Diaphragmatic recovery after lung volume reduction surgery

In patients with severe COPD and emphysema, hyperinflation can impair diaphragmatic mechanics, and its reduction may contribute to the clinical benefits of lung volume reduction surgery (LVRS). At ERS 2026 in Barcelona, Dr Christelle van der Velde, thoracic surgeon in training and PhD candidate at the University Hospitals Leuven, presented a poster describing preliminary findings from an ongoing prospective observational cohort study investigating diaphragmatic recovery following minimally invasive lung LVRS and assessing whether diaphragmatic ultrasound could serve as a surrogate for invasive assessment of diaphragmatic function.

The study included 28 patients, of whom 20 completed six-month follow-up and 14 underwent invasive measurements. Preliminary results showed significant improvements in pulmonary function, including FEV1, residual volume and RV/TLC, as well as six-minute walking distance and St George’s Respiratory Questionnaire scores. Transdiaphragmatic pressure also improved significantly following LVRS.

Ultrasound measures of diaphragmatic thickening fraction and excursion were highly variable, showed no significant improvement and did not correlate with invasive measurements. These findings suggest that ultrasound and invasive techniques may capture different aspects of diaphragmatic recovery. Further analysis will examine relationships between diaphragmatic function and clinical outcomes to clarify its role in treatment response after LVRS.