title: Inspiratory muscle training may increase peak inspiratory flow in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  When choosing a specific inhalation device for a chronic obstructive pulmonary disease (COPD) patient, the internal airflow resistance and the ability of the patient to overcome it and to create an optimal inspiratory flow are essential.
  
  
  OBJECTIVE
  The purpose of the present study was to investigate: (1) the peak inspiratory flow (PIF) that a patient with COPD can generate while breathing through two dry powder inhalers and (2) whether in patients with low PIF specific inspiratory muscle training (SIMT) will increase the PIF and exceed the minimal PIF that is considered necessary to guarantee optimal lung deposition of the drug.
  
  
  METHODS
  Inspiratory muscle strength and PIFs were measured in 60 patients with COPD. Then 28 patients with severe COPD and low PIF were randomized to receive SIMT or to a control group.
  
  
  RESULTS
  With the Turbuhaler, 12 patients (20%) could not generate the optimal flow of 60 l/min. PIF correlated very well with maximal inspiratory mouth pressure (PI(max)) for the Diskus and the Turbuhaler, as well as for both males and females (p < 0.001). Following the training period, there was a statistically significant increase in the PI(max) in the training group. This increase was associated with a significant increase in the PIF. All patients overcame the minimal threshold PIF following the training.
  
  
  CONCLUSIONS
  Some patients with severe COPD are not able to generate adequate flow to secure optimal lung deposition of the inhalation with the Turbuhaler. SIMT improves inspiratory muscle strength as well as PIF. Following 8 weeks of training, the optimal PIF enabling adequate lung deposition of the drug was attained in all the trained patients.
authors.affiliation: Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel. weiner@hillel-yaffe.health.gov.il
authors.forename: Paltiel
authors.initials: P
authors.lastname: Weiner
authors.forename: Margalit
authors.initials: M
authors.lastname: Weiner
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012132:Respiratory Muscles / Q000503:physiopathology*; D012720:Severity of Illness Index