Is There An Asymmetric Excursion In Copd?

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitations. Diaphragmatic excursion, which measures the movement of the thoracic diaphragm during breathing, is reduced in emphysema patients, indicating a decrease in the contractile ability of the diaphragm. The DE max of patients with COPD was significantly lower than that of controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01).

The study found that patients with COPD showed significant improvements in respiratory muscle strength, thoracic excursion, and thoracic range of movement (p < 0.01) except for thoracic flexion. COPD involves both airflow limitations and lung hyperinflation, making the diaphragm weaker. Asymmetrical chest expansion is more common in severe COPD patients, and palpation of the chest can detect abnormal respiratory excursion. Unequal movement indicates asymmetry and poor diaphragmatic excursion, respectively.

Tactile vocal fremitus is a sensation where chest wall compliance and excursion during respirations are markedly reduced bilaterally with ribs 3-7 exhibiting inhalation dysfunctions bilaterally. Normal diaphragmatic excursion should be 3–5 cm, and lung compliance can be calculated by dividing volume by pressure (C = V/P). There must be a lot of plerual disease before this asymmetry can be identified on exam.

In conclusion, COPD is a common inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitations. Diaphragmatic excursion, chest wall compliance, and thoracic range of movement are all important factors to consider when diagnosing and treating COPD.

Does COPD cause asymmetrical chest expansion?

Any lung or pleural disease can cause a decrease in overall chest expansion, which is typically low in COPD patients due to their high FRC and limited chest expansion capability. Abnormal chest expansion is often associated with diffuse lung and pleural diseases like emphysema, stiff thorax, and diaphragmatic paralysis. Other conditions that can cause a decrease in chest expansion include kyphoscoliosis, unilateral lung volume loss, and unilateral space-occupying lesions like pneumothorax, pleural effusion, and large masses.

What is the normal lung excursion?

Diaphragmatic excursion is the movement of the thoracic diaphragm during breathing, typically 3-5 cm. It can be increased to 7-8 cm in well-conditioned individuals. The procedure involves the patient exhaling and holding it, with the doctor percussing down their back in the intercostal margins until sounds change from resonant to dull. The patient then takes a deep breath in and holds it, with the provider percussing down again.

The distance between the two spots is measured, and repeating on the other side, usually higher up on the right side. If the diaphragmatic excursion is less than 3-5 cm, the patient may have pneumonia or a pneumothorax, which can be diagnosed with a chest x-ray.

What are the distinguishing characteristics of COPD?

Chronic obstructive pulmonary disease (COPD), also known as emphysema or chronic bronchitis, is a lung disease causing restricted airflow and breathing issues. It is primarily caused by smoking and air pollution, and its symptoms include coughing, difficulty breathing, wheezing, and tiredness. While COPD is not curable, symptoms can improve with avoiding smoking, exposure to air pollution, and vaccinations. Treatment options include medicines, oxygen, and pulmonary rehabilitation. Common symptoms include difficulty breathing, chronic cough, and fatigue.

What are the typical findings of COPD?

COPD is a chronic obstructive pulmonary disease (COPD) characterized by inflammation and damage to the lungs, leading to the accumulation of phlegm and other debris within the airways. This can result in a range of symptoms, including coughing, dyspnea, wheezing, and fatigue. The most common causes are smoking and air pollution. Although there is no cure for COPD, symptoms can be alleviated by abstaining from smoking, limiting exposure to air pollution, and receiving vaccinations. Treatment options include pharmacological agents, supplemental oxygen, and pulmonary rehabilitation. The most common symptoms are dyspnea, a chronic cough, and fatigue.

What is asymmetry of the lungs?

Assess the lungs by comparing upper, middle, and lower lung zones on the left and right. Asymmetry of lung density is represented by abnormal whiteness (increased density) or abnormal blackness (decreased density). Determine which side is abnormal by identifying an area different from the surrounding ipsilateral lung. If the alveoli and small airways fill with dense material, the lung is considered consolidated. However, consolidation does not always indicate infection, as small airways may fill with fluid, blood, or cells.

Clinical information can help determine the diagnosis. An air bronchogram is a characteristic sign of consolidation, where dense and white areas are present, while larger airways are relatively low-density (blacker).

What is the expansion of COPD?

COPD is a chronic lung disease caused by long-term exposure to harmful substances, with cigarette smoke being the most common cause. It is characterized by two common types: emphysema and chronic bronchitis. Chronic bronchitis is an inflammation of the bronchi tubes, preventing airflow and producing extra mucus. Emphysema is caused by damaged alveoli, limiting oxygen passage into the bloodstream. Despite its severity, COPD is treatable and can be managed with proper care to improve symptoms and quality of life. It also reduces the risk of other related conditions like heart disease and lung cancer.

What are the physical findings of a patient with COPD?

The physical examination of COPD patients includes hyperinflation, wheezing, diffusely decreased breath sounds, hyperresonance on percussion, and prolonged expiration. Systemic manifestations include decreased fat-free mass, impaired systemic muscle function, osteoporosis, anemia, depression, pulmonary hypertension, cor pulmonale, and left-sided heart failure. Common symptoms include a productive cough or acute chest illness, which is worse in the morning and produces a small amount of colorless sputum. Breathlessness is the most significant symptom, usually occurring in the sixth decade of life. FEV 1 is the most common variable used to grade COPD severity, but not the best predictor of mortality.

What causes asymmetric chest expansion?

Ventilatory excursion assessment involves evaluating the synchrony of expansion and chest expansion associated with deep forceful inspiration. Asymmetrical expansion may indicate decreased ventilation to one side, which may be due to thoracic wall abnormalities, structural immobility, defect, pain, or obstruction of airways. Other factors may include inflamed, fibrosed, or malignantly infiltrated pleura, unilateral pleural effusion, interstitial pulmonary processes, or complete obstruction of airways on the ipsilateral side.

Functional severing of the phrenic nerve or intraabdominal process causing paralysis of the ipsilateral hemidiaphragm may also cause asymmetrical expansion. Palpation is used to assess further abnormalities, such as gynecomastia suspected due to observed breast enlargement or spider hemangiomas confirmed by palpation of breast tissue. Deviation of the trachea to one side can indicate either pulling the trachea to one side or pushing it away, such as tumors or inflammatory masses. Spontaneous movement of the trachea in synchrony with the pulse suggests the presence of an aortic aneurysm.

What is symmetric chest excursion?

Asymmetrical chest expansion is abnormal, where both sides take off at the same time and extent. This can be caused by unilateral lung or pleural disease. To assess chest expansion, apply different amounts of pressure and have the patient sit erect with equal pressure. If the patient has decreased chest expansion on the right side, it may indicate apushing lesion from the right, such as pneumothorax, pleural effusion, or a large mass. The next step will help narrow down these possibilities. It is crucial to have the patient erect and use equal pressure with their hands when assessing chest expansion.

What is the typical appearance of a COPD patient?

In cases of advanced emphysema, the ribs typically assume a horizontal position, and dorsal kyphosis is a common occurrence. Additional findings include a prominent sternum, elevated clavicles, a shortened neck, and widened intercostal spaces.

What are the physical manifestations of COPD?

COPD symptoms include shortness of breath, increased gasping for air, and an ongoing cough. Triggers like smells, cold air, poor air quality, colds, flu, or lung infections can cause a sudden worsening of symptoms called a flare-up or exacerbation. During a flare-up, you may have difficulty catching your breath, chest tightness, more coughing, changes in sputum color or amount, and a fever. If symptoms worsen suddenly, call your healthcare provider who may prescribe antibiotics, bronchodilators, and steroids to help you breathe. Severe symptoms may require hospital treatment.