Statistical significance was assumed for two-tailed p<0.05. There are some factors due to which the alveoli may remain collapsed even when you inhale. The feedback link Was this Article Helpful on this page can be used to report content that is not accurate, up-to-date or questionable in any manner. There may be no obvious signs or symptoms of atelectasis. There are three major types of atelectasis: adhesive, compressive, and obstructive. https://doi.org/10.1097/00004728-200411000-00010. https://www.uptodate.com/contents/search. Commonest cause of atelectasis is due to blockage of airway. Atelectasis occurs when parts of the lung tissue do not fill up with air. Our study has several limitations to be addressed. If I Want To Conceive, Will My Husband's Diabetes Affect Our Baby ? Subsegmental atelectasis is usually mild and does not produce symptoms that may cause discomfort for the . [2], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Being due to gravity, it usually has a dependent and subpleural distribution. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. On CT atelectasis is seen commonly in the dependent lung regions as an ill-defined area of increased attenuation or subpleural curvilinear opacities ( Fig. This is very common when one has gone through a blunt force or trauma on the chest. A subtype of subsegmental atelectasis is linear atelectasis (also known as discoid or plate-like atelectasis, and historically as Fleischner lines on chest radiographs ). In-hospital mortality was not different among groups (p=0.55). Mild dependent atelectasis refers to small areas of the lung near the spine that do not fully expand when a person is lying down, states NetWellness. Smoking or excessive exposure to cigarette smoke. Mucus that plugs the airway, foreign objects in the . To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. After treatment, a collapsed lung usually begins working the way it should again. I don't even have history of tb. Your lungs are where your body takes in oxygen and gets rid of carbon dioxide. This may occur in two ways. G Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L, et al. In this sense, in the group of patients without atelectasis 18 patients (15%) needed to be admitted in the ICU, compared to 2 patients (7%) in the group of small atelectasis (p=0.37) and to 6 patients (75%) in the group of larger atelectasis (p<0.01). Data from the prevalence of atelectasis, ICU admission rate and mortality are shown as percentage of the group. Doctors call that condition atelectasis. Atelectasis with pneumonia: a pathophysiologic study. Moreover, the hypoxic pulmonary vasoconstriction reflex (Euler-Liljestrand mechanism [17]) may further worsen ischemic and thrombotic phenomena in the lung. 'dependent' means that the less inflated areas are in regions of the lung where gravity is pulling the. LB: review of the manuscript. On the CT Scan they found no pericardial effusion, but they did find bibasilar subsegmental atelectasis. Smetana GW, et al. If you have a procedure coming up, speak with a healthcare professional about ways to reduce your risk of atelectasis after surgery. Surgery. The term atelectasis . Coughing a lot with pus and mucus is the main symptom of bronchiectasis. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. If you do have signs and symptoms, they may include: Always seek medical attention right away if you have trouble breathing. Linear opacities in the lung base are noted compatibke with subsegmental atelectasis ? Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. Do lung tumors and atelectasis of the lung look similar on high resolution ct scan of lungs? Get answers from Pulmonologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. PubMed i had mild inflammation and took dexamethasone? Increased pulmonary vascular resistance (PVR), Inflammation as a local tissue biologic response, Impaired penetration of antibiotics into lung tissue, Factors that can initiate or exaggerate lung injury, Reduced breath sound on the ipsilateral side of. Meconium can block air from entering the alveoli, causing . Should I be worried at 30 yrs? This content does not have an Arabic version. Terms and Conditions, (n.d.). Make a donation. It is like a balloon with the air let out. A single copy of these materials may be reprinted for noncommercial personal use only. People who have to stay in bed for long periods of time should try to move around regularly. When inactivated, decreased expansion of the alveoli can occur as a result of increased local surface tension causing a reduction in resting lung volume globally. Eur J Radiol. Google Scholar. When an individual stays in supine position {generally during a CT scan} the portion of lung {dependent} does not inflate completely. Thorax. Atelectasis is a collapse in part of the lungs. The medication that puts you to sleep (called anesthesia) can affect how your lungs work. Loss of the Left hemidiaphragm outline posteriorly and denser lower thoracic vertebrae can be observed on the lateral view. Since minimal dependent atelectasis affects only a small part of the lungs, the symptoms are generally not too severe. Incidence doesn't increase in patient with increased age, The incidence of atelectasis in patients who have recently undergone general anesthesia is as high as 90%, It is commonly observed as a complication in, Atelectasis is less commonly seen in patients with conditions like, Cephalad displacement of the diaphragm in, pathophysiologic mechanism (e.g., compressive atelectasis), the amount of lung involved (e.g., lobar, segmental, or subsegmental atelectasis). What does this mean? Nearly everyone who has major surgery develops some amount of atelectasis. This content does not have an English version. health information, we will treat all of that information as protected health Chest. If a tumor or another health condition is causing the problem, your doctor will treat it. In fact, they required a higher ICU admission rate, with greater need of intubation and invasive mechanical ventilation. https://www.uptodate.com/contents/search. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Healthline Media does not provide medical advice, diagnosis, or treatment. Expert Rev Respir Med. Spirometry is an important test for your lung health. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. The condition may also be caused due to injury in the liver. What is Mild Dependent Atelectasis? This is the American ICD-10-CM version of J98.11 - other international versions of ICD-10 J98.11 may differ. down - often related to the patient being in one position for a long time. . If you are a Mayo Clinic patient, this could Foreign object in the airway (most common in children . Accessed August 20, 2018. What are treatment methods. For potential or actual medical emergencies, immediately call 911 or your local emergency service. This condition . Atelectasis of Lung as a First Sign of Lung Cancer - longdom.org Diagnosis: JAMA. Scores used in the study & Analysis of in-hospital mortality adjusted to pulmonary embolism (PE). View complete answer on mayoclinic.org. Atelectasis is also known as a collapsed lung or partially collapsed lung. Mild dependent atelectasis refers to small areas of the lung near the spine that do not fully expand when a person is lying down, states NetWellness. Doctoral Degree. Google Scholar. The development of significant atelectasis favors more chances of respiratory complications and a higher morbidity with greater risk of ICU admission and need for invasive mechanical ventilation. When lying down, you may be asked to ensure that your head is below the level of your heart. Treatment for many occurrences of atelectasis involves loosening mucus in the lungs, performing deep breathing exercises and removing obstructions by bronchoscopy, according to MedlinePlus. https://doi.org/10.1016/j.resp.2020.103455. Medications. For potential or actual medical emergencies, immediately call 911 or your local emergency service. This can force some of the air out of your alveoli, causing them to deflate. i'm 44. my mother died of ipf at 43.should i worry? [1][2], Following table comprises the classification of atelectasis based on pathophysiologic mechanism[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], Atelectasis can be classified on the basis of location according to radiological patterns of collapse[12]. Atelectasis is a condition in which there is collapse of lung tissue ( parenchyma) with loss of volume. b Patient with small atelectasis. Stark P, et al. A Quick Review. https://doi.org/10.1007/s00134-020-06088-1. WebMD does not provide medical advice, diagnosis or treatment. Indeed, up to 38 patients (24%) showed some degree of atelectasis at chest CT: 30 (19%) patients showed small atelectasis in the chest CT and 8 patients (5%) showed large atelectasis. Jan 26, 2010. Kinetic Therapy: It is defined as the continuous turning of a patient slowly along the longitudinal axis to 40 onto each side, using a specialized bed. We adjusted in-hospital mortality based on the presence of pulmonary embolism (PE) by comparing the mortality between the groups with PE versus no PE (since the reason for inclusion in the study was the performance of a chest CT due to a respiratory worsening, including suspect of PE associated with SARS-CoV-2 pneumonia, Additional file 1). They are the terminal part of respiratory system. The worst SatO2/FiO2 ratio was different among groups (p=0.03), being 300 (range 99 to 431) in the patients without atelectasis, 379 (range 247 to 453) in patients with small atelectasis (p=0.05), and 182 (range 113 to 359) in patients with large atelectasis (p=0.37). These can help reduce inflammation by reducing swelling and mucus . Atelectasis. If this analysis was significant, two-by-two post hoc comparisons (2 or Fisher test) were carried out between the groups. Intensive Care Med. Surfactant deficiency tends to happen to infants who are born prematurely. Posterior dependent atelectasis bilaterally. Atelectasis is a medical condition that occurs when your lung or a part of your lung fails to expand properly. Many instances of minimal dependent atelectasis do not require any treatment, as the problem gets resolved on its own. Nasal and/or oral steroids. the location (i.e., specific lobe or segment location). Mayo Clinic does not endorse companies or products. For these, please consult a doctor (virtually or in person). This scarring is permanent and makes it harder for your alveoli to inflate. When vigorous chest therapy is not favorable for the patient or contraindicated for example individuals with chest trauma, unstable vertebral fractures, extensive burns, smoke inhalation, neuromuscular diseases, etc. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. To do this, they might have you do one or more of the following tests: Treating atelectasis depends on the underlying cause and how severe your symptoms are. This may be due to a reflex nervous stimulus. Chest physiotherapy is also quite effective in treating atelectasis. Though it cannot be cured, treatment can help manage symptoms. shortness of breath. In this database, the personal data of the patients were adequately encoded to guarantee data protection. Mild atelectasis is rarely life threatening and usually goes away quickly once the cause is addressed. The white out (complete opacification of a hemithorax) can be seen in complete lung collapse. Atelectasis. Whether if these differences are associated directly or indirectly to atelectasis has to be determined on further studies. Injury. The authors declare no competing interests. It is a condition where the alveoli are deflated down to little or no volume, as distinct from pulmonary consolidation, in which they are filled with liquid.It is often called a collapsed lung, although that term may also refer to pneumothorax. Atelectasis might produce minimal symptoms if it develops slowly or involves only a small portion of the lung. It's a condition where all or part of a. 2005 - 2023 WebMD LLC. The chest xray should be reviewed and discussed with your asthma specialist. The findings of the tests will help your doctor determine the appropriate treatment path. In the group of patients with large atelectasis 33% of patients with PE died while none (0%) of patients without PE died in-hospital. The total CT score was the sum of the individual lobar scores and ranged from 0 (no involvement) to 25 (maximum involvement). when standard chest physiotherapy has been failed to produce a positive outcome. [9, 10], takes into account the percentage of lobar infiltration and even pleural effusion, which could be logically associated with worst outcome. Patients with no atelectasis required 15 (7 to 23) days of in-hospital admission, compared to 14 (6 to 23) days in patients with small atelectasis (p=0.99) and to 40 (17 to 54) days in patients with large atelectasis (p=0.02) (Fig. What Is A Detoxification Diet & How Is It Helpful? . Following are the treatments followed depending upon the underlying cause: Blockage. Atelectasis is a lung condition that happens when your airways or the tiny sacs at the end of them dont expand the way they should when you breathe. Results in minimal opacity and is often overlooked. If you're experiencing mild atelectasis, your doctor may recommend the following treatments: Medications to reduce hyperinflation or apnea. In adults, atelectasis most commonly occurs after major surgery. Manage cookies/Do not sell my data we use in the preference centre. Prematurity: Atelectasis is a relatively common complication of prematurity because premature babies may not have enough surfactant, the fluid that helps keep alveoli open. In some cases of narrowed airways, respiratory stimulants are effective at widening the airway. Atelectasis is the condition when the lungs do not work efficiently. Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2. . Reaction to anesthetic drugs. If the lungs are affected marginally, this condition is called mild dependent atelectasis. Our articles are resourced from reputable online pages. Atelectasis means a partial or full lung collapse. It often occurs after heart bypass surgery. Pleural effusion, also called water on the lung, happens when fluid builds up between your lungs and chest cavity. Mild eventration of the right diaphragm was seen. JAMA. In addition, outcome variables that have value when it comes to the analysis of the prognosis, such as in-hospital mortality, days of admission to the ICU (if required) or total days of hospitalization were collected. The collapse of the lungs may be either full or partial. Among them, 19% of the patients showed small atelectasis and 5% of the patients showed large atelectasis. The establishment of an early treatment with non-invasive respiratory ventilation to reverse atelectasis or prevent their progression, together with intensive surveillance or in intermediate care, could prevent a progression of lung injury with a worse outcome in patients in which this condition is detected. https://www.physio-pedia.com/index.php?title=Atelectasis&oldid=312944, Respiratory System - Assessment and Examination. There are certain scars which are developed in the lungs due to surgery of certain chemicals which are accidentally inhaled. 31,112 satisfied customers. Biopsy? Some research suggests that certain breathing exercises and muscle training may lower the risk of atelectasis after certain surgeries. Through better care and quick medical intervention, the condition is reversible. The Video below demonstrates on the use incentive spirometer: The Video below demonstrates on different chest physiotherapy treatment options in pediatric population: Flexible bronchoscopy can be used for both diagnosing and treating a patient with atelectasis. Indeed, ICU admission rate was lower in patients with small atelectasis compared to large atelectasis (p<0.01). What Is Pleural Effusion (Fluid in the Chest)? The mild bibasilar atelectasis, even after treatment may reduce the overall capacity of the lungs. Representative chest Computed Tomography scans in patients with SARS-CoV-2 pneumonia. PubMedGoogle Scholar. https://doi.org/10.1007/s00134-020-06033-2. Here, your blood dumps carbon dioxide and picks up fresh oxygen to carry to the cells in your body. Management of critically ill adults with COVID-19. Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. You can learn more about how we ensure our content is accurate and current by reading our. Mayo Clinic is a not-for-profit organization. Advertising revenue supports our not-for-profit mission. There are various causes due to which mild bibasilar atelectasis may happen. If your breathing becomes increasingly difficult, seek emergency medical help. Research has shown that lifestyle modifications, including following a nutrient-rich diet, can help protect your lungs. It is usually the bottom portion, and is therefore asymptomatic. https://doi.org/10.1183/09031936.00013908. Atelectasis can develop due to a blocked airway or pressure from outside of the lung, explains Mayo Clinic. Deficiency of acquired dysfunction(e . Atelectasis: Types and pathogenesis in adults. The decision should be taken quickly so as to prevent further damage and to prevent the tumor from metastasizing. Carbon dioxide also passes from the blood to the sacs to leave the body. Adjusting for PE, (see Additional file 1 for more information), in the no atelectasis group, 19% of the patients with PE deceased compared to 6.9% of mortality in those who did not have PE. The term atelectasis can also be used to describe the collapse of a previously inflated lung, either partially or fully, because of specific respiratory disorders. privacy practices. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. For these, please consult a doctor (virtually or in person). information submitted for this request. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. The following complications may result from atelectasis: Atelectasis in children is often caused by a blockage in the airway. If there is any bleeding in the lungs, a clot is formed which leads to blockage in the lungs leading to collapse. Perioperative Pulmonary Atelectasis: Part I. The term does not specify how much of the lung has collapsed. 2020;295(3):200463. https://doi.org/10.1148/radiol.2020200463. Ground-glass opacities (GGOs) show up as lighter-colored or gray patches on chest CT scans of the lungs. SatO2/FiO2 ratio at the time of CT. 2005-2023 Healthline Media a Red Ventures Company. 2015;9:97. This may be due to the use of anesthesia or the patient might be suffered from irritation in diaphragm. The term subsegmental atelectasis includes any loss of lung volume so small that it does not cause indirect signs of volume loss (as might be seen with larger atelectases). Wichmann D, Sperhake JP, Ltgehetmann M, Steurer S, Edler C, Heinemann A, et al. What doctor specializes? Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Things that can raise your chances of it include: The two main types of atelectasis are obstructive (also called resorptive) and nonobstructive. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. said i have minimal dependent atelectasis at lung bases. Eur J Radiol. Correspondence to Types and mechanisms of pulmonary atelectasis, Pulmonary Atelectasis Clinical Presentation: History, Physical, Causes, Atelectasis, Middle Lobe Syndrome and Plastic Bronchitis. To decrease atelectasis risk, keep small objects out of reach of children. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Last medically reviewed on November 10, 2021. Atelectasis. Pleural thickening can indicate serious diseases, such as mesothelioma. It is very commonly seen in the posterior lung bases on CT, particularly in elderly individuals. Shallow breathing. Top Contributors = Areeba Raja, Elena Ferrero Vila, Hing Long Yip, Kim Jackson, Lucinda hampton, Wendy Walker and Sujoy Bose. Luftsichel sign is present (hyper-expanded superior segment of the left lower lobe). What is mild dependent atelectasis? Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Your doctor will monitor you carefully and suggest rest or certain procedures until the lung reinflated. The blockage may be due to mucus production or obstruction due to foreign object. What does minimal linear atelectasis in the lung base mean? Third, the group without atelectasis might not be considered as a standard control group but a group of patients with significant oxygenation impairment due to several causes (including PE), hence introducing a possible selection bias as patients without atelectasis and mild infection would not be represented. However, theyre different conditions. 2020 [published online ahead of print]. Radiology. In order to assess the clinical severity of pneumonia, the patient's score on the CURB 65 scale was collected upon hospital admission [7] [see Additional file 1]. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. The consent submitted will only be used for data processing originating from this website. We made this distinction based on proposed pathophysiology of the SARS-CoV-2 pneumonia and its relationship with oxygenation: it has been suggested that the progression of the disease would be associated with more severe hypoxia [15]. Time course of lung changes at chest CT during recovery from Coronavirus Disease 2019 (COVID-19). Lancet Respir Med. Lung collapse/atelectasis can occur for many reasons asthmatics get collapse because of mucus plugs in the airway.Sometimes aspiration causes atelect Atelectasis is defined as diminished volume affecting all or part of a lung - an incomplete expansion of part of the lung. Mild Bibasilar Atelectasis is the condition in which the lowest lobes or the inferior lobes of the lungs mildly collapse. In the present study we found that in patients with SARS-CoV-2 pneumonia the prevalence of atelectasis was 24%. Bibasilar Atelectasis Signs and Symptoms. [2], The table below contains the different physical therapy treatment options in patients with atelectasis.