Pulmonary rehabilitation improves exercise tolerance in patients with bronchiectasis

Abstract

For patients with bronchiectasis, does pulmonary rehabilitation either with or without inspiratory muscle training (IMT) improve exercise tolerance? Randomised controlled trial. Outpatient-based pulmonary rehabilitation program of a UK hospital. Patients with bronchiectasis confirmed by highresolution computer tomography. Exclusion criteria included concomitant emphysema, an acute exacerbation in the previous six weeks, long-term oral corticosteroid use, and significant co-morbidities. Thirty-two patients were randomised to pulmonary rehabilitation plus IMT (PRIMT) (n = 12), pulmonary rehabilitation plus sham IMT (PR-Sham) (n = 11), or a control group with no intervention (n = 9). Pulmonary rehabilitation consisted of exercise training and multidisciplinary education sessions for eight weeks. Exercise consisted of three 45- minute periods per week with a target exercise intensity of 80% of the peak heart rate achieved on an initial maximal incremental exercise test. Two sessions per week were performed at the hospital and involved cycling, treadmill walking, and stair climbing. A third session of walking was performed at home, using the Borg dyspnoea scale to guide intensity. IMT was performed for 15 minutes twice daily over the eight-week period using a pressure threshold device. Pressure was set at 30% of the patient's maximal inspiratory pressure and increased by 5% each week to a maximum of 60%. Sham IMT followed the same regimen except that the pressure was always 7 cmH 2 O. The incremental shuttle walk test, endurance exercise capacity, and respiratory muscle strength were assessed in all groups at baseline and at the end of the program. The endurance exercise test involved walking on a treadmill at 85% of peak oxygen uptake. Over the eight weeks, improvement in the incremental shuttle walk test was significantly greater in the PR-IMT group (by 113 m, 95% CI 45 to 182) and PRSham group (by 86 m, 95% CI 42 to 130) than the control group. Similarly, change in endurance exercise capacity was significantly better in the PR-IMT group (by 720 m, 95% CI 342 to 1098) and PR-Sham group (by 505 m, 95% CI 128 to 883) than the control group. Change in maximal inspiratory pressure was significantly better in the PR-IMT group (by 23 cmH 2 O, 95% CI 10 to 36) and the PR-Sham group (by 14 cmH 2 O, 95% CI 2 to 25) than that seen in the control group. The inclusion of IMT did not produce a statistically significant benefit over pulmonary rehabilitation alone for these outcomes during the training period. Pulmonary rehabilitation with or without IMT improves exercise tolerance and inspiratory muscle strength in subjects with bronchiectasis.