Lung Ultrasound Assessment of Lung Hyperinflation in Patients with Stable COPD: An Effective Diagnostic Tool

Yongjian Chen,1 Jingyun Li,2 Zhixing Zhu,3 Guorong Lyu1,2 1Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China; 2School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of ChinaCorrespondence: Guorong Lyu, Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, Quanzhou, Fujian, 362000, People’s Republic of China, Tel +86-595-22525702, Email lgr_feus@sina.comPurpose: To evaluate the degree of lung hyperinflation (LH) in patients with stable chronic obstructive pulmonary disease (COPD) by lung ultrasound score (LUS) and assess its value.Patients and Methods: We conducted a study of 149 patients with stable COPD and 100 healthy controls recruited by the Second Affiliated Hospital of Fujian Medical University. The pleural sliding displacement (PSD) was measured, the sliding of the pleura in different areas was observed, and LUS was calculated from both of them. The diaphragm excursion (DE), residual capacity (RV), total lung capacity (TLC), inspiratory capacity (IC) and functional residual capacity (FRC) were measured. We described the correlation between ultrasound indicators and pulmonary function indicators reflecting LH. Multiple linear regression analysis was used. The ROC curves of LUS and DE were drawn to evaluate their diagnostic efficacy, and De Long method was used for comparison.Results: (1) The LUS of patients with stable COPD were positively correlated with RV, TLC, RV/TLC and FRC and negatively correlated with IC and IC/TLC (r1=0.72, r2=0.41, r3=0.72, r4=0.70, r5=− 0.56, r6=− 0.65, P < 0.001). The correlation was stronger than that between DE at maximal deep inspiration and the corresponding pulmonary function indices (r1=− 0.41, r2=− 0.26, r3=− 0.40, r4=− 0.43, r5=0.30, r6=0.37, P < 0.001). (2) Multiple linear regression analysis showed that LUS were significantly correlated with IC/TLC and RV/TLC. (3) With IC/TLC< 25% and RV/TLC> 60% as the diagnostic criterion of severe LH, the areas under the ROC curves of LUS and DE at maximal deep inspiration for diagnosing severe LH were 0.914 and 0.385, 0.845 and 0.543, respectively (P < 0.001).Conclusion: The lung ultrasound score is an important parameter for evaluating LH. LUS is better than DE at maximal deep inspiration for diagnosing severe LH and is expected to become an effective auxiliary tool for evaluating LH.Keywords: chronic obstructive pulmonary disease, lung hyperinflation, ultrasound, pleural sliding displacement, pulmonary function