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Chen X, Hu S, Jia X, Zeng B. Incremental Load Respiratory Muscle Training Improves Respiratory Muscle Strength and Pulmonary Function in Children with Bronchiectasis. Can Respir J 2024; 2024:8884030. [PMID: 38818499 PMCID: PMC11139531 DOI: 10.1155/2024/8884030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/22/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
Methods Participants underwent respiratory muscle training for 24 weeks. The main results were changes in respiratory muscle strength and pulmonary function indices (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate (PEF), forced expiratory flow 25-75% (FEF25-75%), and maximal midexpiratory flow 75/25 (MMEF75/25)) before, 12 weeks after, and 24 weeks after the intervention. The secondary outcomes were changes in the exercise load and work rate, exercise work, Leicester Cough Questionnaire (LCQ) scale, and Fatigue Severity Scale (FSS). Results Compared with before the intervention, after 24 weeks of respiratory muscle training, the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were significantly enhanced (P < 0.05), while FVC, FEV1, and PEF were significantly increased (P < 0.01). FEF25-75 and MMEF75/25 values showed significant improvement compared to those before training (P < 0.05). The exercise loading, work, and exercise work rate of expiratory muscle training were significantly improved compared to those before intervention (P < 0.05). The LCQ score increased significantly (P < 0.001), and the FSS score decreased significantly (P < 0.001). Conclusion Incremental load respiratory muscle training effectively improved children's lung function over the long term, improved the strength of their inspiratory and expiratory muscles, and improved their quality of life.
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Affiliation(s)
- Xiaolong Chen
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Shidong Hu
- Department of Pediatric Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xiaohui Jia
- Department of Pediatric Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Bingbing Zeng
- Center of Traditional Chinese Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
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Ni R, Cai L, Xing Y, Fan X. The Effects of Respiratory Training Combined with Limb Exercise on Pulmonary Function and Quality of Life in Patients with Bronchiectasis. J Multidiscip Healthc 2023; 16:475-482. [PMID: 36861133 PMCID: PMC9968867 DOI: 10.2147/jmdh.s388944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023] Open
Abstract
Objective To investigate the effects of respiratory rehabilitation training combined with limb rehabilitation on sputum clearance and quality of life in patients with bronchiectasis. Methods A retrospective analysis of 86 patients with bronchiectasis was divided into an intervention group and an observation group, with 43 cases in each group. All patients were above 18 years of age with no history of relevant drug allergies. Patients in the observation group were treated with conventional drugs, and those in the intervention group were given respiratory rehabilitation training and limb rehabilitation on this basis. After three months of treatment, the indexes of sputum discharge, sputum traits, lung function, and the 6-minute walk distance (6MWD) were compared and quality of life and survival skills were assessed using the Barthel index and a quality-of-life comprehensive assessment questionnaire (GQOLI-74). Results The percentage of patients with mild Barthel index in the intervention group was higher than that in the observation group, and the difference between the groups was statistically significant (P < 0.05). After treatment, the scores of life quality and the lung function in the intervention group were higher than those in the observation group (both P < 0.05). After three months of treatment, the sputum volume and sputum viscosity scores of the two groups were higher than those before treatment (P < 0.05). Conclusion Respiratory rehabilitation training with limb exercise rehabilitation can effectively improve the sputum clearance rate, lung function, and quality of life of patients with bronchiectasis and is thus worthy of clinical promotion and application.
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Affiliation(s)
- Rongping Ni
- Department of Geriatric Respiratory and Critical Care, The First Affiliated Hospital of Anhui Medical University, Hefei, AnhuiPeople’s Republic of China
| | - Lizhang Cai
- Department of Respiratory, Shanghai Nanxiang Hospital, Shanghai, People’s Republic of China
| | - Yingru Xing
- Department of Clinical Laboratory, Huainan Oriental Hospital Group of Anhui University of Science and Technology, Huainan, AnhuiPeople’s Republic of China
| | - Xiaoyun Fan
- Department of Geriatric Respiratory and Critical Care, The First Affiliated Hospital of Anhui Medical University, Hefei, AnhuiPeople’s Republic of China,Correspondence: Xiaoyun Fan, Department of Geriatric Respiratory and Critical Care, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, People’s Republic of China, Tel +86 13956988552, Email
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The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis. Qual Life Res 2023; 32:1-26. [PMID: 35460472 PMCID: PMC9034447 DOI: 10.1007/s11136-022-03133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life. METHODS The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments). CONCLUSION Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.
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Hamzeh H, Spencer S, Kelly C, Pilsworth S. Evaluation of outcome reporting in clinical trials of physiotherapy in bronchiectasis: The first stage of core outcome set development. PLoS One 2023; 18:e0282393. [PMID: 36928192 PMCID: PMC10019700 DOI: 10.1371/journal.pone.0282393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The aim of this study is to explore outcomes currently reported in physiotherapy trials for bronchiectasis and investigate the level of consistency in outcome reporting. This mapping of outcomes will be used to inform the development of a core outcome set (COS) for physiotherapy research in bronchiectasis. Outcomes reported in randomised clinical trials (RCTs) and RCT protocols were reviewed and evaluated. We included trials with physiotherapy as the main intervention, including pulmonary rehabilitation, exercise prescription, airway clearance, positive expiratory pressure devices, breathing training, self-management plans, and home exercise program. Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and the physiotherapy evidence database (PEDro) were searched from inception using a prespecified search strategy. Records including adult patients with bronchiectasis were included. Outcomes were listed verbatim and categorised into domains based on a pre-specified system, frequency of reporting and sources of variation were inspected. RESULTS Of 2158 abstracts screened, 37 trials (1202 participants) and 17 trial protocols were identified. Eighteen different physiotherapy techniques were investigated. A total of 331 outcomes were reported. No single outcome was reported by all trials. The most reported outcomes were lung function (27 trials, 50%), health related quality of life (26 trials, 48.1%), and dyspnoea (18 trials, 33.3%). A list of 104 unique outcomes covering 23 domains was created. Trials focus on physiological outcomes, mainly those related to respiratory system functions. Outcomes related to functioning and life impact are often neglected. CONCLUSION Outcome reporting in physiotherapy research for bronchiectasis was found to be inconsistent in terms of choosing and defining outcomes. Developing a core outcome set in this area of research is needed to facilitate aggregation of future trial results in systematic reviews that will in turn inform the strength of evidence for the effectiveness of physiotherapy. Outcome choice should include all stakeholders, including patients. TRIAL REGISTRATION This study is registered in the PROSPERO registry under the number CRD42021266247.
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Affiliation(s)
- Hayat Hamzeh
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- * E-mail:
| | - Sally Spencer
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Carol Kelly
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Samantha Pilsworth
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
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Faverio P, De Giacomi F, Bodini BD, Stainer A, Fumagalli A, Bini F, Luppi F, Aliberti S. Nontuberculous mycobacterial pulmonary disease: an integrated approach beyond antibiotics. ERJ Open Res 2021; 7:00574-2020. [PMID: 34046491 PMCID: PMC8141831 DOI: 10.1183/23120541.00574-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/24/2021] [Indexed: 01/11/2023] Open
Abstract
Nontuberculous mycobacterial (NTM) pulmonary disease (PD) is an emerging condition with heterogeneous manifestations from both the microbiological and the clinical point of view. Diagnostic and therapeutic guidelines are available but there are still unmet patients' and physicians' needs, including therapy-related adverse events, symptom control, management of comorbidities, risk of re-exposure to the pathogen and unfavourable outcomes. In the present review, we provide currently available evidence for an integrated approach to NTM-PD beyond antibiotic therapy. This includes 1) avoiding exposure to environments where mycobacteria are present and careful evaluation of lifestyle and habits; 2) implementing a personalised pulmonary rehabilitation plan and airway clearance techniques to improve symptoms, exercise capacity, health-related quality of life (QoL) and functional capacity in daily living activities; 3) a nutritional evaluation and intervention to improve health-related QoL and to control gastrointestinal side-effects during antimicrobial therapy, particularly in those with low body mass index and history of weight loss; and 4) managing comorbidities that affect disease outcomes, including structural lung diseases, immune status evaluation and psychological support when appropriate. An integrated approach, including risk factor prevention, management of comorbidities, nutritional evaluation and intervention and pulmonary rehabilitation, should be considered in the optimal management of nontuberculous mycobacterial pulmonary diseasehttps://bit.ly/2YEqvQg
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Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federica De Giacomi
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Bruno Dino Bodini
- Pulmonary Rehabilitation, ASST Rhodense, Casati Hospital, Garbagnate Milanese, Italy
| | - Anna Stainer
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Alessia Fumagalli
- Pulmonary Rehabilitation Unit - Research Hospital of Casatenovo, Italian National Research Centre on Aging, Casatenovo, Italy
| | - Francesco Bini
- Respiratory Unit, Internal Medicine Dept, ASST Rhodense, G. Salvini Hospital, Garbagnate Milanese, Italy
| | - Fabrizio Luppi
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Abstract
BACKGROUND Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established. OBJECTIVES To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis. SEARCH METHODS We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references. SELECTION CRITERIA We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22). AUTHORS' CONCLUSIONS This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.
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Affiliation(s)
- Annemarie L Lee
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Carla S Gordon
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
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McCreery JL, Mackintosh KA, Mills-Bennett R, McNarry MA. The Effect of a High-Intensity PrO2Fit Inspiratory Muscle Training Intervention on Physiological and Psychological Health in Adults with Bronchiectasis: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063051. [PMID: 33809595 PMCID: PMC8001489 DOI: 10.3390/ijerph18063051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023]
Abstract
Bronchiectasis is characterised by airflow obstruction and hyperinflation resulting in respiratory muscle weakness, and decreased exercise capacity. Inspiratory muscle training (IMT) is potentially an alternative treatment strategy to enhance respiratory muscle strength and endurance. Therefore, the aim was to investigate the effects of IMT on those with bronchiectasis. Eighteen participants (10 bronchiectasis) took part in an eight-week, three times a week IMT programme at 80% sustained maximal inspiratory pressure (SMIP). Lung function, respiratory muscle strength and endurance, exercise capacity, physical activity and self-determination theory measures were taken. Participants also took part in a semi-structured interview to assess their perceptions and experience of an IMT intervention. After eight weeks of IMT, bronchiectasis and healthy participants exhibited significant increases in MIP (27% vs. 32%, respectively), SMIP (16% vs. 17%, respectively) and inspiratory duration (36% vs. 30%, respectively). Healthy participants exhibited further improvements in peak expiratory flow and maximal oxygen consumption. Bronchiectasis participants reported high levels of perceived competence and motivation, reporting higher adherence and improved physical ability. Eight weeks of IMT increased inspiratory muscle strength and endurance in those with bronchiectasis. IMT also had a positive effect on perceived competency and autonomy, with bronchiectasis participants reporting improved physical ability and motivation, and high adherence.
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Affiliation(s)
- Jessica L McCreery
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
| | - Rebekah Mills-Bennett
- Physiotherapy Department, Glangwili Hospital, Dogwili Rd Carmarthen, Carmarthen SA312AF, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
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Muammer K, Mutluay F, Demir R, Özkan AA. Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial. Respir Med 2020; 172:106119. [PMID: 32877886 DOI: 10.1016/j.rmed.2020.106119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Abstract
Background OBJECTIVE: To investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. METHODS This prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. RESULTS There were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). CONCLUSION Our study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. CLINICAL TRIAL REGISTRATION NUMBER NCT03523026.
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Affiliation(s)
- Kıymet Muammer
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatma Mutluay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Medipol University, Istanbul, Turkey.
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alev Arat Özkan
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Lan CC, Lai SR, Chien JY. Nonpharmacological treatment for patients with nontuberculous mycobacterial lung disease. J Formos Med Assoc 2020; 119 Suppl 1:S42-S50. [PMID: 32499207 DOI: 10.1016/j.jfma.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Patients with nontuberculous mycobacterial lung disease (NTM-LD) often have significant exercise intolerance and poorer health-related quality of life (HRQL). The goals of treatment for NTM-LD should include reducing the severity of symptoms, improving HRQL, and reducing acute exacerbations. Nonpharmacological treatment, including pulmonary rehabilitation program and optimal nutritional strategy, should be one part of treatment for NTM-LD. A pulmonary rehabilitation (PR) program can comprise education, airway clearance techniques instruction, exercise training program, and inspiratory muscle training (IMT). Airway clearance techniques can improve the volume of sputum expectorated, cough symptom, breathlessness, and HRQL. Exercise training can improve exercise capacity and HRQL, and reduce acute exacerbations and dyspnea. Clinical benefits of IMT remain controversial but high-intensity IMT has been shown to be effective in increasing respiratory muscle strength with concurrent improvement of HRQL and exercise capacity. Body weight and muscle mass loss are common in patients with NTM-LD. An adequate protein and caloric diet combined with antioxidant nutrients might be the most appropriate dietary strategy. Comprehensive treatment for NTM-LD should include the combination of both pharmacological and nonpharmacological treatments. The management programs should be tailored to the individual's condition.
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Affiliation(s)
- Chou-Chin Lan
- Division of Pulmonary Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation School of Medicine, Tzuchi University, New Taipei City, Taiwan
| | - Sheng-Ru Lai
- Department of Dietetics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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10
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The Efficacy of Therapeutic Respiratory Muscle Training Interventions in People with Bronchiectasis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9010231. [PMID: 31952338 PMCID: PMC7019679 DOI: 10.3390/jcm9010231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Respiratory muscle dysfunction is an important health problem with high morbidity and mortality and associated costs in patients with bronchiectasis (BC). The aim of this study was to analyse the effects of therapeutic respiratory muscle training (RMT) interventions on improving sputum clearance, ventilator function, muscle strength and functional capacity in BC. Methods: Systematic review and meta-analysis were conducted following PRISMA guidelines. Two independent investigators searched using several electronic databases. The methodological quality of nine studies was assessed using the PEDro scale. Study selection/eligibility criteria: The following were included: randomised controlled trials, randomised crossover trials and pilot studies of patients with BC that used the intervention as RMT (inspiratory/expiratory) and evaluations of respiratory muscle strength (maximal expiratory pressure/maximal inspiratory pressure). This systematic review was registered in PROSPERO (CRD42017075101). Nine studies were included, five of which obtained an A recommendation grade, three with B, and one with C. Study quality was poor to good (mean PEDro Score of 6.375 out of 10). Studies had small sample sizes (8–98). Results show improvements on PImax in favour of therapeutic respiratory muscle training intervention (MD = 6.08; 95% CI = 1.38, 10.77; p < 0.01; I2 = 92%). However, high heterogeneity was identified on meta-analysis.
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11
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Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, Grillo L, Gruffydd-Jones K, Harvey A, Haworth CS, Hiscocks E, Hurst JR, Johnson C, Kelleher PW, Bedi P, Payne K, Saleh H, Screaton NJ, Smith M, Tunney M, Whitters D, Wilson R, Loebinger MR. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019; 74:1-69. [PMID: 30545985 DOI: 10.1136/thoraxjnl-2018-212463] [Citation(s) in RCA: 230] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adam T Hill
- Respiratory Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Anita L Sullivan
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital), Birmingham, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, NIHR Biomedical Research Centre for Aging and Freeman Hospital Adult Bronchiectasis service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Stuart J Elborn
- Royal Brompton Hospital and Imperial College London, and Queens University Belfast
| | - Andres R Floto
- Department of Medicine, University of Cambridge, Cambridge UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | | | - Alex Harvey
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Peter W Kelleher
- Centre for Immunology and Vaccinology, Chelsea &Westminster Hospital Campus, Department of Medicine, Imperial College London.,Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London.,Chest & Allergy Clinic St Mary's Hospital, Imperial College Healthcare NHS Trust
| | - Pallavi Bedi
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | | | | | | | - Maeve Smith
- University of Alberta, Edmonton, Alberta, Canada
| | - Michael Tunney
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | | | - Robert Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
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Ozalp O, Inal‐Ince D, Cakmak A, Calik‐Kutukcu E, Saglam M, Savci S, Vardar‐Yagli N, Arikan H, Karakaya J, Coplu L. High‐intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial. Respirology 2018; 24:246-253. [DOI: 10.1111/resp.13397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ozge Ozalp
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Deniz Inal‐Ince
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Aslihan Cakmak
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Ebru Calik‐Kutukcu
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Melda Saglam
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Sema Savci
- School of Physiotherapy and RehabilitationDokuz Eylül University Izmir Turkey
| | - Naciye Vardar‐Yagli
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Hülya Arikan
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Jale Karakaya
- Faculty of Medicine, Department of BiostatisticsHacettepe University Ankara Turkey
| | - Lütfi Coplu
- Faculty of Medicine, Department of Chest MedicineHacettepe University Ankara Turkey
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13
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Affiliation(s)
- Annemarie L Lee
- Monash University; Department of Physiotherapy; Melbourne Australia
- Institute for Breathing and Sleep; Commercial Road Melbourne Australia
- La Trobe University; Department of Rehabilitation, Nutrition and Sport; Melbourne Australia
| | - Carla S Gordon
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Department of Physiotherapy; Melbourne Australia
| | - Christian R Osadnik
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Monash Lung and Sleep; Melbourne Australia
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14
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Pehlivan E, Mutluay F, Balcı A, Kılıç L. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clin Rehabil 2018; 32:1328-1339. [PMID: 29843525 DOI: 10.1177/0269215518777560] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. DESIGN Prospective randomized controlled trial. SETTING Pulmonary Rehabilitation center. SUBJECTS A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. METHODS All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. RESULTS The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups. CONCLUSION A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.
