الفهرس 
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Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by incomplete reversible airflow limitation. chronic airflow limitation imposes a load on respiratory muscles, flattening of the diaphragm and reducing its ability to generate tension.
The impairment of diaphragm is suggested to be an important factor, which is associated with alterations in the principal pulmonary function parameters such as FEV1.
The aim of this work was to study the clinical usefulness of ultrasound in evaluation of the lung, pleura and diaphragm in patients with COPD and correlating it to spirometry parameters
This prospective case- control study was conducted on one hundred patients diagnosed with COPD divided into 40 patients with stable COPD, and 60 COPD patients with acute exacerbation. In addition, 20 age and sex matched healthy individuals were included as a control group.
Ultrasonography is superior to chest X-ray for determining the presence of pleural effusion, and estimating its volume. Also, lung ultrasonography is superior to chest X-ray for the identification of findings consistent with pneumonia confirmed with chest CT as the “gold standard” and has a diagnostic accuracy that approaches chest CT.
Our results showed that lung ultrasound was equal to diagnostic chest radiology in detection of pleural effusion, consolidation, lung mass, and pneumothorax with no statistically significant difference. However, lung ultrasound showed limited ability in detection of emphysematous bullae with statistically significant difference compared to chest CT.
The mean values of diaphragmatic thickness and excursion decrease among stable COPD and COPD with exacerbation patients with highly significant statistical differences in comparison to healthy controls. Based on pairwise comparison between the three groups, there was highly significant association between diaphragmatic measurements and the presence of COPD (stable COPD versus healthy controls). In stable COPD, diaphragmatic thickness and excursion were significantly lower than healthy controls
The mean values of diaphragmatic thickness and excursion were negatively correlated with the presence of COPD. The more worsening of COPD the more decline in diaphragmatic measurements
In the current study, we demonstrated that diaphragmatic measurements did not show significant difference between the exacerbation and stable COPD groups.
We found that diaphragmatic measurements (thickness and excursion) showed significant negative correlation with BMI, mMRC dyspnea scale. Also, we found a significant negative correlation between frequency of COPD exacerbation and diaphragmatic excursion.
Conclusion
Transthorathic ultrasound (TUS) is a non-invasive, simple and available bedside diagnostic tool for examination in outpatient clinic. TUS has a better diagnostic performance for diagnosis of diaphragmatic dysfunction in COPD patients and its relation to severity. Transthoracic ultrasound is nearly equivalent to CT in detecting most disorders such as pleural effusion, consolidation, pneumothorax, lung mass. Using transthoracic ultrasound can save time and decrease the need for chest CT evaluation of COPD patients.
TUS measurements of diaphragm excursion and thickness in COPD patients can provide non-invasive measurement of daiphragmatic dysfunction that may help clinicians in disease staging and patient follow-up.