Respiratory muscles training in COPD patients

Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges

As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.

Chest Physiotherapy Interventions for Children During SARS-COV-2 Pandemic

Since the first case of Severe Acute Respiratory Syndrome Coronavirus-2/Coronavirus Disease 2019 (SARS-COV-2/COVID-19) was discovered in Wuhan, China, it spread to vast limits globally and became a public health disaster, affecting nearly all countries around the globe. Along with mainstream medical treatment, alternative medicine desperately was the need of the hour for youngsters to manage their symptoms while being self-quarantined and ultimately to improve their chances of survival and recovery from COVID-19. Since the beginning of SARS-COV-2, few studies address the clinical-functional presentation of viral infection and management with physiotherapy for children. Major online electronic databases PubMed, PEDro, and Google Scholar were researched to identify, organize and commission the current review. To create a search strategy, Medical Subject Headings and Descriptors of Science and Health were utilized. The authors looked for other studies by screening the references list of the potentially pertinent papers. These computerized searches turned up studies and those studies' bibliographies with pertinent citations were examined. Personal protective equipment was a crucial component for protection and contact precaution. Following hypoxia, effective oxygen therapy is administered right away. When necessary, under the right circumstances, nasal high-flow oxygen therapy, non-invasive ventilation, lung-protective breathing methods, and prone positioning can be used. Children with SARS-CoV-2/COVID-19 may benefit from physiotherapy interventions with a focus on ventilatory management, airway clearance procedures, early activities, and mobilization.

Respiratory Muscle Strength and Aerobic Performance Among Chronic Obstructive Pulmonary Disease (COPD) Patients: A Correlational Study

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, yielding various respiratory symptoms and categorized under several descriptors: early, mild, young, pre-COPD, and preserved ratio impaired spirometry. COPD is synonymous with symptoms such as dyspnea and cough, in addition to others like exercise intolerance, which result from respiratory muscle weakness. Therefore, the emergence of respiratory strength assessment tools for such patients is not surprising. However, evidence is limited regarding the impact of respiratory muscle strength on the physical performance of COPD patients. Therefore, this study employs the MicroRPM device (Medikart HealthCare Systems Pvt. Ltd., Delhi, India) to measure maximum inspiratory and expiratory pressure utilizing mouth pressure. Methodology We recruited a total of 40 patients for the study. All patients received a thorough assessment for hemodynamic stability and were categorized according to the Global Initiative for Chronic Obstructive Lung Disease criteria of COPD. The patients then underwent a training session for the MicroRPM device. We took each patient's inspiratory and expiratory pressure measurements, then determined their six-minute walk distance and modified the Borg scale rating. Results We observed no significant correlation between maximum inspiratory pressure (Pimax) and six-minute walk distance (r=-0.023, p=0.890) or modified Borg scale (r=-0.044, p=0.788); additionally, the correlation between maximum expiratory pressure (Pemax) and modified Borg scale was not significant (r=-0.192, p=0.235). However, the correlation between Pemax and six-minute walk distance was both negative and significant (r=-0.384, p=0.014). Conclusion Based on our results, respiratory muscle strength can influence the aerobic performance of COPD patients.

The Efficacy of Expiratory Muscle Training during Inspiratory Load in Healthy Adult Males: A Randomized Controlled Trial

This study aimed to evaluate the effects of expiratory muscle training (EMT) on respiratory muscle strength and respiratory distress during inspiratory load. Thirty-one healthy adult males were randomly divided into an EMT group who underwent EMT (n = 15) and a control group who did not undergo EMT (n = 16). The EMT group underwent EMT with a 50% load of maximum expiratory mouth pressure (PEmax) for 15 min, twice a day, every day, for 4 weeks. The parameter of respiratory muscle fatigue was a decrease in maximum inspiratory mouth pressure (PImax) and PEmax during 20 min of inspiratory load; thus, PImax and PEmax during inspiratory load were measured. Respiratory distress during inspiratory load was assessed using the Borg scale. These assessments were performed on the same subjects in each group before and after the 4 week study. In the EMT group, the PEmax values after the study were significantly higher than those before the study (p < 0.01). Furthermore, before the study, the PImax and PEmax values for the EMT group during inspiratory load were significantly lower than those before inspiratory load (p < 0.01). However, after the study, there was no difference in these values between during and before inspiratory load. In the EMT group, the Borg scale value during inspiratory load from 6 to 20 min was significantly lower after the study than before the study (p < 0.05). EMT increases expiratory muscle strength, thereby attenuating decreased respiratory muscle strength (PImax and PEmax) and respiratory distress during inspiratory load in healthy subjects.