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Affiliation(s)
- Esra Pehlivan
- 1 Department of Pulmonary Rehabilitation, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatma Mutluay
- 2 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Medipol University, Istanbul, Turkey
| | - Arif Balcı
- 1 Department of Pulmonary Rehabilitation, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Lütfiye Kılıç
- 1 Department of Pulmonary Rehabilitation, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Hill AT, Barker AF, Bolser DC, Davenport P, Ireland B, Chang AB, Mazzone SB, McGarvey L. Treating Cough Due to Non-CF and CF Bronchiectasis With Nonpharmacological Airway Clearance: CHEST Expert Panel Report. Chest 2018; 153:986-993. [PMID: 29355548 PMCID: PMC6689075 DOI: 10.1016/j.chest.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/24/2017] [Accepted: 01/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In bronchiectasis due to cystic fibrosis (CF) and other causes, airway clearance is one of the mainstays of management. We conducted a systematic review on airway clearance by using non-pharmacological methods as recommended by international guidelines to develop recommendations or suggestions to update the 2006 CHEST guideline on cough. METHODS The systematic search for evidence examined the question, "Is there evidence of clinically important treatment effects for non-pharmacological therapies in cough treatment for patients with bronchiectasis?" Populations selected were all patients with bronchiectasis due to CF or non-CF bronchiectasis. The interventions explored were the non-pharmacological airway clearance therapies. The comparison populations included those receiving standard therapy and/or placebo. Clinically important outcomes that were explored were exacerbation rates, quality of life, hospitalizations, and mortality. RESULTS In both CF and non-CF bronchiectasis, there were systematic reviews and overviews of systematic reviews identified. Despite these findings, there were no large randomized controlled trials that explored the impact of airway clearance on exacerbation rates, quality of life, hospitalizations, or mortality. CONCLUSIONS Although the cough panel was not able to make recommendations, they have made consensus-based suggestions and provided direction for future studies to fill the gaps in knowledge.
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Affiliation(s)
- Adam T Hill
- Royal Infirmary and University of Edinburgh, Edinburgh, Scotland.
| | | | - Donald C Bolser
- College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Paul Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL
| | | | - Anne B Chang
- Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia
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Abstract
BACKGROUND Bronchiectasis is a long term respiratory condition with an increasing rate of diagnosis. It is associated with persistent symptoms, repeated infective exacerbations, and reduced quality of life, imposing a burden on individuals and healthcare systems. The main aims of therapeutic management are to reduce exacerbations and improve quality of life. Self-management interventions are potentially important for empowering people with bronchiectasis to manage their condition more effectively and to seek care in a timely manner. Self-management interventions are beneficial in the management of other airways diseases such as asthma and COPD (chronic obstructive pulmonary disease) and have been identified as a research priority for bronchiectasis. OBJECTIVES To assess the efficacy, cost-effectiveness and adverse effects of self-management interventions for adults and children with non-cystic fibrosis bronchiectasis. SEARCH METHODS We searched the Cochrane Airways Specialised Register of trials, clinical trials registers, reference lists of included studies and review articles, and relevant manufacturers' websites up to 13 December 2017. SELECTION CRITERIA We included all randomised controlled trials of any duration that included adults or children with a diagnosis of non-cystic fibrosis bronchiectasis assessing self-management interventions delivered in any form. Self-management interventions included at least two of the following elements: patient education, airway clearance techniques, adherence to medication, exercise (including pulmonary rehabilitation) and action plans. DATA COLLECTION AND ANALYSIS Two review authors independently screened searches, extracted study characteristics and outcome data and assessed risk of bias for each included study. Primary outcomes were, health-related quality of life, exacerbation frequency and serious adverse events. Secondary outcomes were the number of participants admitted to hospital on at least one occasion, lung function, symptoms, self-efficacy and economic costs. We used a random effects model for analyses and standard Cochrane methods throughout. MAIN RESULTS Two studies with a total of 84 participants were included: a 12-month RCT of early rehabilitation in adults of mean age 72 years conducted in two centres in England (UK) and a six-month proof-of-concept RCT of an expert patient programme (EPP) in adults of mean age 60 years in a single regional respiratory centre in Northern Ireland (UK). The EPP was delivered in group format once a week for eight weeks using standardised EPP materials plus disease-specific education including airway clearance techniques, dealing with symptoms, exacerbations, health promotion and available support. We did not find any studies that included children. Data aggregation was not possible and findings are reported narratively in the review.For the primary outcomes, both studies reported health-related quality of life, as measured by the St George's Respiratory Questionnaire (SGRQ), but there was no clear evidence of benefit. In one study, the mean SGRQ total scores were not significantly different at 6 weeks', 3 months' and 12 months' follow-up (12 months mean difference (MD) -10.27, 95% confidence interval (CI) -45.15 to 24.61). In the second study there were no significant differences in SGRQ. Total scores were not significantly different between groups (six months, MD 3.20, 95% CI -6.64 to 13.04). We judged the evidence for this outcome as low or very low. Neither of the included studies reported data on exacerbations requiring antibiotics. For serious adverse events, one study reported more deaths in the intervention group compared to the control group, (intervention: 4 of 8, control: 2 of 12), though interpretation is limited by the low event rate and the small number of participants in each group.For our secondary outcomes, there was no evidence of benefit in terms of frequency of hospital admissions or FEV1 L, based on very low-quality evidence. One study reported self-efficacy using the Chronic Disease Self-Efficacy scale, which comprises 10 components. All scales showed significant benefit from the intervention but effects were only sustained to study endpoint on the Managing Depression scale. Further details are reported in the main review. Based on overall study quality, we judged this evidence as low quality. Neither study reported data on respiratory symptoms, economic costs or adverse events. AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether self-management interventions benefit people with bronchiectasis. In the absence of high-quality evidence it is advisable that practitioners adhere to current international guidelines that advocate self-management for people with bronchiectasis.Future studies should aim to clearly define and justify the specific nature of self-management, measure clinically important outcomes and include children as well as adults.
