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Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 701-708

Chronic obstructive pulmonary disease and ultrasonographic assessment of quadriceps muscle

1 Department of Chest Diseases, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
2 Department of Rheumatology & Rehabilitation, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Correspondence Address:
MD Eman Sobh
Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; Al-Zahraa University Hospital, Abbassia, 11517, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjamf.sjamf_86_19

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Introduction Quadriceps muscle (QM) dysfunction has been recognized as a major cause of impaired physical activity in patients with chronic obstructive pulmonary disease (COPD). Clinical assessment of muscle power is not fully accurate in differentiating the degree of impairment. The use of muscle ultrasound has been introduced to study extrapulmonary complications in COPD such as diaphragm and limb muscle impairment. Aim To assess the relationship between severity of COPD and ultrasonographic assessment of QM and its strength by dynamometer. Patients and methods This prospective observational case–control study was conducted on 100 patients with stable COPD attending Chest Diseases Outpatient Clinic and 100 healthy controls with normal lung functions from December 2017 to June 2019. Spirometry, arterial blood gases, and 6-min walking distance were done for all cases. A hand-held dynamometer was used to measure QM strength. Ultrasonography was used to evaluate QM subcutaneous fat, quadriceps muscle thickness (QMT), and rectus femoris cross-sectional area (RFCSA). Results Patients with COPD had significantly lower QM clinical power and strength by dynamometer and decreased QMT and RFCSA in comparison with controls. Overall, 89% of patients with COPD had decreased QM strength by dynamometer, 68% had decreased QMT, and 67% had decreased RFCSA. Most of the patients with COPD who experienced QM weakness were older, had low body mass, had more severe airway obstruction, had more advanced COPD stage, and had lower quality-of-life scores. Life space activity (LSA) score, thigh circumference, and maximum voluntary volume were the factors that had significant effect on RFCSA. However, disease duration, dyspnea score, COPD Assessment Test score, LSA score, and thigh circumference had significant effect on QMT. Meanwhile, LSA and maximum voluntary volume had significant effect on QM strength. Conclusion Most patients with COPD had QM weakness and are associated with more advanced disease and worse quality of life. These findings are important and indicate that peripheral muscle assessment should be incorporated into the clinical assessment of COPD.

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