INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

We analyze the effect of inspiratory muscle training (IMT) in patients with chronic obstructive pulmonary disease (COPD), with special empha sis on its effects on inspiratory, muscle function and clinical outcom es. We reviewed only randomized, controlled studies that have either c ontrolled both the load a?ld the breathing pattern when using resistiv e training or have employed a threshold trainer in which the load is i ndependent of the pattern of breathing, since methodological aspects m ay explain inconsistent results in the literature. In these circumstan ces, most of the studies demonstrated positive effects on inspiratory muscle function. Clinical effects were seldom evaluated; limited avail able data showed a reduction in dyspnea that was related to an increas e in maximal inspiratory pressures (PIMax). When exercise capacity was evaluated through the distance the patients were able to walk in 6 or 12 minutes, most studies demonstrated a significant increase. Other r eported positive effects were improvement in nocturnal SaO(2), inspira tory muscle power output and maximal inspiratory flow rate. Based in t his review, a recommended training regime appears to be an intermediat e load (30-40% PIMax) using a threshold device for 30 minutes daily fo r at least 5 weeks. Although in the literature the criteria for select ing patients are not always well defined, we consider IMT as a helpful procedure for pulmonar rehabilitation in those patients with a modera tely severe inspiratory muscle dysfunction presenting dyspnea during d aily living activities despite optimal therapy.