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Affiliation(s)
- Carol Kelly
- Edge Hill UniversityFaculty of Health and Social CareOrmskirkUK
| | - Seamus Grundy
- Aintree University HospitalDepartment of Thoracic MedicineLiverpoolUK
- University of LiverpoolInstitute of Translational MedicineLiverpoolUK
| | - Dave Lynes
- Edge Hill UniversityFaculty of Health and Social CareOrmskirkUK
| | - David JW Evans
- Lancaster UniversityLancaster Health HubLancasterUKLA1 4YG
| | - Sharada Gudur
- Lancashire Teaching Hospitals NHS Foundation TrustDepartment of Respiratory MedicinePrestonUK
| | | | - Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
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Al-Jahdali H, Alshimemeri A, Mobeireek A, Albanna AS, Al Shirawi NN, Wali S, Alkattan K, Alrajhi AA, Mobaireek K, Alorainy HS, Al-Hajjaj MS, Chang AB, Aliberti S. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis. Ann Thorac Med 2017; 12:135-161. [PMID: 28808486 PMCID: PMC5541962 DOI: 10.4103/atm.atm_171_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022] Open
Abstract
This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.
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Affiliation(s)
- Hamdan Al-Jahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alshimemeri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Mobeireek
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Pulmonary Division, Riyadh, Saudi Arabia
| | - Amr S. Albanna
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Siraj Wali
- College of Medicine, King Abdulaziz University, Respiratory Unit, Department of Medicine, Jeddah, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulrahman A. Alrajhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Infectious Disease Division, Riyadh, Saudi Arabia
| | - Khalid Mobaireek
- College of Medicine, King Saud University, King Khalid University Hospital, Pediatric Pulmonology Division, Riyadh, Saudi Arabia
| | - Hassan S. Alorainy
- King Faisal Specialist Hospital and Research Centre, Respiratory Therapy Services, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Clinical Sciences, College of Medicine. University of Sharjah, Sharjah, UAE
| | - Anne B. Chang
- International Reviewer, Children's Centre of Health Research Queensland University of Technology, Queensland
- International Reviewer, Brisbane and Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Stefano Aliberti
- International Reviewer, Department of Pathophysiology and Transplantation, University of MilanInternal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Via Francesco Sforza 35, 20122, Milan, Italy
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Liaw MY, Wang LY, Pong YP, Tsai YC, Huang YC, Yang TH, Lin MC. Preliminary investigation of cardiopulmonary function in stroke patients with stable heart failure and exertional dyspnea. Medicine (Baltimore) 2016; 95:e5071. [PMID: 27749577 PMCID: PMC5059080 DOI: 10.1097/md.0000000000005071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF).This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I-III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index.A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were -52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = -0.318, P < 0.05) and distal (r = -0.391, P < 0.01) parts of the upper extremities and lower extremities (r = -0.288, P < 0.05), FVC (r = -0.471, P < 0.01), predicted FVC% (r = -0.299, P < 0.05), and FEV1 (r = -0.397, P < 0.01). MEP was positively associated with average Brunnstrom stage of the distal area of the upper extremities (r = 0.351, P < 0.05), FVC (r = 0.526, P < 0.01), FEV1 (r = 0.429, P < 0.01), and FEV1/FVC (r = -0.482, P < 0.01). FEV1/FVC was negatively associated with the average Brunnstrom stage over the proximal (r = -0.414, P < 0.01) and distal (r = -0.422, P < 0.01) parts of the upper extremities and lower extremities (r = -0.311, P < 0.05) and Barthel index (r = -0.313, P < 0.05).Stroke patients with stable CHF and exertional dyspnea had restrictive lung disorder and respiratory muscle weakness, which were associated with the neurological status of the affected limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction.