[2][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. This condition usually affects the alveoli in the lower part of your lungs. Etiology, diagnosis and treatment in childhood atelectasis. Sounds like you have a history of poorly controlled asthma. In case the atelectasis is caused by a blockage, you will need to undergo a medical procedure known as a bronchoscopy. What does it mean when you have a mild plate like atelectasis in the lung? Gravity-dependent atelectasis occurs due to a combination of reduced alveolar volume and increased perfusion. Atelectasis is also known as a collapsed lung or partially collapsed lung. Liu KC, Xu P, Lv WF, Qiu XH, Yao JL, Gu JF, Wei W. CT manifestations of coronavirus disease-2019: a retrospective analysis of 73 cases by disease severity. Pulmonary atelectasis in anaesthesia and critical care. The air then fills the space outside of the lung, between the lung and chest wall. In a posterior -anterior view, the loss of silhouette of the right heart border can be seen. Atelectasis is a complete or partial collapse of the lung, which can cause serious complications like pneumonia and respiratory failure, although it is treatable. parenchyma, atelectasis presents as a common occurrence in neonates. They look for any previous lung conditions youve had or any recent surgeries. What does this mean? In: Ferri's Clinical Advisor 2018. The duration of oxygen therapy was different among groups (p=0.04). Though minimal dependent atelectasis is not a serious condition, it should be checked and treated by a doctor without any delay. The symptoms are mostly related to the fact that blood is no longer supplied with enough oxygen. Clotting of the Blood: Blood clotting is also known to be one of the causes of bibasilar atelectasis. We and our partners use cookies to Store and/or access information on a device. When larger units of lung parenchyma is involved it is called "collapse" (or . Infection. If only a few alveoli are involved or it happens slowly, you might not have any symptoms. Atelectasis is a common complication of various pulmonary and chest disorders, including RDS, MAS, and pneumonia, rather than an independent disease. (No Ratings Yet) 2020;323(22):232930. No evidence of any air bronchograms. These usually include pain relievers, inhaled bronchodilators and acetylcysteine. 'mild' means that the changes are slight/minimal. The airways continue branching and get progressively smaller until they end in little air sacs called alveoli. Pneumothorax is very similar to pleural effusion but involves a buildup of air, rather than fluid, between the linings of your lung and chest. The right hemidiaphragm may appear elevated because of the obliteration. Atelectasis is the complete or partial collapse of a lung or lobe of a lung, according to Mayo Clinic. Bronchiectasis is a condition where damage causes the tubes in your lungs (airways) to widen or develop pouches. Treatment for mild atelectasis. Its also important for them to frequently practice taking deep breaths. Chest high-frequency oscillations (CHFO) can be delivered via The Metaneb System. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. This causes the mucus to drain away from the bottom of your lungs. You may develop atelectasis if you breathe in a foreign object. Patients with larger compared to smaller atelectasis showed less SatO2/FiO2 ratio, higher rate of ICU admission and longer length of in-hospital stay. I had a ct scan of my abdomen and pelvis. The length of in-hospital stay was different among groups (p=0.01). transferred to this software, were duly encoded. The elastic tissue in your lung pulls inward, driving air out of your alveoli. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Sat O2/FiO2 ratio from each patient was collected as an indirect estimate of lung oxygenation capacity [11] at two moments: at the time of the chest CT and the worse ratio during the hospitalization. This a term means parts of the lung are under-inflated or collapsed. Ferri FF. As the lowest lobes of the lungs get collapsed, the alveoli situated in these lobes could no longer exchange the gases from the blood. 2007;62(3):2539. But if your airways get blocked or something puts pressure on your lungs, they might not inflate the way they should. The patients underwent the chest CT study because of a respiratory worsening (decrease Pa/Fi O2, increase in oxygen therapy support) and in no circumstance for scientific purposes. #1. It is a reversible condition and usually occurs secondary to an underlying pathology. Spirometry Procedure: How to Prepare, Side Effects, and Risks, Everything You Need to Know About Chronic Obstructive Pulmonary Disease (COPD), sputum (phlegm, or thick mucus) production, sharp chest pain, especially when you take a deep breath or cough, inhalation of a foreign object, such as a small toy or small pieces of food, mucus plug (a buildup of mucus) in an airway, tumor in the lung tissue that presses on the airway, take pain medications and sedatives after the surgery, being under or having recently been under anesthesia, usually for surgery, undergoing cardiopulmonary bypass surgery, with increased risk during and after, abdominal and thoracic surgery, with increased risk during and after, having obesity or being pregnant, which can cause the diaphragm muscle to move out of its normal position and reduce lung capacity, stop smoking if you smoke, ideally 6 to 8 weeks ahead of surgery, use an incentive spirometer to encourage deep breathing.