RESUMO
Objective Quantitative analysis of chest radiographs of patients with and without chronic obstructive pulmonary disease (COPD) determining if the data obtained from such radiographic images could classify such individuals according to the presence or absence of disease. Materials and Methods For such a purpose, three groups of chest radiographic images were utilized, namely: group 1, including 25 individuals with COPD; group 2, including 27 individuals without COPD; and group 3 (utilized for the reclassification /validation of the analysis), including 15 individuals with COPD. The COPD classification was based on spirometry. The variables normalized by retrosternal height were the following: pulmonary width (LARGP); levels of right (ALBDIR) and left (ALBESQ) diaphragmatic eventration; costophrenic angle (ANGCF); and right (DISDIR) and left (DISESQ) intercostal distances. Results As the radiographic images of patients with and without COPD were compared, statistically significant differences were observed between the two groups on the variables related to the diaphragm. In the COPD reclassification the following variables presented the highest indices of correct classification: ANGCF (80%), ALBDIR (73.3%), ALBESQ (86.7%). Conclusion The radiographic assessment of the chest demonstrated that the variables related to the diaphragm allow a better differentiation between individuals with and without COPD. .
RESUMO
INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) provoca alterações na função respiratória e altera as estruturas musculoesqueléticas da caixa torácica, limitando, cada vez mais, a capacidade de respiração do indivíduo. OBJETIVOS: analisar quantitativamente as radiografias torácicas de indivíduos com DPOC e estabelecer um comparativo entre a prova de função pulmonar, a força muscular respiratória, a mobilidade torácica, a capacidade funcional e os achados dos exames radiográficos. MÉTODO: Foram avaliados 15 indivíduos com DPOC, os quais realizaram os exames de espirometria, teste da caminhada de seis minutos, manovacuometria e cirtometria. Os valores obtidos nesses testes foram comparados com medidas efetuadas na radiografia de tórax desses pacientes. Os valores obtidos para cada variável foram normalizados dividindo-se tais valores pela altura retroesternal. RESULTADOS: A variável que apresentou correlação mais significativa com as variáveis de espirometria (CVF e PFE) e de cirtometria (Xifoide CR e Axilar CR) foi o ângulo costofrênico. A variável de imagem ALB DIR correlacionou-se positivamente com a variável PI máx. O nível de rebaixamento diafragmático esquerdo e a distância intercostal direita e esquerda não apresentaram correlação com as variáveis dos exames fisioterápicos. CONCLUSÃO: A variável que apresentou correlação mais significativa com os exames foi o ângulo costofrênico, o que indica que o comprometimento do diafragma impacta nas condições gerais do DPOC. Sendo assim, o estudo apontou que o comprometimento do músculo diafragma observado nos exames de fisioterapia em indivíduos com DPOC correlaciona-se com as variáveis de imagem, que avaliam o diafragma nas imagens radiográficas.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) causes changes in respiratory function and alters the musculoskeletal structures of the chest, increasingly limiting an individual's ability to breathe. OBJECTIVES: To quantitatively analyze chest radiographs of patients with COPD and establish a comparison among the pulmonary function, respiratory muscle strength, thoracic mobility, functional capacity and findings of radiographic exams. METHOD: We studied 15 subjects with COPD who performed the spirometry test, the six-minute walk, manovacuometry and micrometry. The values obtained from these tests were compared with measurements made on chest radiographs of these patients. The values obtained for each variable were normalized by dividing them by retrosternal height. RESULTS: The variable that correlated most significantly with the variables of spirometry (FVC and PEF) and cirtometry (Xiphoid CR and Axillary CR) was the costo-phrenic angle. The image variable ALB DIR positively correlated with the variable PI max. The level of left diaphragmatic drawdown, intercostals right and left distances were not correlated with the variables of physiotherapy exams. CONCLUSION: The variable that correlated most significantly with the tests was the costo-phrenic angle, which indicates that the involvement of the diaphragm has impact on the general conditions of COPD. Thus, the study showed that impairment of the diaphragm in patients with COPD observed in tests of physiotherapy correlate with image variables that assess the diaphragm in radiography.