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Affiliation(s)
- Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation
| | - Ya-Ping Pong
- Department of Physical Medicine and Rehabilitation
| | | | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation
| | | | - Meng-Chih Lin
- Department of Respiratory Therapy
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Correspondence: Meng-Chih Lin, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung 83305, Taiwan (e-mail: )
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Chen PC, Liaw MY, Wang LY, Tsai YC, Hsin YJ, Chen YC, Chen SM, Lin MC. Inspiratory muscle training in stroke patients with congestive heart failure: A CONSORT-compliant prospective randomized single-blind controlled trial. Medicine (Baltimore) 2016; 95:e4856. [PMID: 27631248 PMCID: PMC5402591 DOI: 10.1097/md.0000000000004856] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiopulmonary function can be adversely affected after a cerebrovascular accident in patients with congestive heart failure (CHF). The aim of this study was to investigate the efficacy and feasibility of inspiratory muscle training (IMT) for stroke patients with CHF. METHODS A prospective randomized single-blind controlled trial was conducted in a single tertiary medical center in southern Taiwan between May 2011 and July 2015. Forty-one patients were enrolled, of whom 21 completed the study (IMT group n = 11 and control group n = 10). Both groups participated in a conventional stroke rehabilitation program. Patients in the IMT group received an additional IMT program beginning with an intensity of 30% maximal inspiratory pressure (MIP), then increased by 2cmH2O each week for 30 minutes daily for at least 5 days a week for 10 weeks. MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient. RESULTS There were significant differences from baseline in MIP (P = 0.008), percent predicted forced vital capacity (P = 0.033), forced expiratory volume in 1 second (FEV1) (P = 0.008), percent predicted FEV1 (P = 0.008), and Barthel Index (P = 0.012) in the IMT group, and Barthel Index (P = 0.027) in the control group. There were significant differences between groups in MIP (20.91 ± 19.73 vs -9.00 ± 26.01, adjusted P value = 0.023) and Barthel Index (24.55 ± 22.30 vs 7.50 ± 8.25, adjusted P value = 0.044). CONCLUSION The 10-week IMT was feasible and effective in improving inspiratory force and activities of daily living for the stroke patients with CHF.
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Affiliation(s)
| | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation
- Correspondence: Mei-Yun Liaw, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung 83305, Taiwan (e-mail: )
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation
| | | | - Yi-Jung Hsin
- Department of Physical Medicine and Rehabilitation
| | - Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Department of Respiratory Therapy
| | - Shyh-Ming Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Department of Respiratory Therapy
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Welsh EJ, Evans DJ, Fowler SJ, Spencer S. Interventions for bronchiectasis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2015; 2015:CD010337. [PMID: 26171905 PMCID: PMC7086475 DOI: 10.1002/14651858.cd010337.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of the bronchi, and presents typically with a chronic productive cough (or chronic wet cough in children) and recurrent infective exacerbations. It significantly impacts daily activities and quality of life, and can lead to recurrent hospitalisations, severe lung function impairment, respiratory failure and even death. OBJECTIVES To provide an overview of the efficacy and safety of interventions for adults and children with bronchiectasis from Cochrane reviews.To identify gaps in the evidence base that will inform recommendations for new research and reviews, and to summarise information on reported outcomes and make recommendations for the reporting of standard outcomes in future trials and reviews. METHODS We included Cochrane reviews of non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Database of Systematic Reviews. The search is current to 11 February 2015. We also identified trials that were potentially eligible for, but not currently included in, published reviews to make recommendations for new Cochrane reviews. We assessed the quality of included reviews using the AMSTAR criteria. We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials and guideline data. The primary outcomes were exacerbations, lung function and quality of life. MAIN RESULTS We included 21 reviews but extracted data from, and rated the quality of, only nine reviews that reported results for people with bronchiectasis alone. Of the reviews with no usable data, two reviews included studies with mixed clinical populations where data were not reported separately for people with bronchiectasis and 10 reviews did not contain any trials. Of the 40 studies included across the nine reviews, three (number of participants nine to 34) included children. The studies ranged from single session to year-long studies. Each review included from one to 11 trials and 28 (70%) trials in the overview included 40 or fewer participants. The total number of participants included in reviews ranged from 40 to 1040. The age range of adult participants was from 36 to 73 years and children ranged from six to 16 years. The proportion of male participants ranged from 21% to 72%. Where reported, mean baseline forced expiratory volume in one second (FEV1) ranged from 1.17 L to 1.66 L and from 47% to 88% predicted. Most of the reviews had search dates older than two years.We have summarised the published evidence as outlined in Cochrane reviews, but it was not possible to draw definitive conclusions. There was inconclusive evidence on the use of long-term antibiotics and nebulised hypertonic saline for reducing exacerbation frequency and evidence that human deoxyribonuclease (RhDNase) increases exacerbation frequency. Improvements in lung function were reported for inhaled corticosteroids (ICS) though this was small and not clinically relevant. Evidence of benefit for hyperosmolar agents and mucolytics was inconclusive. There was limited evidence of improvements in quality of life with airway clearance techniques and physical therapy but evidence of benefit for hyperosmolar agents was inconclusive. Secondary outcomes were not clearly reported in all trials in the included reviews. Improvements in dyspnoea, wheeze and cough-free days were reported for small trials of ICS and LABA (long-acting beta2-agonsts)/ICS and cough reduction was also reported for a small bromhexine trial. Reduction in sputum production was reported for long-term antibiotics and airway clearance techniques but evidence of benefit for hyperosmolar agents was inconclusive.Adverse events were included as outcomes in seven reviews. The review of long-term (four weeks to one year) prophylactic courses of antibiotics reported significantly more cases of wheeze (Peto odd ratio (OR) 8.56, 95% confidence intervals (CI) 1.63 to 44.93), dyspnoea (12 versus three, P value = 0.01) and chest pain (seven versus zero, P value = 0.01) from the same trial (74 participants) but no differences in occurrence of diarrhoea, rash or number of withdrawals. In the review of mucolytics versus placebo, relevant outcomes were not reported for erdosteine comparisons and no significant adverse effects were reported for bromhexine, though adverse events were associated with RhDNase (OR 28.19, 95% CI 3.77 to 210.85, 1 study). Of the remaining five reviews, adverse events were not reported in the single trials included in the ICS review or the physical therapy review and the impact of adverse events in the single trial included in the inhaled LABA/ICS combination versus ICS review were unclear. The reviews of short-term courses of antibiotics and inhaled hyperosmolar agents reported no significant differences in occurrence of adverse events. Fewer admissions to hospital were reported for long-term antibiotics, but this outcome was not reported in all reviews. No reviews reported differences in mortality, but again this outcome was not included in all reviews.We did not explicitly include antibiotic resistance as an outcome in the review, but this was unclear in the Cochrane reviews and evidence from other trials should be considered.We rated all reviews as high quality (AMSTAR), though opportunities for improved reporting (e.g. summary of findings and GRADE evaluation of the evidence) were identified for inclusion in future updates of the reviews. However, the majority of trials were not high quality and confidence in the effects of treatments, therefore, requires additional evidence from larger and more methodologically robust trials. We evaluated the overall coverage of important topics in bronchiectasis by mapping the quality of the current evidence base against published guidelines and identifying high priority areas for new research on; use of short-course and long-term antibiotics, ICS and oral corticosteroids, inhaled hyperosmolars, mucolytics, and use of airway clearance techniques. AUTHORS' CONCLUSIONS This overview clearly points to significant opportunities for further research aimed at improving outcomes for people with bronchiectasis. We have highlighted important endpoints for studies (particularly exacerbations, quality of life and lung function), and areas of clinical practice that are in most urgent need of evidence-based support (including long-term antibiotics, ICSs and mucolytics).As the evidence is confined to small trials of short duration, it is not currently possible to assess the balance between the benefits and potential harms of treatments for bronchiectasis.
