title: Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.
abstract: Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.
authors.affiliation: Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France marc.beaumont@univ-brest.fr.
authors.forename: M
authors.initials: M
authors.lastname: Beaumont
authors.affiliation: Pulmonary Physiology Unit, EA2438, European University of Occidental Brittany, University Brest Centre, Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Mialon
authors.affiliation: Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Ber-Moy
authors.affiliation: Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.
authors.forename: C
authors.initials: C
authors.lastname: Lochon
authors.affiliation: Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.
authors.forename: L
authors.initials: L
authors.lastname: Péran
authors.affiliation: Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, European University of Occidental Brittany, EA3878, Morlaix, France.
authors.forename: R
authors.initials: R
authors.lastname: Pichon
authors.affiliation: Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.
authors.forename: C
authors.initials: C
authors.lastname: Gut-Gobert
authors.affiliation: Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.
authors.forename: C
authors.initials: C
authors.lastname: Leroyer
authors.affiliation: Pulmonary and Reanimation Unit, Pitié salpétrière Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Morelot-Panzini
authors.affiliation: Department of Internal Medicine and Chest Diseases, University Hospital of Brest, European University of Occidental Brittany, EA3878 (G.E.T.B.O), CIC INSERM 0502, Brest, France.
authors.forename: F
authors.initials: F
authors.lastname: Couturaud
mesh_terms: D000368:Aged; D001945:Breathing Exercises / Q000379:methods*; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D012132:Respiratory Muscles; D014109:Total Lung Capacity; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: COPD; dyspnea; dyspnea score; hyperinflation; pulmonary rehabilitation; respiratory muscle training