【論文摘要】Effectiveness of Inspiratory Muscle Training in Patients With Chronic Obstructive Pulmonary Disease After Exacerbation

【論文摘要】吸氣肌訓練對慢性阻塞性肺病患者急性惡化後之療效探討

Wei-Yu Huang(黃維羽) ； Jung-Yien Chien(簡榮彥) ； Miao-Ju Hsu(許妙如) ； Huey-Dong Wu(吳惠東) ； Li-Ying Wang(王儷穎)

《物理治療》 48卷2期 (2023/06) Pp. 123-124

https://doi.org/10.6215/FJPT.202306.O22

摘要

Background and Purpose: Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often have decreased maximal inspiratory pressure (PI_(max)), reduced exercise capacity, and impaired quality of life (QoL). Pulmonary rehabilitation (PR) initiated after exacerbations could improve exercise capacity and QoL, and that inspiratory muscle training (IMT) could benefit inspiratory muscle function in patients with stable chronic obstructive pulmonary disease (COPD). This study aimed to examine the effectiveness of IMT in addition to PR on inspiratory muscle function, functional exercise capacity, and QoL in patients with AECOPD. Methods: Patients with AECOPD and a PImax < 80 cm H_2O were recruited and randomized into the experimental (PR + IMT) or the control (PR + sham IMT) group. All subjects underwent an 8-week structured PR, and the experimental group received an additional IMT with an intensity of 30%PI_(max). The study measured PI_(max), six-minute walk distance (6MWD), QoL using OPD St. George's Respiratory Questionnaire (SGRQ), and inspiratory muscle activation during threshold loaded breathing using surface electromyography at baseline (T0), Week 4 (T1), Week 8 (T2), and 1-month follow-up (T3). The generalized estimating equation model was used to analyze data, and the statistical significance level was set at 0.05. Results: A total of 16 patients (n = 8 per group) participated in this study. The experimental group showed significantly greater PI_(max) (104.3 ± 16.9 vs. 72.3 ± 12.8 cm H_2O), and less diaphragm activation during threshold loaded breathing (32.2 ± 9.1 vs. 53.7 ± 14.8%), at T2 compared to the control group (both p < 0.001). Compared to the control group, the experimental showed more improvements in 6MWD (+ 66.3 m vs. + 32.5 m) and SGRQ total scores (-22.6 vs. -13.5) from T0 to T2 (both p < 0.05). Conclusions: The combination of IMT and PR, compared to PR alone, provided more improvements in inspiratory muscle function, functional exercise capacity, and QoL in patients with AECOPD. Clinical Relevance: The combination of IMT and PR might improve the overall management of AECOPD.