Correlation of diaphragm thickness with pulmonary function test in Parkinson’s disease

doi:10.5662/wjm.v16.i3.115087

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 115087
Published online Sep 20, 2026. doi: 10.5662/wjm.v16.i3.115087

Correlation of diaphragm thickness with pulmonary function test in Parkinson’s disease

Zeliha Cosgun, Emine Afsin, Ramazan Kurul, Sule Aydin Turkoglu, Melike Elif Kalfaoglu, Gulali Aktas

Zeliha Cosgun, Melike Elif Kalfaoglu, Department of Radiology, Abant Izzet Baysal University, Bolu 14030, Türkiye

Emine Afsin, Department of Pulmonology, Abant Izzet Baysal University, Bolu 14030, Türkiye

Ramazan Kurul, Department of Physiotherapy in Faculty of Health Sciences, Abant Izzet Baysal University, Bolu 14030, Türkiye

Sule Aydin Turkoglu, Department of Neurology, Abant Izzet Baysal University, Bolu 14030, Türkiye

Gulali Aktas, Department of Internal Medicine, Abant Izzet Baysal University, Bolu 14030, Türkiye

Author contributions: Cosgun Z contributed to writing-original draft; Afsin E contributed to writing-first draft; Kalfaoglu ME writing-review & editing, supervision; Aktas G contributed to supervision; Cosgun Z, Afsin E, Kurul R, Turkoglu SA, and Aktas G contributed to writing and review and editing, conceptualization; Cosgun Z and Afsin E contributed to visualization, investigation, formal analysis, data curation; Afsin E, Kurul R, Turkoglu SA, and Aktas G contributed to methodology; Kurul R, Turkoglu SA, and Aktas G contributed to investigation.

AI contribution statement: Our manuscript was not AI-generated. Only ChatGPT was used for language polishing and grammar checking. No AI was involved in study design, data analysis, or result interpretation. All text and images are original, created independently by the authors.

Institutional review board statement: This prospective cohort study was approved by the Ethics Committee of our hospital (approval No: 2021/146, approval date: June 8, 2021).

Informed consent statement: Informed consent obtained from all participants before the study.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.

Data sharing statement: All data generated during this work is available by the corresponding author on reasonable requests.

Corresponding author: Gulali Aktas, Chief Physician, Professor, Department of Internal Medicine, Abant Izzet Baysal University, Golkoy, Bolu 14030, Türkiye. draliaktas@yahoo.com

Received: October 13, 2025
Revised: November 4, 2025
Accepted: December 23, 2025
Published online: September 20, 2026
Processing time: 276 Days and 3.8 Hours

Abstract

BACKGROUND

Dopaminergic neurons are lost in Parkinson’s disease (PD), a degenerative neurological condition. While the effects of PD on motor functions are well understood, its impact on respiratory function is less clear. In PD patients with suspicious pulmonary symptoms, the presence and degree of impairment in lung function often cannot be optimally assessed through pulmonary function tests (PFTs) due to the patients' neurological symptoms.

AIM

To examine the relationship between diaphragmatic thickness as determined by ultrasonography (US) and conventional PFTs in PD patients. Additionally, we evaluated the potential use of diaphragmatic thickness as an alternative measure for assessing respiratory function in PD patients who are unable to perform PFTs.

METHODS

A total of 43 PD patients who presented to the clinics between June 15, 2021, and June 30, 2022, were included. Patients with coronavirus disease 2019 infection history, conditions affecting diaphragmatic motility, recent thoracic or abdominal surgery, or imaging showing restrictive masses were excluded. Demographic data, disease duration, Hoehn-Yahr stage, and medication use were recorded. PFTs were used to evaluate forced vital capacity, forced expiratory volume in the first second, and other parameters, while US was used to measure diaphragmatic thickness. Breathlessness was assessed using the modified medical research council dyspnea scale.

RESULTS

Significant correlations were found between peak expiratory flow (PEF) and diaphragm fraction (P = 0.019), as well as between PEF percentage and diaphragmatic thickness during expiration (P = 0.023). In early-stage PD, diaphragmatic thickness during inspiration correlated with oxygen saturation (P = 0.048). In advanced-stage PD, PEF and PEF% were significantly correlated with diaphragm thickness during expiration [r = 0.405, P = 0.049 (for PEF); r = 0.463, P = 0.023 (for PEF%)] and diaphragm fraction [r = -0.476, P = 0.019 (for PEF); r = -0.617, P = 0.001 (for PEF%)].

CONCLUSION

Present study assessed the relationship between PFTs and diaphragmatic thickness in PD patients. Diaphragmatic thickness measured by US was found to correlate with certain PFT parameters, suggesting it could be used as an alternative measure for assessing respiratory function in Parkinson’s patients who have difficulty performing PFTs.

Keywords: Parkinson’s disease; Ultrasonography; Diaphragmatic thickness; Pulmonary function test; Respiratory function

Core Tip: In addition to motor impairments, Parkinson’s disease is also associated with respiratory dysfunction. This study investigated the relationship between diaphragm thickness measured by ultrasound and pulmonary function test (PFT) parameters. The results demonstrated significant correlations, particularly in advanced-stage patients, between diaphragm thickness and PFT values. Ultrasound-based diaphragm assessment may serve as a promising non-invasive alternative for monitoring respiratory function in Parkinson’s patients who are unable to perform PFTs.