in patients with COPD? Eur Respir J. 2012;40(2):322–329. doi:10.1183/09031936.00157711
    1. Laveneziana P, Webb KA, Ora J, Wadell K, O’Donnell DE. Evolution of dyspnea during exercise in chronic obstructive pulmonary disease: impact of critical volume constraints. Am J Respir Crit Care Med. 2011;184(12):1367–1373. doi:10.1164/rccm.201106-1128OC
    1. De Troyer A, Leeper JB, McKenzie DK, Gandevia SC. Neural drive to the diaphragm in patients with severe COPD. Am J Respir Crit Care Med. 1997;155(4):1335–1340. doi:10.1164/ajrccm.155.4.9105076
    1. Palange P, Valli G, Onorati P, et al. Effect of heliox on lung dynamic hyperinflation, dyspnea, and exercise endurance capacity in COPD patients. J Appl Physiol (1985). 2004;97(5):1637–1642. doi:10.1152/japplphysiol.01207.2003
    1. O’Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: applying physiology to clinical practice. COPD Res Pract. 2015;1(1):4. doi:10.1186/s40749-015-0008-8
    1. Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362(3):217–227. doi:10.1056/NEJMoa0808836
    1. Seymour JM, Spruit MA, Hopkinson NS, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J. 2010;36(1):81–88. doi:10.1183/09031936.00104909
    1. Guerri R, Gayete A, Balcells E, et al. Mass of intercostal muscles associates with risk of multiple exacerbations in COPD. Respir Med. 2010;104(3):378–388. doi:10.1016/j.rmed.2009.10.015
    1. Park MJ, Cho JM, Jeon KN, et al. Mass and fat infiltration of intercostal muscles measured by CT histogram analysis and their correlations with COPD severity. Acad Radiol. 2014;21(6):711–717. doi:10.1016/j.acra.2014.02.003
    1. Greening NJ, Harvey-Dunstan TC, Chaplin EJ, et al. Bedside assessment of quadriceps muscle by ultrasound after admission for acute exacerbations of chronic respiratory disease. Am J Respir Crit Care Med. 2015;192(7):810–816. doi:10.1164/rccm.201503-0535OC
    1. De Troyer A, Kirkwood PA, Wilson TA. Respiratory action of the intercostal muscles. Physiol Rev. 2005;85(2):717–756. doi:10.1152/physrev.00007.2004
    1. Wallbridge P, Parry SM, Das S, et al. Parasternal intercostal muscle ultrasound in chronic obstructive pulmonary disease correlates with spirometric severity. Sci Rep. 2018;8(1):15274. doi:10.1038/s41598-018-33666-7
    1. Vogiatzis I, Habazettl H, Aliverti A, et al. Effect of helium breathing on intercostal and quadriceps muscle blood flow during exercise in COPD patients. Am J Physiol Regul Integr Comp Physiol. 2011;300(6):R1549–59. doi:10.1152/ajpregu.00671.2010
    1. Louvaris Z, Vogiatzis I. Contrasting the physiological effects of heliox and oxygen during exercise in a patient with advanced COPD. Breathe (Sheff). 2019;15(3):250–257. doi:10.1183/20734735.0197-2019
    1. Louvaris Z, Vogiatzis I, Aliverti A, et al. Blood flow does not redistribute from respiratory to leg muscles during exercise breathing heliox or oxygen in COPD. J Appl Physiol (1985). 2014;117(3):267–276. doi:10.1152/japplphysiol.00490.2014
    1. Suh ES, Mandal S, Harding R, et al. Neural respiratory drive predicts clinical deterioration and safe discharge in exacerbations of COPD. Thorax. 2015;70(12):1123–1130. doi:10.1136/thoraxjnl-2015-207188
    1. Patout M, Meira L, D’Cruz R, et al. Neural respiratory drive predicts long-term outcome following admission for exacerbation of COPD: a post hoc analysis. Thorax. 2019;74(9):910–913. doi:10.1136/thoraxjnl-2018-212074
    1. Nakanishi N, Oto J, Ueno Y, Nakataki E, Itagaki T, Nishimura M. Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study. J Intensive Care. 2019;7:56. doi:10.1186/s40560-019-0410-4
    1. Dres M, Dube BP, Goligher E, et al. Usefulness of parasternal intercostal muscle ultrasound during weaning from mechanical ventilation. Anesthesiology. 2020;132(5):1114–1125. doi:10.1097/ALN.0000000000003191
    1. Maltais F, Decramer M, Casaburi R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014;189(9):e15–62. doi:10.1164/rccm.201402-0373ST
    1. De Troyer A, Wilson TA. Effect of acute inflation on the mechanics of the inspiratory muscles. J Appl Physiol (1985). 2009;107(1):315–323. doi:10.1152/japplphysiol.91472.2008
    1. Klooster K, Slebos DJ, Zoumot Z, Davey C, Shah PL, Hopkinson NS. Endobronchial valves for emphysema: an individual patient-level reanalysis of randomised controlled trials. BMJ Open Respir Res. 2017;4(1):e000214. doi:10.1136/bmjresp-2017-000214
    1. Criner GJ, Sue R, Wright S, et al. A Multicenter RCT of Zephyr(R) endobronchial valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151–1164. doi:10.1164/rccm.201803-0590OC
    1. Davey C, Zoumot Z, Jordan S, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi trial): study design and rationale. Thorax. 2015;70(3):288–290. doi:10.1136/thoraxjnl-2014-205127
    1. Park TS, Hong Y, Lee JS, et al. Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report. Int J Chron Obstruct Pulmon Dis. 2015;10:1501–1511.
