Influence of Inspiratory Muscle Training on Respiratory Functions among Uncontrolled Asthmatics

Year 2022, , 506 - 513, 31.05.2022

Aylin Özgen Alpaydın , Begum Gorgulu Selin Ercan , Sevgi Özalevli

https://doi.org/10.30621/jbachs.998416

Cited By: 1

Abstract

Background: Specific breathing exercises are reported to improve quality of life and reduce symptoms; although no significant benefit on lung function or reduction of exacerbation risk. Additionally, inspiratory muscle training (IMT) aims to increase diaphragm and inspiratory muscle endurance. In this regard, IMT has been studied in uncontrolled asthma patients to investigate its effect on respiratory symptoms and pulmonary functions.
Methods: Twenty-one uncontrolled and partially controlled asthmatic patients were included in the study. Asthma control test (ACT), asthma quality of life questionnaire (AQLQ), and spirometric evaluations were performed. The study population was randomized into two groups. The standard care group (n=10) received standard medical treatment while the intervention (n=11) group practiced a portable threshold IMT device following standard medical treatment.
Results: The study was completed by 15 patients due to 6 lost follow up (one intervention group and 5 standard care) and one asthma exacerbation. We have found that the intervention group tended to have increased pulmonary function test parameters and AQLQ scores, moreover; MIP values and ACT scores have statistically significant increases after IMT(p=0.01, p=0.02 respectively).
Conclusion: Add-on IMT to standard medical treatment could improve asthma control by strengthening inspiratory muscles in uncontrolled asthmatic patients. IMT could be considered in the non-pharmacological treatments of uncontrolled asthmatic patients. Despite the limited number of patients, this study revealed that IMT might have positive outcomes for uncontrolled asthma patients.

Keywords

uncontrolled asthma, inspiratory muscle training, pulmonary function, inspiratory muscle endurance, quality of life

References

• 1. 2017 GINA Report, Global Strategy for Asthma Management and Prevention, Available from: https://ginasthma.org/wp-content/uploads/2019/04/wmsGINA-2017-main-report-final_V2.pdf
• 2. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring Quality of Life in Asthma. American Review of Respiratory Disease. 1993. pp. 832–838. doi:10.1164/ajrccm/147.4.832
• 3. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188: e13–64.
• 4. Similowski T, Yan S, Gauthier AP, Macklem PT, Bellemare F. Contractile properties of the human diaphragm during chronic hyperinflation. N Engl J Med. 1991;325: 917–923.
• 5. Lougheed MD, Diane Lougheed M, Dostaler SM, Fisher T. Symptom Perception In Asthma: Repeatability Of Perception Scores For Dynamic Hyperinflation And Bronchoconstriction. D101. DIAGNOSIS AND TREATMENT OF ASTHMA. 2010. doi:10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6650
• 6. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine. 2006. pp. 1390–1413. doi:10.1164/rccm.200508-1211st
• 7. Gloeckl R, Schneeberger T, Jarosch I, Kenn K. Pulmonary Rehabilitation and Exercise Training in Chronic Obstructive Pulmonary Disease. Deutsches Aerzteblatt Online. 2018. doi:10.3238/arztebl.2018.0117
• 8. Perez T, Chanez P, Dusser D, Devillier P. Small airway impairment in moderate to severe asthmatics without significant proximal airway obstruction. Respir Med. 2013;107: 1667–1674.
• 9. Lougheed MD, Diane Lougheed M, Fisher T, O’Donnell DE. Dynamic Hyperinflation During Bronchoconstriction in Asthma. Chest. 2006. pp. 1072–1081. doi:10.1378/chest.130.4.1072
• 10. Turner LA, Mickleborough TD, McConnell AK, Stager JM, Tecklenburg-Lund S, Lindley MR. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals. Med Sci Sports Exerc. 2011;43: 2031–2038.
• 11. ATS/ERS Statement on Respiratory Muscle Testing. American Journal of Respiratory and Critical Care Medicine. 2002. pp. 518–624. doi:10.1164/rccm.166.4.518
• 12. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training in patients with bronchial asthma. Chest. 1992;102: 1357–1361.
• 13. Weiner P, Magadle R, Beckerman M, Berar-Yanay N. The relationship among inspiratory muscle strength, the perception of dyspnea and inhaled beta2-agonist use in patients with asthma. Can Respir J. 2002;9: 307–312.
• 14. Shei R-J, Paris HLR, Wilhite DP, Chapman RF, Mickleborough TD. The role of inspiratory muscle training in the management of asthma and exercise-induced bronchoconstriction. Phys Sportsmed. 2016;44: 327–334.
• 15. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc. 2003;35: 237–244.
• 16. Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med. 2014;35: 369–389.
• 17. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test☆A survey for assessing asthma control. Journal of Allergy and Clinical Immunology. 2004. pp. 59–65. doi:10.1016/j.jaci.2003.09.008
• 18. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26: 319–338.
• 19. Uysal MA, Mungan D, Yorgancioglu A, et al. The validation of the Turkish version of Asthma Control Test. Qual Life Res. 2013;22: 1773–1779.
• 20. Bora M, Alpaydin AO, Yorgancioglu A, et al. Does asthma control as assessed by the asthma control test reflect airway inflammation? Multidiscip Respir Med. 2011;6: 291–298.
• 21. Threshold IMT. [cited 14 Jun 2021]. Available: https://www.philips.com.tr/healthcare/product/HCHS730010/treshold-inspiratory-muscle-trainer
• 22. Ramos E, de Oliveira LVF, Silva AB, et al. Peripheral muscle strength and functional capacity in patients with moderate to severe asthma. Multidiscip Respir Med. 2015;10: 3.
• 23. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47: 1019–1024.
• 24. Silva IS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Ferreira GMH. Inspiratory muscle training for asthma. Cochrane Database Syst Rev. 2013; CD003792.
• 25. Bruurs MLJ, van der Giessen LJ, Moed H. The effectiveness of physiotherapy in patients with asthma: a systematic review of the literature. Respir Med. 2013;107: 483–494.