Patients with dyspnea often have difficulty coming off the ventilator, especially in the ICU but even in pulmonology clinics. One frequently overlooked cause of this problem is diaphragm dysfunction. To accurately diagnose disorders of this muscle at the bedside—both in patients who are ventilated and spontaneously breathing—it is necessary to be familiar with the entire clinical spectrum as well as high-risk groups.
“Even 24 hours of mechanical ventilation can cause atrophy of the diaphragm and weakness, which can prevent or delay extubation, increase the length of stay, and result in additional complications,” said Muhammad Ehtesham, MD, MBBS, FCCP. “Similarly, I have seen people with this problem, even in the clinic, who have issues such as neuromuscular disease or emphysema with hyperinflation.”
Dr. Ehtesham will chair the interactive, case-driven CHEST 2026 session Underdiagnosed, Undermanaged: The Modern Challenge of Diaphragm Dysfunction at 3:15 pm MST on Monday, October 19, in the Phoenix Convention Center, West Building, Room 104B. During the session, experts will spotlight key warning signs of diaphragm dysfunction, such as orthopnea and paradoxical breathing; demonstrate point-of-care ultrasound techniques, such as diaphragmatic excursion, thickening fraction, and rapid M-mode assessment; and evaluate current and evolving management strategies.
“The goal of this session is to educate chest medicine clinicians on how best to approach these patients,” Dr. Ehtesham said. “There are very specific standards to follow, questions to ask, and tests to be ordered to arrive at a diagnosis of diaphragm dysfunction, as well as structured therapeutic strategies.”
Komal Singh, MD, Pulmonary and Critical Care Fellow at Henry Ford Health, will begin the session by presenting illustrative clinical scenarios that explore this often-underdiagnosed pulmonary condition.
Dr. Ehtesham, Associate Professor of Medicine at Michigan State University and Pulmonary and Critical Care Specialist at Henry Ford Health, will then focus on key warning signs and risk factors to assist clinicians in identifying diaphragm dysfunction in both clinical and ICU settings.
Taro Minami, MD, FCCP, Associate Professor in the Warren Alpert Medical School at Brown University, will discuss point-of-care ultrasound techniques as well as pitfalls to avoid in mastering bedside diagnosis of diaphragm dysfunction.
“The heart of the discussion will be how to evaluate these patients, especially with diaphragmatic ultrasound, and the need to use other different metrics to assess the diaphragm,” Dr. Ehtesham said.
Rania Esteitie, MD, FCCP, Assistant Professor of Internal Medicine at Central Michigan University and Pulmonary and Critical Care Specialist at Covenant HealthCare, will close the session by reviewing current management approaches, such as noninvasive ventilation and phrenic pacing, and offering a glimpse into emerging therapies.
“There is a gap in terms of training about diaphragm dysfunction,” Dr. Ehtesham said. “With this session, we want to fill that knowledge gap and try to improve the care of our patients.”
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