Application of Inspiratory Muscle Training to Improve Physical Tolerance in Older Patients with Ischemic Heart Failure

Regardless of the management regime for heart failure (HF), there is strong evidence supporting the early implementation of exercise-based cardiac rehabilitation (CR). Respiratory therapy is considered to be an integral part of such secondary prevention protocols. The aim of the study was to evaluate the effect of inspiratory muscle training (IMT) on exercise tolerance and the functional parameters of the respiratory system in patients with heart failure involved in cardiac rehabilitation. The study included 90 patients with HF who took part in the second-stage 8-week cycle of cardiac rehabilitation (CR). They were randomly divided into three groups: Group I underwent CR and IMT; Group II only CR; and patients in Group III underwent only the IMT. Before and after the 8-week cycle, participants were assessed for exercise tolerance and the functional parameters of respiratory muscle strength. Significant statistical improvement concerned the majority of the hemodynamic parameters, lung function parameters, and respiratory muscle strength in the first group. Moreover, the enhancement in the exercise tolerance in the CR + IMT group was accompanied by a negligible change in the HR_peak. The results confirm that the addition of IMT to the standard rehabilitation process of patients with heart failure can increase the therapeutic effect while influencing some of the parameters measured by exercise electrocardiography and respiratory function.

A New Nasal Restriction Device Called FeelBreathe® Improves Breathing Patterns in Chronic Obstructive Pulmonary Disease Patients during Exercise

A device called FeelBreathe (FB)^® was designed, developed, and patented for inspiratory muscle training. The main aim was to determine the acute responses on lung ventilation, gas exchange, and heart rate during exercise in patients with chronic obstructive pulmonary disease (COPD) with and without the use of FB. In this study, a randomized cross-over trial was performed with 18 men diagnosed with COPD (FEV₁ between 30% and 70% of its predicted value). Each participant randomly conducted two trials with 30 min of rest between them with the same protocol on a treadmill for 10 min at a constant rate of 50% of VO_2peak. Each test was performed randomly and in a crossover randomized design in two different conditions: (1) oronasal breathing; and (2) nasal breathing with FB (nasal ventilatory flow restriction device). It was observed that FB had positive effects on dynamic hyperinflation, breathing pattern, and breathing efficiency, with higher expiratory and inspiratory time. Despite these differences, blood oxygen saturation percentage, oxygen uptake, and heart rate showed a similar response for both conditions during exercise. The results suggest that exercise performed with FB improved ventilatory responses compared to the oronasal mode in COPD patients. This new tool could be used during most daily tasks and exercise programs.

The respiratory physiome: Clustering based on a comprehensive lung function assessment in patients with COPD

Background

While spirometry and particularly airflow limitation is still considered as an important tool in therapeutic decision making, it poorly reflects the heterogeneity of respiratory impairment in chronic obstructive pulmonary disease (COPD). The aims of this study were to identify pathophysiological clusters in COPD based on an integrated set of standard lung function attributes and to investigate whether these clusters can predict patient-related outcomes and differ in clinical characteristics.

Methods

Clinically stable COPD patients referred for pulmonary rehabilitation underwent an integrated assessment including clinical characteristics, dyspnea score, exercise performance, mood and health status, and lung function measurements (post-bronchodilator spirometry, body plethysmography, diffusing capacity, mouth pressures and arterial blood gases). Self-organizing maps were used to generate lung function based clusters.

Results

Clustering of lung function attributes of 518 patients with mild to very severe COPD identified seven different lung function clusters. Cluster 1 includes patients with better lung function attributes compared to the other clusters. Airflow limitation is attenuated in clusters 1 to 4 but more pronounced in clusters 5 to 7. Static hyperinflation is more dominant in clusters 5 to 7. A different pattern occurs for carbon monoxide diffusing capacity, mouth pressures and for arterial blood gases. Related to the different lung function profiles, clusters 1 and 4 demonstrate the best functional performance and health status while this is worst for clusters 6 and 7. All clusters show differences in dyspnea score, proportion of men/women, age, number of exacerbations and hospitalizations, proportion of patients using long-term oxygen and number of comorbidities.

Conclusion

Based on an integrated assessment of lung function variables, seven pathophysiological clusters can be identified in COPD patients. These clusters poorly predict functional performance and health status.

Exercise tolerance and balance of inspiratory-to-expiratory muscle strength in relation to breathing timing in patients with chronic obstructive pulmonary disease

RATIONALE

Little is known about the applicability of respiratory muscle training based on exertional pathophysiological conditions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between breathing timing and exertional responses, as well as whether exertional changes in the inspiratory duty cycle (Ti/Ttot) affect pathophysiological conditions, including respiratory muscles.

