Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial

Abstract

The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of in the IMT group.

Inspiratory muscle training in stable COPD patients: enough is enough?

“…All these dishes that have been ordered are now served in this issue of the European Respiratory Journal. In the single-blind RCT by BEAUMONT et al [8], 149 severe COPD patients were allocated to 4-week PRP with or without IMT. Dyspnoea was assessed by means of different tools including the recently proposed Multidimensional Dyspnea Profile questionnaire [9].…”

“…It is noteworthy that the total sample size of 751 patients studied in these two RCTs [8,10] taken together accounts for almost the total sample size of all 32 studies eligible for the meta-analysis [6]. In an age of meta-analyses that are not always necessary (in some cases, including only two eligible studies and few patients, perhaps more useful to academic careers than to real progress of knowledge), the work of these authors must be appreciated.…”

“…In both studies, training method (threshold inspiratory training) and intensity (up to 60% of maximal inspiratory pressure) were in line with recommendations. However, the IMT protocols involved 3-and 4-week training in the studies by BEAUMONT et al [8] and SCHULTZ et al [10] respectively, whereas some studies included in the meta-analysis [6] lasted up to 4 months. Nevertheless, when evaluating a training protocol, the number of sessions might be more relevant than, or equally relevant to, the overall duration [11].…”

Add‐on interventions during pulmonary rehabilitation

“…The value of IMT as an add‐on modality during PR was less clear for a long time. In 2018, three large studies (including a total sample size of 971 COPD patients) were published that investigated the effects of an additional IMT during PR . All three studies showed conclusively that complementary IMT on top of a general (endurance and strength) training programme significantly improved PI max .…”

Inspiratory muscle training in COPD: can data finally beat emotion?

“…In the larger Schultz and colleagues16 randomised 611 patients to receive intensive or sham IMT in the context of a 3-week inpatient rehabilitation programme. In the other Beaumont and colleagues17 randomised 150 more severe patients to receive single blind IMT (or not) as part of a 4-week trial of rehabilitation. Charususin18 randomised 219 patients with both COPD and evidence of inspiratory muscle weakness (defined as a PI max  <60 cmH 2 O or 50% of predicted) to receive real or sham IMT as part of a PRP bringing to combined total of patients randomised to almost 1000.…”