Improvements in Perimeter Thoracic Mobility on Patients with COPD after Pulmonary Rehabilitation: A Case Series
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Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, LUXEMBOURG
AOU San Luigi Gonzaga, Orbassano, ITALY
Casa di Cura Villa Serena, Piossasco (TO), ITALY
IRCCS Fondazione Don Carlo Gnocchi, Milan, ITALY
Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, SPAIN
Publication date: 2022-02-02
Electron J Gen Med 2022;19(3):em361
To evaluate if the perimeter thoracic mobility (PTM) improvements could be identified by measuring its perimeter during pulmonary rehabilitation (PR), searching for its correlations with standards clinical and functional assessments.

A case series.

Twenty patients underwent a PR and accessed the arterial blood gas analyses, FVC, FEV1, FEV/FEV1, 6-minute walk test (6MWT), and the PTM measurement assessed at the angle of the Louis level and the xiphoid process level.

PR improved PTM on the angle of Louis (p=0.03) but not on the xiphoid process. These improvements are negatively correlated with improvements in PaCO2.

In COPD patients, a successful PR is accompanied by a reduction of the upper chest wall resting perimeter and by an improvement of the perimeter thoracic mobility.

Clinical relevance:
The centimeter tape is a useful device able to identify PTM improvements in COPD patients.

Singh D, Agusti A, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur Respir J. 2019;53(5):1900164. https://doi.org/10.1183/139930... PMid:30846476.
Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: Role of exercise capacity and health status. Am J Respir Crit Care Med. 2003;167(4):544-9. https://doi.org/10.1164/rccm.2... PMid:12446268.
Aliverti A, Stevenson N, Dellacà RL, Lo Mauro A, Pedotti A, Calverley PM. Regional chest wall volumes during exercise in chronic obstructive pulmonary disease. Thorax. 2004;59(3):210-6. https://doi.org/10.1136/thorax... PMid:14985554 PMCid:PMC1746979.
Gagliardi E, Innocenti Bruni G, Presi I, Gigliotti F, Scano G. Thoraco-abdominal motion/displacement does not affect dyspnea following exercise training in COPD patients. Respir Physiol Neurobiol. 2014;190:124-30. https://doi.org/10.1016/j.resp... PMid:24140573.
Fronczek M, Mysłek K, Sajek A, Padula G, Kopacz K. Effect of diaphragm postisometric relaxation in older adults. Top Geriatr Rehabil. 2019;35(2):104-7. https://doi.org/10.1097/TGR.00....
de Souza GHM, Ferraresi C, Moreno MA, et al. Acute effects of photobiomodulation therapy applied to respiratory muscles of chronic obstructive pulmonary disease patients: A double-blind, randomized, placebo-controlled crossover trial. Lasers Med Sci. 2020;35(5):1055-63. https://doi.org/10.1007/s10103... PMid:31654154.
Bockenhauer SE, Chen H, Julliard KN, Weedon J. Measuring thoracic excursion: Reliability of the cloth tape measure technique. J Am Osteopath Assoc. 2007;107(5):191-6. PMid:17596587.
da Silva Caldeira V, Starling CC, Britto RR, Martins JA, Sampaio RF, Parreira VF. Reliability and accuracy of cirtometry in healthy adults. J Bras Pneumol. 2007;33(5):519-26. https://doi.org/10.1590/s18063... PMid:18026649.
Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390-413. https://doi.org/10.1164/rccm.2... PMid:16760357.
Massaroni C, Carraro E, Vianello A, et al. Optoelectronic plethysmography in clinical practice and research: A review. Respiration. 2017;93(5):339-54. https://doi.org/10.1159/000462... PMid:28329750.
Corbellini C, Boussuges A, Villafañe JH, Zocchi L. Diaphragmatic mobility loss in subjects with moderate to very severe COPD may improve after in-patient pulmonary rehabilitation. Respir Care. 2018;63(10):1271-80. https://doi.org/10.4187/respca... PMid:30065081.
de Cordoba Lanza F, de Camargo AA, Archija LR, Selman JP, Malaguti C, Dal Corso S. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respir Care. 2013;58(12):2107-12. https://doi.org/10.4187/respca... PMid:23674814.
Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158(5):1384-7. https://doi.org/10.1164/ajrccm... PMid:9817683.
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38. https://doi.org/10.1183/090319... PMid:16055882.
Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64. https://doi.org/10.1164/rccm.2... PMid:24127811.
Jubran A, Tobin MJ. The effect of hyperinflation on rib cage-abdominal motion. Am Rev Respir Dis. 1992;146(6):1378-82. https://doi.org/10.1164/ajrccm... PMid:1456551.
Georgiadou O, Vogiatzis I, Stratakos G, et al. Effects of rehabilitation on chest wall volume regulation during exercise in COPD patients. Eur Respir J. 2007;29(2):284-91. https://doi.org/10.1183/090319... PMid:17107987.
Puente-Maestu L, Abad YM, Pedraza F, Sánchez G, Stringer WW. A controlled trial of the effects of leg training on breathing pattern and dynamic hyperinflation in severe COPD. Lung. 2006;184(3):159-67. https://doi.org/10.1007/s00408... PMid:16902841.
Scichilone N, La Sala A, Bellia M, et al. The airway response to deep inspirations decreases with COPD severity and is associated with airway distensibility assessed by computed tomography. J Appl Physiol (1985). 2008;105(3):832-8. https://doi.org/10.1152/japplp... PMid:18617628 PMCid:PMC2536818.
Wilkens H, Weingard B, Lo Mauro A, Schena E, Pedotti A, Sybrecht GW, Aliverti Aet al. Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after lung transplantation. Thorax. 2010;65(9):808-14. https://doi.org/10.1136/thx.20... PMid:20805177.
Aliverti A, Quaranta M, Chakrabarti B, Albuquerque AL, Calverley PM. Paradoxical movement of the lower ribcage at rest and during exercise in COPD patients. Eur Respir J. 2009;33(1):49-60. https://doi.org/10.1183/090319... PMid:18799505.
Vogiatzis I, Stratakos G, Athanasopoulos D, et al. Chest wall volume regulation during exercise in COPD patients with GOLD stages II to IV. Eur Respir J. 2008;32(1):42-52. https://doi.org/10.1183/090319... PMid:18321930.
Yan S, Sliwinski P, Macklem PT. Association of chest wall motion and tidal volume responses during CO2 rebreathing. J Appl Physiol (1985). 1996;81(4):1528-34. https://doi.org/10.1152/jappl.... PMid:8904564.