الفهرس 
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Abstract
COPD is one of the top three causes of death worldwide and 90% of these deaths occur in low -and middle -income countries.
However, in many patients the disease is associated with several systemic manifestations that can effectively result in impaired functional capacity, worsening dyspnea, reduced health-related quality of life and increased mortality. The best recognized manifestations include the presence of concomitant the loss and dysfunction of skeletal muscles, cardiovascular compromise, malnutrition, osteoporosis, anemia, increased gastroesophageal reflux and clinical depression and anxiety.
Skeletal muscle dysfunction occurs in COPD patients and influences both respiratory and non-respiratory muscles. It represents a very important comorbidity leading to worse outcomes, including increased mortality and hospitalization rates. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work.
Diaphragmatic ultrasound is a useful method to assess the anatomy and function of the diaphragm, specifically diaphragmatic excursion and thickening. Because of the portability of ultrasound device, ultrasound of the diaphragm can be easily performed at outpatient clinic or bedside in the ward, intensive care unit, or emergency department. The supine position is the preferred positioning for diaphragmatic ultrasound because there is less variability and greater reproducibility.
Although the gold standard for muscle mass testing is computed tomography (CT), magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DEXA), these measurements have some limitations. They are time-consuming, expensive and require specialized equipment and cannot operate at bedside. The CT and DEXA can carry radiation hazards.
Ultrasound (US) is widely used to diagnose and follow-up in the clinic. It can distinguish muscle tissue from subcutaneous fat and show the thickness and cross-sectional area of muscle.
This study was a cross sectional prospective study, comprising of 44 cases who were diagnosed as COPD according to Global Initiative for chronic Obstructive Lung Disease (GOLD, 2020) criteria, conducted from 30th of August 2020 until 30th of July 2022 at Chest Department and out patient clinic (OPC), Ain Shams University Hospitals.
All patients were subjected to the following:-
• Full history taking focusing on smoking status using pack-year index, number of exacerbations in the last year as an indicator of disease severity.
• Complete clinical assessment.
• Transthoracic US of the diaphragm was done to examine diaphragmatic thickness and excursion.
• Biceps and triceps muscles thickness estimated with a B-mode ultrasound
• SMM estimation done using Eufy Body Sense Smart Scale
With inclusion criteria including, Stable COPD patients admitted to Chest Department or visiting out- patient clinic at Ain Shams University Hospitals.
And Exclusion criteria including, Heart failure, liver cell failure, other system failure, acute exacerbation of COPD, endocrinal disorders, concomitant chronic pulmonary disease, systemic steroids use in the last 2 months, concomitant muscular disorders (e.g. Myositis, Multiple Sclerosis Fibromyalgia, Muscular Dystrophy, or Neuromuscular Disorders).
The following results obtained
Patients with low SMM significantly had higher smoking pack/years and number of exacerbations in the last year as well as significantly lower bilateral copula thickness, copula excursion, biceps thickness and triceps thickness, in addition more frequent current smoking.
Copulae thickness and excursion showed significant positive correlations with, biceps thickness and triceps thickness as well as significant negative correlations with smoking pack/years and number of exacerbations in the last year, and there was significant positive correlation between copulae thickness and excursion.
Biceps and triceps thickness showed positive correlation with both copulae thickness and excursion, as well as significant negative correlation with smoking pack/years and number of exacerbations in the last year.
Smoking pack/years and low SMM were significant independent factors that decreased copula excursion, while copula thickness was an independent factor that increased copula excursion. Number of exacerbations in last year and low SMM were significant independent factors that decreased copula thickness.
Smoking pack/years and low SMM were significant independent factors that decreased biceps and triceps thickness.
Smoking pack/years and number of exacerbations in the last year were significant independent factors that increased the likelihood of having low SMM.