Why does copd cause barrel chest

It's not always talked about, but it is quite common during the later stages of COPD, or emphysema. This is simply a term to describe the shape of the ribs in your chest and thoracic regions. Your ribs form what is called a "cage" of bones that surround your lungs, diaphragm, and heart. The ribs are 12 pairs of curved bones that attach to the spinal column in your back.

They circle around to the front of the body where the top 7 pairs attach to the sternum, also called the breastbone. The next 3 pairs attach to a kind of cartilage in the front.

The final 2 pairs are attached only to your spine, but "float" in the front. In healthy people, the ribs slope downward slightly from back to front. But in people with a barrel chest, the shape of the rib cage tends to round outward and your chest area starts to look as round as a barrel. Think of how your chest expands when you take a deep breath in and hold it.

Bodybuilders with overdeveloped chest muscles may also appear to have a barrel chest. However, this post is concerned with barrel chests that result from chronic respiratory conditions, such as emphysema and severe asthma.

In the form of COPD known as emphysema, there can be many changes in the lungs that make it harder to breathe over time. The airways and the cells in them also become more rigid and less able to expand and contract as you breathe.

Your diaphragm also flattens and weakens, which matters because it's a key muscle for moving air into and out of your lungs. This clogs the lungs and makes it harder to breathe. Mucus can be yellow, greenish, white, or clear. People with COPD tend to get sick with upper respiratory tract infections more easily and take longer to recover. When you have COPD, the airways that allow oxygen to flow to your lungs are often more narrow than normal.

As the air struggles to get through these thinner passageways, it causes the airway walls to vibrate. The vibration produces a whistling sound known as wheezing. Bronchodilator and steroid medicines can open up your airways to improve breathing and relieve your wheezing. Wheezing is a serious symptom that requires medical attention especially with symptoms that include:. COPD can also turn your lips and nails a bluish color.

Normally, your blood is red. This bluish-colored blood can give your lips and fingernails a blue hue. A bluish discoloration of the skin is also called cyanosis. Swelling in your legs or feet is another serious symptom.

To make up for the damage to your lungs, your heart has to pump harder to get enough oxygen to the rest of your body. Over time, your heart muscle can become damaged and enlarged from the extra work. BMI was associated with increased AP diameter in these patients. Chronic obstructive pulmonary disease COPD is characterized by progressive, incompletely reversible airflow obstruction, and enhanced chronic inflammatory responses to noxious particles or gases in the airways and lungs 1.

In a significant proportion of patients with COPD, reduced lung elastic recoil combined with expiratory flow limitation eventually leads to lung hyperinflation with progression of disease 2. Increased lung volume and hyperinflation may cause changes in the shape of the thoracic cage in COPD patients.

Despite these findings, previous investigations examining changes in the thoracic cage of COPD patients have reported varying results. Studies measuring the diameter of the thorax have reported no differences in terms of total lung capacity TLC and residual volume RV between patients with emphysema and healthy subjects 8 , 9.

Other studies have reported an increase in the AP diameter of the thorax in patients with COPD compared with normal subjects, especially in the lower part of the thoracic cage, when examined at the level of functional residual capacity We hypothesized that because changes in the shape of the thoracic cage in the normal population can be affected by various factors such as height, weight, age and sex 11 , 12 , 13 , these changes in COPD patients may be more complex than initially believed. The primary objective of this study, therefore, was to evaluate changes and differences in thoracic cage dimensions of patients with COPD compared with normal controls using chest computed tomography.

Our secondary objective was to investigate the factors associated with changes in thoracic cage dimensions in patients with COPD. Patients with stable COPD, who visited the department of outpatient pulmonology, were reviewed. Patients with underlying lung disease, such as bronchiectasislung cancer, interstitial lung disease and fibrothorax, and those with co-existing deformity of the thoracic cage were excluded.

The normal control group comprised individuals who visited general health clinics and underwent a chest computed tomography CT scan and had normal spirometry results. Age- and sex-matched healthy individuals were enrolled as normal controls.

Body mass index BMI -matched control subjects were recruited because of the influence of height and weight on thoracic cage dimensions. Individuals in the control group with any history of lung disease were excluded. Clinical characteristics and demographic data, including smoking history and pulmonary function, were retrospectively collected by chart review. Given the retrospective nature of the study and the use of anonymized data, requirements for informed consent were waived.

Spirometric testing was performed in accordance with criteria published by the American Thoracic Society and the European Respiratory Society The highest value from at least three independent measurements was recorded.

Lung function parameters were expressed as a percentage of the reference values. Exercise performance was based on a standardized protocol and measured using the distance covered in the 6-minute walk test 6-MWT Thoracic cage diameters were measured using chest CT and a modified method based on a previous report Thoracic cage diameters were measured it at three anatomical levels thoracic vertebrae level 3, 6, and 9 because measurement at one anatomical level may result in error s.

The measurements were performed by one professor of the diagnostic radiology department, who performed three measurements at different times at each thoracic level and averaged the data. For each thoracic segment, several thoracic cage diameters were measured using an electronic caliper at CT scan. Continuous variables and categorical variables were compared using an unpaired t test, and the groups were compared using Pearson's chi-square test.

Univariate and multivariate linear or logistic regression analyses were performed to evaluate factors associated with change s in thoracic cage dimensions. All statistical analyses were performed using SPSS version Eighty-five patients 76 male, 9 female; mean age, The proportion of non-smokers was higher in controls than in the COPD group. A comparison of thoracic cage dimensions between COPD patients and normal controls is presented in Table 3. COPD: chronic obstructive pulmonary disease; A: the maximal transverse diameter; B: mid-sagittal anteroposterior diameter; C and D: the maximal anteroposterior diameter of the right and left hemithorax.

Table 6 summarizes the results of the univariate and multivariate regression analysis for factors related to increased ratio of AP and transverse diameter of the thoracic cage in patients with COPD. In univariate analysis, height, BMI and smoking status were significantly associated with increased ratio of AP and transverse diameter of the thoracic cage in patients with COPD.

The finding of increased AP diameter of the thoracic cage in COPD patients is consistent with results reported in previous studies 9 , 12 , 17 , 18 , 19 , 20 , 21 , However, as a measurement method, we consider that the use of CT in our study was more accurate than the simple caliper measurement of the chest wall and chest X-ray reported in previous studies 16 , 21 , If changes in the thoracic cage are reflective of the degree of hyperinflation, which is associated with more severe airflow obstruction, it is generally a more structural change in patients with COPD.

However, the AP diameter of the thoracic cage did not exhibit a difference according to the severity of COPD in our study. In addition, increased lung volume, which was assessed using TLC and RV in this study, was not associated with increased AP diameter of the thoracic cage. These results suggest that thoracic cage changes in COPD may be associated with not only the degree of hyperinflation and lung function decline, but also various other factors including age, sex, weight, and height.

Age is an important factor in changes of the thoracic cage in the normal population. The elderly population typically exhibits a narrowing of the intervertebral disk space, which causes curvature of the spine, known as kyphosis Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.

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