Diaphragm Ultrasonography as a Tool to Assess Paradoxical Breathing in a Patient With Asthma Attack.
A 67-year-old woman experienced chronic dyspnea, wheezes, and dry cough for 1 year and was
admitted to our hospital. She had no remarkable medical history. Her dyspnea worsened over
2 months and was admitted to the hospital for further diagnostic and therapeutic interventions.
On examination, the patient was in respiratory distress.
The blood pressure, pulse rate, respiratory rate, temperature, and oxygen saturation were 158/108 mmHg, 108 beats per minute, 30 breaths per minute, 36.4 °C, and 92%, respectively while she was breathing ambient air.
Physical examination revealed paradoxical breathing with the chest wall moving inwards during inspiration and outwards during expiration together with diffuse inspiratory and expiratory wheezes of Jonson Grade. Diaphragm ultrasonography was performed to assess her respiratory failure, which revealed a normally functioning diaphragm, i.e.
Thus, paradoxical breathing was assumed to be due to high respiratory load that was triggered by severe asthma attack. In summary, this case illuminates the importance of diaphragm ultrasonography as a tool to assess paradoxical breathing; moreover, it revealed that the paradoxical breathing
observed in the patient was not associated with diaphragm dysfunction. In general, paradoxical breathing suggests diaphragm dysfunction or other respiratory muscle However, Tobin et al reported that this could be observed because of an increased respiratory load rather than muscle fatigue. In our case, diaphragm ultrasonography revealed that paradoxical breathing is without diaphragm dysfunction. Therefore, we assume that it was due to increased respiratory load that was triggered by severe asthma attack.
Pulm Res Respir Med Open J. 2016; SE(1): S14-S16. doi: 10.17140/PRRMOJ-SE-1-105