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Affiliation(s)
- Emma J Welsh
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceLondonUKSW17 0RE
| | - David J Evans
- Hemel Hempstead HospitalThoracic MedicineHillfield RoadHemel HempsteadHertsUKHP2 4AD
- Harefield HospitalHill End RoadHarefieldUKUB9 6JH
| | - Stephen J Fowler
- University Hospital of South ManchesterUniversity of Manchester, NIHR Respiratory and Allergy Clinical Research FacilityManchesterUK
- Lancashire Teaching Hospitals NHS Foundation TrustPrestonUK
| | - Sally Spencer
- Lancaster UniversityFaculty of Health and MedicineBailriggLancasterLancashireUKLA1 4YD
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Barğı G, Güçlü MB, Arıbaş Z, Akı ŞZ, Sucak GT. Inspiratory muscle training in allogeneic hematopoietic stem cell transplantation recipients: a randomized controlled trial. Support Care Cancer 2015; 24:647-659. [DOI: 10.1007/s00520-015-2825-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/16/2015] [Indexed: 11/28/2022]
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Snijders D, Fernandez Dominguez B, Calgaro S, Bertozzi I, Escribano Montaner A, Perilongo G, Barbato A. Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis: Is there evidence? Int J Immunopathol Pharmacol 2015; 28:150-9. [PMID: 26078380 DOI: 10.1177/0394632015584724] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022] Open
Abstract
Non-cystic fibrosis bronchiectasis (nCFb) is an acquired condition of variable etiology. An impaired mucociliary clearance seems to be one of the mechanisms behind nCFb, and treatment involves antibiotics, mucoactive agents, and airway clearance techniques (ACTs). Traditional ACTs have four components: postural drainage, percussion, vibration of the chest wall, and coughing. Reviewing the international medical literature on the use of ACTs for patients with nCFb from 1989 to the present day, we retrieved 93 articles, of which 35 met our selection criteria for this analysis. We reviewed active cycle of breathing techniques (ACBT), forced expiration techniques (FET), autogenic drainage, postural drainage, oscillating positive expiratory pressure (OPep), high frequency chest wall oscillation (HFCWO), and exercise or pulmonary rehabilitation. Overall, ACTs appear to be safe for individuals (adults and children) with stable bronchiectasis; where there may be improvements in sputum expectoration, selected measures of lung function, and health-related quality of life. Unfortunately, there is a lack of RCTs in nCFb patients, especially in children. Moreover, none of the studies describes long-term effects of ACTs. It should be noted that a single intervention might not reflect the longer-term outcome and there is no evidence to recommend or contest any type of ACTs in nCFb management. Multicenter RCTs are necessary to evaluate the different techniques of ACTs especially in children with nCFb.
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Affiliation(s)
- D Snijders
- Department of Women's and Children's Health, University of Padova, Italy
| | | | - S Calgaro
- Department of Women's and Children's Health, University of Padova, Italy
| | - I Bertozzi
- Department of Women's and Children's Health, University of Padova, Italy
| | | | - G Perilongo
- Department of Women's and Children's Health, University of Padova, Italy
| | - A Barbato
- Department of Women's and Children's Health, University of Padova, Italy
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Lee AL, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Rautela L, Stirling RG, Thompson PJ, Holland AE. Minimal important difference in field walking tests in non-cystic fibrosis bronchiectasis following exercise training. Respir Med 2014; 108:1303-9. [PMID: 25087836 DOI: 10.1016/j.rmed.2014.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 6-min walk distance (6MWD) and incremental shuttle walk distance (ISWD) are clinically meaningful measures of exercise capacity in people with non-cystic fibrosis (CF) bronchiectasis, but the change in walking distance which constitutes clinical benefit is undefined. This study aimed to determine the minimal important difference for the 6MWD and ISWD in non-CF bronchiectasis. METHODS Thirty-seven participants with mean FEV1 70% predicted completed both field walking tests before and after an 8-week exercise program. The minimal important difference was calculated using a distribution-based and anchor-based method, with the global rating of change scale used. RESULTS The mean change in 6MWD in participants who reported themselves to be unchanged was 10 m, compared to 36 m (small change) and 45 m (substantial change) (p = 0.01). For the ISWD, the mean change in participants who reported themselves to be unchanged was 33 m, compared to 54 m (small change) and 73 m (substantial change) (p = 0.04). The anchor-based method defined the minimal important difference for 6MWD as 24.5 m (AUC 0.76, 95% CI 0.61-0.91) and for ISWD as 35 m (AUC 0.88, 95% CI 0.73-0.99), based on participant's global rating of change. The distribution-based method indicated a value of 22.3 m for the 6MWD and 37 m for the ISWD. There was excellent agreement between the two methods for the 6MWD (kappa = 0.91) and the ISWD (kappa = 0.92). CONCLUSIONS Small changes in 6MWD and ISWD may represent clinically important benefits in people with non-CF bronchiectasis. These data are likely to assist in the interpretation of change in exercise capacity following intervention.
