BACKGROUND: When choosing a specific inhalation device for a chronic obstructive pulmonary disease (COPD) patient, the internal airflow resistance and the ability of the patient to overcome it and to create an optimal inspiratory flow are essential.
OBJECTIVES: The purpose of the present study was to investigate: (1) the peak inspiratory flow (PIF) that a patient with COPD can generate while breathing through two dry powder inhalers and (2) whether in patients with low PIF specific inspiratory muscle training (SIMT) will increase the PIF and exceed the minimal PIF that is considered necessary to guarantee optimal lung deposition of the drug.
METHODS: Inspiratory muscle strength and PIFs were measured in 60 patients with COPD. Then 28 patients with severe COPD and low PIF were randomized to receive SIMT or to a control group.
RESULTS: With the Turbuhaler, 12 patients (20%) could not generate the optimal flow of 60 l/min. PIF correlated very well with maximal inspiratory mouth pressure (PI(max)) for the Diskus and the Turbuhaler, as well as for both males and females (p < 0.001). Following the training period, there was a statistically significant increase in the PI(max) in the training group. This increase was associated with a significant increase in the PIF. All patients overcame the minimal threshold PIF following the training.
CONCLUSIONS: Some patients with severe COPD are not able to generate adequate flow to secure optimal lung deposition of the inhalation with the Turbuhaler. SIMT improves inspiratory muscle strength as well as PIF. Following 8 weeks of training, the optimal PIF enabling adequate lung deposition of the drug was attained in all the trained patients.
PMID: 16155355 DOI: 10.1159/000088095

The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of PImax after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of PImax in the IMT group.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02074813.
Copyright ©ERS 2018.
PMID: 29371379 DOI: 10.1183/13993003.01107-2017

PURPOSE: To examine the effect of incentive spirometry in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD) patients and compare its efficacy with inspiratory resistive muscle training (IMT) technique.
DESIGN: Randomized controlled trial.
METHODS: Thirty patients with COPD, from a general hospital in Mashhad, Iran, were randomly assigned to two study groups. All subjects trained daily in two 15-minute sessions, 4 days a week, for 4 weeks. Respiratory function tests were compared before interventions and at the end of weeks 2 and 4.
FINDINGS: Both techniques improved the mean values of all respiratory function tests (p≤.01). The IMT technique was more effective to improve MVV and PImax (p≤.05). PEFR was better improved in the incentive spirometry group (p≤.05). There was no significant difference for other spirometric parameters between two groups.
CONCLUSIONS: Incentive spirometry can be considered as an effective component for pulmonary rehabilitation in COPD patients.
© 2013 Association of Rehabilitation Nurses.
KEYWORDS: COPD; incentive spirometry; inspiratory resistive muscle training; rehabilitation
PMID: 24402740 DOI: 10.1002/rnj.136

The purpose of this study was to determine if inspiratory muscle training (IMT) alters the oxygen cost of breathing (Vo(2RM)) during voluntary hyperpnea. Sixteen male cyclists completed 6 wk of IMT using an inspiratory load of 50% (IMT) or 15% placebo (CON) of maximal inspiratory pressure (Pi(max)). Prior to training, a maximal incremental cycle ergometer test was performed to determine Vo(2) and ventilation (V(E)) at multiple workloads. Pre- and post-training, subjects performed three separate 4-min bouts of voluntary eucapnic hyperpnea (mimic), matching V(E) that occurred at 50, 75, and 100% of Vo(2 max). Pi(max) was significantly increased (P < 0.05) by 22.5 ± 8.7% from pre- to post-IMT and remained unchanged in the CON group. The Vo(2RM) required during the mimic trial corresponded to 5.1 ± 2.5, 5.7 ± 1.4, and 11.7% ± 2.5% of the total Vo(2) (Vo(2T)) at ventilatory workloads equivalent to 50, 75, and 100% of Vo(2 max), respectively. Following IMT, the Vo(2RM) requirement significantly decreased (P < 0.05) by 1.5% (4.2 ± 1.4% of Vo(2T)) at 75% Vo(2 max) and 3.4% (8.1 ± 3.5% of Vo(2T)) at 100% Vo(2 max). No significant changes were shown in the CON group. IMT significantly reduced the O(2) cost of voluntary hyperpnea, which suggests that a reduction in the O(2) requirement of the respiratory muscles following a period of IMT may facilitate increased O(2) availability to the active muscles during exercise. These data suggest that IMT may reduce the O(2) cost of ventilation during exercise, providing an insight into mechanism(s) underpinning the reported improvements in whole body endurance performance; however, this awaits further investigation.
PMID: 21979803 DOI: 10.1152/japplphysiol.00954.2011

BACKGROUND: In recent years, there has been increased interest in the subjective quality of life (QoL) of patients with bronchial asthma. QoL is a significant indicator guiding the efforts of professionals caring for patients, especially chronically ill ones. The identification of factors affecting the QoL reported by patients, despite their existing condition, is important and useful to provide multidisciplinary care for these patients.
AIM: To investigate the clinical factors affecting asthma patients' QoL.
METHODS: The study comprised 100 patients (73 female, 27 male) aged 18-84 years (mean age was 45.7) treated in the Allergy Clinic of the Wroclaw Medical University Department and Clinic of Internal Diseases, Geriatrics and Allergology. All asthma patients meeting the inclusion criteria were invited to participate. Data on sociodemographic and clinical variables were collected. In this study, we used medical record analysis and two questionnaires: the Asthma Quality of Life Questionnaire (AQLQ) to assess the QoL of patients with asthma and the Asthma Control Test to measure asthma control.
RESULTS: Active smokers were shown to have a significantly lower QoL in the "Symptoms" domain than nonsmokers (P=0.006). QoL was also demonstrated to decrease significantly as the frequency of asthma exacerbations increased (R=-0.231, P=0.022). QoL in the domain "Activity limitation" was shown to increase significantly along with the number of years of smoking (R=0.404; P=0.004). Time from onset and the dominant symptom of asthma significantly negatively affected QoL in the "Activity limitation" domain of the AQLQ (R=-0.316, P=0.001; P=0.029, respectively). QoL scores in the "Emotional function" and "Environmental stimuli" subscale of the AQLQ decreased significantly as time from onset increased (R=-0.200, P=0.046; R=-0.328, P=0.001, respectively).
CONCLUSION: Patients exhibiting better symptom control have higher QoL scores. Asthma patients' QoL decreases as time from onset increases. A lower QoL is reported by patients who visit allergy clinics more often, and those often hospitalized due to asthma. Smoking also contributes to a lower QoL in asthma patients.
KEYWORDS: bronchial asthma; clinical factors; quality of life
PMID: 27143863 PMCID: PMC4844459 DOI: 10.2147/PPA.S103043