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Updated: Jul 6, 2026

Dual Test Gas Pulmonary Diffusing Capacity Measurement During Exercise in Humans Using the Single-Breath Method
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Thoracic ratio and diaphragmatic excursion predict lung function impairment in COPD patients.

Yao Ning Zhuang1, Qing Qing Zhan1, Bin Qin Lin1

  • 1Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China.

Scientific Reports
|July 4, 2026
PubMed
Summary

In chronic obstructive pulmonary disease (COPD), thoracic transverse diameter/anteroposterior diameter ratio and diaphragmatic excursion during deep breathing are key predictors of lung function. Combining these non-invasive measures aids in early COPD identification and personalized management.

Keywords:
Chronic obstructive pulmonary diseaseDecision curve analysisDiaphragmatic functionMediation analysisThoracic anteroposterior diameterThoracic transverse diameter

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Area of Science:

  • Pulmonary Medicine
  • Diagnostic Imaging
  • Respiratory Physiology

Background:

  • Chronic obstructive pulmonary disease (COPD) significantly impacts lung function and diaphragmatic activity.
  • Thoracic skeletal morphology, assessed by the TTD/ATD ratio, may influence respiratory mechanics in COPD.
  • Diaphragmatic excursion during deep breathing (DE-DB) reflects respiratory muscle function and can be impaired in COPD.

Purpose of the Study:

  • To examine the correlation between the TTD/ATD ratio and DE-DB in COPD patients.
  • To evaluate the predictive value of these parameters for lung function impairment.
  • To elucidate the underlying mechanisms and clinical utility of combined assessment using mediation and decision curve analysis.

Main Methods:

  • A cross-sectional study involving 120 COPD patients.
  • Measurement of TTD/ATD ratio, ultrasonographic DE-DB, and pulmonary function tests (including FEV1/FVC and FEV1% predicted).
  • Statistical analyses included correlation, regression, mediation analysis, and decision curve analysis (DCA).

Main Results:

  • Both TTD/ATD ratio and DE-DB decreased with increasing COPD severity and were positively correlated with each other (r=0.569, P<0.001).
  • Both parameters strongly correlated with FEV1/FVC and FEV1% predicted (r=0.73-0.81, P<0.001).
  • DE-DB partially mediated the effect of TTD/ATD on FEV1% predicted (26.2%). The combined model (TTD/ATD + DE-DB) showed superior predictive performance (AUC=0.963) and clinical utility via DCA, enabling effective risk stratification.

Conclusions:

  • Thoracic configuration and diaphragmatic function are closely associated and independent predictors of lung function in COPD.
  • Diaphragmatic function plays a partial mediating role in how thoracic configuration affects lung function.
  • Combined assessment of TTD/ATD and DE-DB offers a powerful, non-invasive tool for early COPD risk stratification and personalized management.