The present study was aimed at evaluating the effects of a specific inspiratory muscle training protocol on the structure of inspiratory muscles in patients with chronic obstructive pulmonary disease. Fourteen patients (males, FEV1, 24 +/- 7% predicted) were randomized to either inspiratory muscle or sham training groups. Supervised breathing using a threshold inspiratory device was performed 30 minutes per day, five times a week, for 5 consecutive weeks. The inspiratory training group was subjected to inspiratory loading equivalent to 40 to 50% of their maximal inspiratory pressure. Biopsies from external intercostal muscles and vastus lateralis (control muscle) were taken before and after the training period. Muscle samples were processed for morphometric analyses using monoclonal antibodies against myosin heavy chain isoforms I and II. Increases in both the strength and endurance of the inspiratory muscles were observed in the inspiratory training group. This improvement was associated with increases in the proportion of type I fibers (by approximately 38%, p < 0.05) and in the size of type II fibers (by approximately 21%, p < 0.05) in the external intercostal muscles. No changes were observed in the control muscle. The study demonstrates that inspiratory training induces a specific functional improvement of the inspiratory muscles and adaptive changes in the structure of external intercostal muscles.

Outpatient rehabilitation programs can achieve worthwhile benefits that persist for a period of 2 years.

The aim of this study was to translate the Chronic Respiratory Questionnaire (CRQ) into Spanish and to test its measurement properties.The study was performed in 60 patients with chronic obstructive pulmonary disease (forced expiratory volume in one second (FEV1) mean±SD 35±14% of reference value). A rigorous process of forward and back translation and review produced an easily comprehensible questionnaire, which was administered together with measures of pulmonary function and exercise capacity. The patients were randomly allocated to one of two groups: 30 received respiratory rehabilitation and the other 30 received standard community care only.Weak to moderate statistically significant correlations (0.2-0.38) were found between the domains of the CRQ and pulmonary function and exercise measures. For the three CRQ domains that measure differences between patients at a point in time, Crohnbach's alpha and intraclass correlation coefficients were: fatigue 0.80 and 0.80; emotional function 0.86 and 0.68; and mastery domains 0.84 and 0.67, respectively. Scores remained stable in patients who were deemed clinically stable, and showed large statistically significant improvement (p<0.0001) in patients in the rehabilitation programme. Only low correlations were found between the changes in CRQ and the changes in pulmonary function and exercise capacity. The index of responsiveness was 0.92 for fatigue, and 0.91 for dyspnoea, emotional function and mastery.In conclusion, the Spanish translation of the Chronic Respiratory Questionnaire is likely to be useful for measuring differences between patients, and particularly for measuring the effects of intervention on quality of life in chronic respiratory disease. Eur Respir J 1998; 11: 55-60.

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