    1. Slebos DJ, Shah PL, Herth FJ, Valipour A. Endobronchial valves for endoscopic lung volume reduction: best practice recommendations from expert panel on endoscopic lung volume reduction. Respir Int Rev Thor Dis. 2017;93(2):138–150. doi:10.1159/000453588
    1. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St George’s Respiratory Questionnaire. Am Rev Respir Dis. 1992;145(6):1321–1327. doi:10.1164/ajrccm/145.6.1321
    1. Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi:10.1249/01.MSS.0000078924.61453.FB
    1. Hurtig-Wennlof A, Hagstromer M, Olsson LA. The International Physical Activity Questionnaire modified for the elderly: aspects of validity and feasibility. Public Health Nutr. 2010;13(11):1847–1854. doi:10.1017/S1368980010000157
    1. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1251. doi:10.1016/0895-4356(94)90129-5
    1. Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94. doi:10.1186/1471-2407-4-94
    1. Wallbridge PD, Joosten SA, Hannan LM, et al. A prospective cohort study of thoracic ultrasound in acute respiratory failure: the C3PO protocol. JRSM Open. 2017;8(5):2054270417695055. doi:10.1177/2054270417695055
    1. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve. 2013;47(3):319–329. doi:10.1002/mus.23671
    1. Sarwal A, Parry SM, Berry MJ, et al. Interobserver reliability of quantitative muscle sonographic analysis in the critically Ill population. J Ultrasound Med. 2015;34(7):1191–1200. doi:10.7863/ultra.34.7.1191
    1. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. doi:10.1371/journal.pmed.0040296
    1. Pizarro C, Schueler R, Hammerstingl C, Tuleta I, Nickenig G, Skowasch D. Impact of endoscopic lung volume reduction on right ventricular myocardial function. PLoS One. 2015;10(4):e0121377. doi:10.1371/journal.pone.0121377
    1. Pizarro C, Ahmadzadehfar H, Essler M, et al. Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution. PLoS One. 2015;10(3):e0118976. doi:10.1371/journal.pone.0118976
    1. Zoumot Z, LoMauro A, Aliverti A, et al. Lung volume reduction in emphysema improves chest wall asynchrony. Chest. 2015;148(1):185–195. doi:10.1378/chest.14-2380
    1. Martinez FJ, Couser JI, Celli BR. Factors influencing ventilatory muscle recruitment in patients with chronic airflow obstruction. Am Rev Respir Dis. 1990;142(2):276–282. doi:10.1164/ajrccm/142.2.276
    1. Kauczor HU, Heussel CP, Fischer B, Klamm R, Mildenberger P, Thelen M. Assessment of lung volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR Am J Roentgenol. 1998;171(4):1091–1095. doi:10.2214/ajr.171.4.9763003
    1. Parry SM, El-Ansary D, Cartwright MS, et al. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care. 2015;30(5):1151.e9–1151.e14. doi:10.1016/j.jcrc.2015.05.024
    1. Gorman RB, McKenzie DK, Pride NB, Tolman JF, Gandevia SC. Diaphragm length during tidal breathing in patients with chronic obstructive pulmonary disease. American Journal of Respiratory & Critical Care Medicine. 2002;166(11):1461–1469. doi:10.1164/rccm.200111-087OC
    1. Gorman RB, McKenzie DK, Butler JE, Tolman JF, Gandevia SC. Diaphragm length and neural drive after lung volume reduction surgery. American Journal of Respiratory & Critical Care Medicine. 2005;172(10):1259–1266. doi:10.1164/rccm.200412-1695OC
    1. Iwasawa T, Kagei S, Gotoh T, et al. Magnetic resonance analysis of abnormal diaphragmatic motion in patients with emphysema. Eur Respir J. 2002;19(2):225–231. doi:10.1183/09031936.02.00044602
    1. Baria MR, Shahgholi L, Sorenson EJ, et al. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest. 2014;146(3):680–685. doi:10.1378/chest.13-2306
    1. Suga K, Tsukuda T, Awaya H, et al. Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Resonance Imaging. 1999;10(4):510–520. doi:10.1002/(SICI)1522-2586(199910)10:4<510::AID-JMRI3>;2-G
    1. Levine S, Nguyen T, Friscia M, et al. Parasternal intercostal muscle remodeling in severe chronic obstructive pulmonary disease. J Appl Physiol (1985). 2006;101(5):1297–1302. doi:10.1152/japplphysiol.01607.2005

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