Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Altered Thoracic Cage Dimensions in Patients with Chronic Obstructive Pulmonary Disease

  • Lim, Su Jin (Department of Internal Medicine, Masan Medical Center) ;
  • Kim, Ju-Young (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Seung Jun (Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Gi Dong (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Cho, Yu Ji (Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Jeong, Yi Yeong (Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Jeon, Kyung Nyeo (Department of Diagnostic Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Jong Deog (Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kim, Jang Rak (Department of Preventive Medicine, Gyeongsang National University School of Medicine) ;
  • Kim, Ho Cheol (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine)
  • Received : 2017.08.14
  • Accepted : 2017.11.21
  • Published : 2018.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, $70.6{\pm}7.1years$) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls ($13.1{\pm}2.8cm$ vs. $12.2{\pm}1.13cm$, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls ($0.66{\pm}0.061$ vs. $0.61{\pm}0.86$; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=-0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

Keywords

References

  1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76. https://doi.org/10.1164/ajrccm.163.5.2101039
  2. Dyspnea: mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 1999;159:321-40. https://doi.org/10.1164/ajrccm.159.1.ats898
  3. Rothpearl A, Varma AO, Goodman K. Radiographic measures of hyperinflation in clinical emphysema: discrimination of patients from controls and relationship to physiologic and mechanical lung function. Chest 1988;94:907-13. https://doi.org/10.1378/chest.94.5.907
  4. Burki NK, Krumpelman JL. Correlation of pulmonary function with the chest roentgenogram in chronic airway obstruction. Am Rev Respir Dis 1980;121:217-23.
  5. Simon G, Pride NB, Jones NL, Raimondi AC. Relation between abnormalities in the chest radiograph and changes in pulmonary function in chronic bronchitis and emphysema. Thorax 1973;28:15-23. https://doi.org/10.1136/thx.28.1.15
  6. Nicklaus TM, Stowell DW, Christiansen WR, Renzetti AD Jr. The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis 1966;93:889-99.
  7. Lando Y, Boiselle P, Shade D, Travaline JM, Furukawa S, Criner GJ. Effect of lung volume reduction surgery on bony thorax configuration in severe COPD. Chest 1999;116:30-9. https://doi.org/10.1378/chest.116.1.30
  8. Pierce JA, Ebert RV. The barrel deformity of the chest, the senile lung and obstructive pulmonary emphysema. Am J Med 1958;25:13-22.
  9. Kilburn KH, Asmundsson T. Anteroposterior chest diameter in emphysema: from maxim to measurement. Arch Intern Med 1969;123:379-82. https://doi.org/10.1001/archinte.1969.00300140025006
  10. Gilmartin JJ, Gibson GJ. Abnormalities of chest wall motion in patients with chronic airflow obstruction. Thorax 1984;39:264-71. https://doi.org/10.1136/thx.39.4.264
  11. Bellemare F, Jeanneret A, Couture J. Sex differences in thoracic dimensions and configuration. Am J Respir Crit Care Med 2003;168:305-12. https://doi.org/10.1164/rccm.200208-876OC
  12. Bellemare JF, Cordeau MP, Leblanc P, Bellemare F. Thoracic dimensions at maximum lung inflation in normal subjects and in patients with obstructive and restrictive lung diseases. Chest 2001;119:376-86. https://doi.org/10.1378/chest.119.2.376
  13. Holcombe SA, Wang SC, Grotberg JB. The effect of age and demographics on rib shape. J Anat 2017;231:229-47. https://doi.org/10.1111/joa.12632
  14. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. https://doi.org/10.1183/09031936.05.00034805
  15. Brooks D, Solway S, Weinacht K, Wang D, Thomas S. Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2003;84:873-6.
  16. Sverzellati N, Colombi D, Randi G, Pavarani A, Silva M, Walsh SL, et al. Computed tomography measurement of rib cage morphometry in emphysema. PLoS One 2013;8:e68546. https://doi.org/10.1371/journal.pone.0068546
  17. Thurlbeck WM, Simon G. Radiographic appearance of the chest in emphysema. AJR Am J Roentgenol 1978;130:429-40. https://doi.org/10.2214/ajr.130.3.429
  18. Sharp JT, Beard GA, Sunga M, Kim TW, Modh A, Lind J, et al. The rib cage in normal and emphysematous subjects: a roentgenographic approach. J Appl Physiol (1985) 1986;61:2050-9. https://doi.org/10.1152/jappl.1986.61.6.2050
  19. Thomas AJ, Supinski GS, Kelsen SG. Changes in chest wall structure and elasticity in elastase-induced emphysema. J Appl Physiol (1985) 1986;61:1821-9.
  20. Walsh JM, Webber CL Jr, Fahey PJ, Sharp JT. Structural change of the thorax in chronic obstructive pulmonary disease. J Appl Physiol (1985) 1992;72:1270-8. https://doi.org/10.1152/jappl.1992.72.4.1270
  21. Cassart M, Gevenois PA, Estenne M. Rib cage dimensions in hyperinflated patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;154(3 Pt 1):800-5. https://doi.org/10.1164/ajrccm.154.3.8810622
  22. Arakawa H, Kurihara Y, Nakajima Y, Niimi H, Ishikawa T, Tokuda M. Computed tomography measurements of overinflation in chronic obstructive pulmonary disease: evaluation of various radiographic signs. J Thorac Imaging 1998;13:188-92. https://doi.org/10.1097/00005382-199807000-00005
  23. Bartynski WS, Heller MT, Grahovac SZ, Rothfus WE, Kurs-Lasky M. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol 2005;26:2077-85.
  24. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging 2006;1:253-60. https://doi.org/10.2147/ciia.2006.1.3.253
  25. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007;370:741-50.
  26. Thurlbeck WM. Postnatal human lung growth. Thorax 1982; 37:564-71. https://doi.org/10.1136/thx.37.8.564
  27. Weaver AA, Schoell SL, Stitzel JD. Morphometric analysis of variation in the ribs with age and sex. J Anat 2014;225:246-61. https://doi.org/10.1111/joa.12203
  28. Shi X, Cao L, Reed MP, Rupp JD, Hoff CN, Hu J. A statistical human rib cage geometry model accounting for variations by age, sex, stature and body mass index. J Biomech 2014;47:2277-85. https://doi.org/10.1016/j.jbiomech.2014.04.045
  29. Salito C, Luoni E, Aliverti A. Alterations of diaphragm and rib cage morphometry in severe COPD patients by CT analysis. Conf Proc IEEE Eng Med Biol Soc 2015;2015:6390-3.
  30. Schols AM, Mostert R, Soeters PB, Wouters EF. Body composition and exercise performance in patients with chronic obstructive pulmonary disease. Thorax 1991;46:695-9. https://doi.org/10.1136/thx.46.10.695
  31. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976-80. https://doi.org/10.1164/ajrccm.153.3.8630582
  32. Vogiatzis I, Zakynthinos S. Factors limiting exercise tolerance in chronic lung diseases. Compr Physiol 2012;2:1779-817.

Cited by

  1. The influence of speleotherapy combined with pulmonary rehabilitation on functional fitness in older adults – preliminary report vol.14, pp.None, 2018, https://doi.org/10.1177/1753466620926952
  2. Lung and fissure shape is associated with age in healthy never-smoking adults aged 20–90 years vol.10, pp.1, 2018, https://doi.org/10.1038/s41598-020-73117-w
  3. A new quantitative assessment method for predicting pneumonia caused by chest wall injury vol.91, pp.3, 2021, https://doi.org/10.1097/ta.0000000000003314