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Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

Abstract

Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.

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  • Authors+Show Affiliations

    ,

    Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France marc.beaumont@univ-brest.fr.

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    Pulmonary Physiology Unit, EA2438, European University of Occidental Brittany, University Brest Centre, Brest, France.

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    Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.

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    Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.

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    Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.

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    Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.

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    Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.

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    Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.

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    Pulmonary and Reanimation Unit, Pitié salpétrière Hospital, Paris, France.

    Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.

    Source

    Chronic respiratory disease 12:4 2015 Nov pg 305-12

    MeSH

    Aged
    Breathing Exercises
    Dyspnea
    Exercise Test
    Exercise Tolerance
    Female
    Forced Expiratory Volume
    Humans
    Inhalation
    Male
    Middle Aged
    Pulmonary Disease, Chronic Obstructive
    Respiratory Muscles
    Total Lung Capacity
    Treatment Outcome
    Vital Capacity

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26170421

    Citation

    Beaumont, M, et al. "Inspiratory Muscle Training During Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: a Randomized Trial." Chronic Respiratory Disease, vol. 12, no. 4, 2015, pp. 305-12.
    Beaumont M, Mialon P, Le Ber-Moy C, et al. Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial. Chron Respir Dis. 2015;12(4):305-12.
    Beaumont, M., Mialon, P., Le Ber-Moy, C., Lochon, C., Péran, L., Pichon, R., ... Couturaud, F. (2015). Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial. Chronic Respiratory Disease, 12(4), pp. 305-12. doi:10.1177/1479972315594625.
    Beaumont M, et al. Inspiratory Muscle Training During Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: a Randomized Trial. Chron Respir Dis. 2015;12(4):305-12. PubMed PMID: 26170421.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial. AU - Beaumont,M, AU - Mialon,P, AU - Le Ber-Moy,C, AU - Lochon,C, AU - Péran,L, AU - Pichon,R, AU - Gut-Gobert,C, AU - Leroyer,C, AU - Morelot-Panzini,C, AU - Couturaud,F, Y1 - 2015/07/13/ PY - 2015/7/15/entrez PY - 2015/7/15/pubmed PY - 2016/8/11/medline KW - COPD KW - dyspnea KW - dyspnea score KW - hyperinflation KW - pulmonary rehabilitation KW - respiratory muscle training SP - 305 EP - 12 JF - Chronic respiratory disease JO - Chron Respir Dis VL - 12 IS - 4 N2 - Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved. SN - 1479-9731 UR - https://www.unboundmedicine.com/medline/citation/26170421/Inspiratory_muscle_training_during_pulmonary_rehabilitation_in_chronic_obstructive_pulmonary_disease:_A_randomized_trial_ L2 - http://journals.sagepub.com/doi/full/10.1177/1479972315594625?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -