Diagnostics of disturbances in the functional state of the diaphragm in patients with chronic obstructive pulmonary disease after COVID-19

Aim. Assessment of the functional state of the diaphragm in patients with COPD who underwent COVID-19.

Materials and methods. The study included 35 patients with COPD complicated by compensated chronic cor pulmonale (CCP): group 1 included 15 patients with COPD who had COVID-19, group 2 included 20 patients with COPD. Patients were examined 3 months after suffering COVID-19. The functional state of the diaphragm was studied using the VIVID S70N ultrasound diagnostic system.

Results. The greatest decrease in the diaphragm dome height was detected in the 1st group (p=0.001). The excursion of the diaphragm during quiet breathing was increased in both groups, in the 2nd group the indicator was 11% more than in the 1st group. The diaphragm excursion during forced breathing was reduced in the 1st group (p=0.02). The rate of diaphragm excursion during inhalation and exhalation during quiet and forced breathing in both groups was significantly increased compared to the control group. However, in the 1st group, the rate of diaphragm excursion on expiration was 49% higher. These changes may indicate respiratory muscle fatigue in COPD patients who have had COVID-19. The thickness of the muscular part of the diaphragm during inhalation and exhalation during quiet breathing in both groups compared to the control group was significantly higher. These indicators in both groups did not significantly differ from each other. There was a decrease in the thickening fraction of the muscular part of the diaphragm during calm (p=0.01) and forced breathing (p=0.001) in both groups, which indicates the onset of fatigue of the muscles of the diaphragm in the 2nd group and the initial development of weakness of the diaphragm in the 1st group who had the greatest decrease in this indicator during forced breathing.

Conclusion. Ultrasonic diagnostic methods significantly expand the possibilities for assessing the functional state of the diaphragm. Patients with COPD who have undergone COVID-19 are characterized by a significant increase in the thickness of the diaphragm, limitation of its mobility, and a slowdown in the rate of relaxation of the muscular part of the diaphragm.

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