METHODS

Forty-five stable COPD patients (mean age: 71.2 years, severe and very severe COPD: 80%) were evaluated based on exertional cardiopulmonary function and respiratory muscle strength. To compare exertional responses and the balance of inspiratory-to-expiratory muscle strength, the patients were divided into two groups according to whether the Ti/Ttot increased (Ti/Ttot-increased group: resting Ti/Ttot ≤ peak Ti/Ttot, n = 21) or decreased during exercise (Ti/Ttot-decreased group: resting Ti/Ttot > peak Ti/Ttot, n = 24).

RESULTS

At peak exercise, the Ti/Ttot was positively correlated with minute ventilation ([Formula: see text] _E), and oxygen uptake ([Formula: see text]) in all patients. No significant differences were seen in breathing frequency, tidal volume, or [Formula: see text] _E at peak exercise between the two groups. Compared with the Ti/Ttot-increased group, the Ti/Ttot-decreased group had significantly lower mean values of [Formula: see text] and ΔFO₂ (the inspired minus expired oxygen concentration) at peak exercise, and significantly higher mean values of the absolute ratio of maximal inspiratory pressure/maximal expiratory pressure.

CONCLUSIONS

The exertional change of breathing timing affected exercise tolerance and the balance of inspiratory-to-expiratory muscle strength; this finding might be helpful in making the contradictory choice of managing COPD patients with inspiratory or expiratory muscle training.

Respiratory motor training and neuromuscular plasticity in patients with chronic obstructive pulmonary disease: A pilot study

The objective of this study was to examine the feasibility of a full-scale investigation of the neurophysiological mechanisms of COPD-induced respiratory neuromuscular control deficits. Characterization of respiratory single- and multi-muscle activation patterns using surface electromyography (sEMG) were assessed along with functional measures at baseline and following 21±2 (mean±SD) sessions of respiratory motor training (RMT) performed during a one-month period in four patients with GOLD stage II or III COPD. Pre-training, the individuals with COPD showed significantly increased (p<0.05) overall respiratory muscle activity and disorganized multi-muscle activation patterns in association with lowered spirometrical measures and decreased fast- and slow-twitch fiber activity as compared to healthy controls (N=4). Following RMT, functional and respiratory sEMG activation outcomes during quite breathing and forced expiratory efforts were improved suggesting that functional improvements, induced by task-specific RMT, are evidence respiratory neuromuscular networks re-organization.

Effect of Wearing the Elevation Training Mask on Aerobic Capacity, Lung Function, and Hematological Variables

Altitude training and respiratory muscle training (RMT) have been reported to improve performance in elite and well-trained athletes. Several devices (altitude and RMT) have been developed to help athletes gain the competitive edge. The Elevation Training Mask 2.0 (ETM) purportedly simulates altitude training and has been suggested to increase aerobic capacity (VO2max), endurance performance, and lung function. Twenty-four moderately trained subjects completed 6 weeks of high-intensity cycle ergometer training. Subjects were randomized into a mask (n = 12) or control (n = 12) group. Pre and post-training tests included VO2max, pulmonary function, maximal inspiration pressure, hemoglobin and hematocrit. No significant differences were found in pulmonary function or hematological variables between or within groups. There was a significant improvement in VO2max and PPO in both the control (13.5% and 9.9%) and mask (16.5% and 13.6%) groups. There was no difference in the magnitude of improvement between groups. Only the mask group had significant improvements in ventilatory threshold (VT) (13.9%), power output (PO) at VT (19.3%), respiratory compensation threshold (RCT) (10.2%), and PO at RCT (16.4%) from pre to post-testing. The trends for improvements in VT and PO at VT between groups were similar to improvements in RCT and PO at RCT, but did not reach statistical significance (VT p = 0.06, PO at VT p = 0.170). Wearing the ETM while participating in a 6-week high-intensity cycle ergometer training program does not appear to act as a simulator of altitude, but more like a respiratory muscle training device. Wearing the ETM may improve specific markers of endurance performance beyond the improvements seen with interval training alone. Key pointsWearing the ETM during a 6-week high-intensity cycle ergometer training program may improve performance variables, such as VO2max, PPO, VT, PO at VT, RCT and PO at RCT.Wearing the ETM did not improve lung function, inspiratory muscle strength, or stimulate changes in hemoglobin or hematocrit levels.The ETM does not simulate altitude, but works more like an respiratory training device.