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Affiliation(s)
- A L Lee
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia; Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton 3010, Victoria, Australia.
| | - C J Hill
- Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia; Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
| | - N Cecins
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia; Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, Hospital Avenue, Nedlands, Perth 6009, Australia.
| | - S Jenkins
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia; Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, Hospital Avenue, Nedlands, Perth 6009, Australia; Curtin University, Kent Street, Bentley, Perth 6102, Australia.
| | - C F McDonald
- Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia; Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
| | - A T Burge
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia.
| | - L Rautela
- Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia; Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
| | - R G Stirling
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia; Department of Medicine, Monash University, Melbourne 3800, Australia.
| | - P J Thompson
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia; Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, Hospital Avenue, Nedlands, Perth 6009, Australia; Curtin University, Kent Street, Bentley, Perth 6102, Australia.
| | - A E Holland
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia; Physiotherapy, La Trobe University, 99 Commercial Road, Melbourne 3004, Victoria, Australia.
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Cebrià i Iranzo MDÀ, Arnall DA, Camacho CI, Tomás JM. Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults. J Geriatr Phys Ther 2014; 37:65-75. [DOI: 10.1519/jpt.0b013e31829938bb] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silva IS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Ferreira GMH. Inspiratory muscle training for asthma. Cochrane Database Syst Rev 2013; 2013:CD003792. [PMID: 24014205 PMCID: PMC7163283 DOI: 10.1002/14651858.cd003792.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In some people with asthma, expiratory airflow limitation, premature closure of small airways, activity of inspiratory muscles at the end of expiration and reduced pulmonary compliance may lead to lung hyperinflation. With the increase in lung volume, chest wall geometry is modified, shortening the inspiratory muscles and leaving them at a sub-optimal position in their length-tension relationship. Thus, the capacity of these muscles to generate tension is reduced. An increase in cross-sectional area of the inspiratory muscles caused by hypertrophy could offset the functional weakening induced by hyperinflation. Previous studies have shown that inspiratory muscle training promotes diaphragm hypertrophy in healthy people and patients with chronic heart failure, and increases the proportion of type I fibres and the size of type II fibres of the external intercostal muscles in patients with chronic obstructive pulmonary disease. However, its effects on clinical outcomes in patients with asthma are unclear. OBJECTIVES To evaluate the efficacy of inspiratory muscle training with either an external resistive device or threshold loading in people with asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and reference lists of included studies. The latest search was performed in November 2012. SELECTION CRITERIA We included randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) in people with stable asthma. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included five studies involving 113 adults. Participants in four studies had mild to moderate asthma and the fifth study included participants independent of their asthma severity. There were substantial differences between the studies, including the training protocol, duration of training sessions (10 to 30 minutes) and duration of the intervention (3 to 25 weeks). Three clinical trials were produced by the same research group. Risk of bias in the included studies was difficult to ascertain accurately due to poor reporting of methods.The included studies showed a statistically significant increase in inspiratory muscle strength, measured by maximal inspiratory pressure (PImax) (mean difference (MD) 13.34 cmH2O, 95% CI 4.70 to 21.98, 4 studies, 84 participants, low quality evidence). Our other primary outcome, exacerbations requiring a course of oral or inhaled corticosteroids or emergency department visits, was not reported. For the secondary outcomes, results from one trial showed no statistically significant difference between the inspiratory muscle training group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnoea and use of beta2-agonist. There were no studies describing inspiratory muscle endurance, hospital admissions or days off work or school. AUTHORS' CONCLUSIONS There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma. The evidence was limited by the small number of trials with few participants together with the risk of bias. More well conducted randomised controlled trials are needed. Future trials should investigate the following outcomes: lung function, exacerbation rate, asthma symptoms, hospital admissions, use of medications and days off work or school. Inspiratory muscle training should also be assessed in people with more severe asthma and conducted in children with asthma.
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Affiliation(s)
- Ivanizia S Silva
- Federal University of Rio Grande do NortePhD Program in Physical Therapy, Federal University of Rio Grande do NorteAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho, 3000, Lagoa NovaNatalRio Grande do NorteBrazil59078‐470
| | - Fernando AL Dias
- Federal University of ParanáDepartment of PhysiologyCentro Politécnico, Jardim das AméricasCaixa Postal 19031CuritibaParanáBrazil81531‐980
| | - Cibele TD Ribeiro
- Federal University of Rio Grande do NorteGraduate Program in PhysiotherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Ricardo O Guerra
- Federal University of Rio Grande do NortePhD Program in Physical TherapyRua Senador Salgado, Filho 3000Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do NortePhD Program in Physical Therapy, Federal University of Rio Grande do NorteAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
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Albuquerque IMD, Rossoni CS, Cardoso DM, Paiva DN, Fregonezi G. Effects of short inspiratory muscle training on inspiratory muscle strength and functional capacity in physically active elderly: A quasi-experimental study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.764925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Pulmonary Rehabilitation Using Modified Threshold Inspiratory Muscle Trainer (IMT) in Patients with Tetraplegia. Case Rep Med 2012; 2012:587901. [PMID: 22536264 PMCID: PMC3318895 DOI: 10.1155/2012/587901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/28/2012] [Accepted: 02/08/2012] [Indexed: 11/17/2022] Open
Abstract
It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions. The treatment was applied through the tracheostomy cannula by a modified IMT device. After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test. As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.
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