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Inspiratory Muscle Training May Be an Option for Patients Who Decline Pulmonary Rehabilitation for COPD

Kelly Davio
While pulmonary rehabilitation (PR) is an evidence-based and cost-effective treatment for people with chronic obstructive pulmonary disease (COPD), uptake of and compliance with this intervention has been poor. For patients who decline PR, inspiratory muscle training (IMT), which involves strengthening the inspiratory muscles by increasing their workload, may be an option, particularly as it can be performed in the home instead of in a clinic.
While pulmonary rehabilitation (PR) is an evidence-based and cost-effective treatment for people with chronic obstructive pulmonary disease (COPD), uptake of and compliance with this intervention has been poor. For patients who decline PR, inspiratory muscle training (IMT), which involves strengthening the inspiratory muscles by increasing their workload, may be an option, particularly as it can be performed in the home instead of in a clinic.

One recent study sought to test the feasibility of IMT as an option for patients who declined PR, and the researchers found that not only could IMT be implemented for this patient population, but it also proved to be acceptable to patients.

The study enrolled 10 adults with COPD who had declined PR. These patients performed 8 weeks of IMT strength training using the Powerbreathe K3 device, through which participants inhaled at a high velocity from residual volume tot total lung capacity 30 times, twice per day, for 5 days each week.

Patients received weekly assessments by a physiotherapist for 8 weeks. After 8 weeks of training, participants continued to conduct their training unsupervised for 3 days each week for 18 weeks. Adherence was measured using the device’s digital records and patient’s diaries. Patients were interviewed at baseline, 8 weeks, and 6 months to assess acceptability of the therapy.

Eight participants completed all 6 months of the program, and 7 were available for follow-up. Overall adherence with the prescribed sessions was 76%, and 33% completed all of their prescribed sessions, while 77% completed more than 70% of their sessions. In the unsupervised period, 37.5% completed all prescribed sessions, and 50% completed more than 70% of their sessions.

Interviews revealed that most patients had never heard of IMT before the study, but this lack of knowledge was not a barrier to accepting the treatment. Factors that influenced acceptability and adherence included problems with the device, such as issues with its filters, and the environment of therapy; some interviewees reported that they liked the fact that they could perform their therapy at home.

While adherence was variable, concerns prior to the study that participants who declined PR might not be adherent with IMT proved to be unfounded; in fact, some patients overtrained with IMT, and 4 participants went on to participate in full PR programs.

While the study was limited by its small sample size, these findings, wrote the study’s authors, show that a randomized controlled trial is warranted to establish the efficacy and cost-effectiveness of IMT in patients who decline PR, as well as to establish whether IMT can help to promote the uptake of PR among patients who initially declined the intervention.

Reference

O’Connor C, Lawson R, Waterhouse J, Mills GH. Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting [published online August 8, 2019]. BMJ Open. doi: 10.1136/bmjopen-2018-028507.

 
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