Improvement In Respiratory Muscle Strength Research Articles

Effect of chest wall mobilization on respiratory muscle function in patients with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial

BackgroundClinical trials have demonstrated positive correlation between pulmonary function and chest wall expansion in COPD. Decrease in chest wall expansion in patients with COPD compromises rib cage mobility and functional length of respiratory muscles that ultimately jeopardize the efficacy and function of respiratory system. MethodThirty male adults (mean age: 74.97 ± 6.29) suffered with severe COPD were randomly allocated to either experimental group (chest wall mobilizations) or control group. Both groups received standardized education and walking exercise (twice/week) for 6 weeks. Patients in experimental group received additional chest wall mobilizations that include stretching and joints mobilization. Pulmonary function, respiratory muscle strength, thoracic excursion, cervical and thoracic range of movement were evaluated at baseline, post-program and at 3-month follow-up. ResultsThere were significantly greater improvements in respiratory muscle strength, thoracic excursion and thoracic range of movement (p < 0.01) except thoracic flexion. Lower thoracic excursion is strongly associated with increase in maximum inspiratory pressure (β = 13.64, p < 0.001) and maximum expiratory pressure (β = 16.23, p < 0.001). Thoracic range of movement especially extension (p < 0.001) and bilateral rotation (p < 0.01) exhibit a strong relationship with increase in lower thoracic excursion (adjusted R2 = 0.876) as shown in multiple regression analysis. ConclusionAdditional chest wall mobilization in the rehabilitation of patients with COPD is likely to enhance thoracic extension and rotation which increase lower thoracic excursion. This significant improvement in chest expansion capacity allows respiratory muscles to work at an optimal functional length which result in greater respiratory muscle strength in patients with severe COPD.

Adding Non-Invasive Positive Pressure Ventilation to Supplemental Oxygen During Exercise Training in Severe Chronic Obstructive Pulmonary Disease: A Randomized Controlled Study.

Chronic obstructive pulmonary disease is currently the fourth leading cause of death in the world. Pulmonary rehabilitation is recommended for chronic obstructive pulmonary disease. This study aimed to evaluate the effects of non-invasive ventilation, supplemental oxygen, and exercise training and supplemental oxygen during exercise training during pulmonary rehabilitation practice in comparison with only exercise training on lung functions, blood gases, lactate levels, respiratory muscle pressures, dyspnea, walking distances, quality of life, and depression in patients with severe chronic obstructive pulmonary disease. The main outcome measure is exercise capacity (6-minute walk test), and the secondary end-point included quality of life. Thirty-five patients (mean ± SD age, 65.4 ± 6.5 years) with a mean bronchodilator forced expiratory volume in the first second of expiration of 39.4 ± 7%, undergoing an 8-week outpatient pulmonary rehabilitation, were randomized to either non-invasive ventilation, supplemental oxygen, and exercise training, supplemental oxygen during exercise training, or exercise training groups. The improvements in respiratory muscle strength were higher in non-invasive ventilation, supplemental oxygen, and exercise training patients than the moderate improvements in the exercise training group. Both non-invasive ventilation, supplemental oxygen, and exercise training and supplemental oxygen during exercise training groups showed significant increases in the 6-minute walk test and incremental shuttle walk test. However, the increase in walking distance was better in non-invasive ventilation, supplemental oxygen, and exercise training group (69.8 ± 53.2 m in 6-minute walk test and 66.6 ± 65.2 m in incremental shuttle walk test, P = .001 and P = .005, respectively) compared to supplemental oxygen during exercise training group (42.5+55.5 m in 6-minute walk test and 53.5+70.2 m in incremental shuttle walk test, P = .01 each, respectively). The total St. George's Respiratory Questionnaire score was similar in all study groups after the intervention. Symptoms of depression significantly improved only in non-invasive ventilation, supplemental oxygen, and exercise training group (-2.8+2.8, P = .006). Non-invasive positive-pressure ventilation (NIPPV) added to supplemental oxygen during exercise training was associated with better physiological adaptations than other modalities.

VP.60 Every breath counts! Inspiratory muscle training in children with neuromuscular diseases: a cross-over randomised controlled trial

Progressive respiratory muscle weakness and ineffective cough contributes to morbidity and mortality in children with neuromuscular diseases (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength and reduce respiratory morbidity. This study aimed to determine the safety and efficacy of IMT in children with NMD. A randomised cross-over study compared three-month intervention (IMT) with control periods. During the intervention, children with NMD (5-18 years) from two provinces in South Africa performed 30 breaths (at 30% of inspiratory muscle strength (Pimax)) with an electronic threshold device, twice daily. During the control period participants did not perform any IMT. Twenty-three participants (median (IQR) age of 12.33 (10.03-14.17) years), mostly male (n=20) and non-ambulant (n=14) were included. No adverse events related to IMT were reported. There was no evidence of a difference in median patient hospitalisation and respiratory tract infection rates between control and intervention periods (p=0.60; p=0.21). During IMT, Pimax and peak cough flow improved with a mean (SD) of 14.57 (±15.67) cmH2O and 32.27 (±36.60) L/min, compared to a change of 3.04(±11.93)cmH2O (p=0.01) and -16.59 (±48.29) L/min (p=0.0005) during the control period. There was no evidence of change in spirometry, functional ability and total health-related quality of life scores following intervention. Patient satisfaction with IMT was high (median 8/10 (IQR 5-10)) and adherence was good. A three-month IMT programme in children with NMD is well tolerated, appears to be safe and is associated with a significant improvement in respiratory muscle strength and cough efficacy.

Feasibility of inspiratory muscle training to improve pulmonary and respiratory muscle function, and for attenuating sleep apnea symptoms in children and adolescent with obstructive sleep apnea and obesity: Case report

Background: Studies have demonstrated a potential risk of pulmonary and respiratory muscle dysfunction in individuals with obstructive sleep apnea (OSA) and/or obesity. Inspiratory muscle training (IMT) is an adjunct intervention designed to improve respiratory muscle strength, decrease severity of OSA, and to enhance sleep quality in adults with OSA. However, its effects on children with OSA and obesity are still largely unknown. Objectives: This case report aims to show the feasibility and the effects of IMT on pulmonary and respiratory muscle function and sleep apnea symptoms of children and adolescents with OSA and obesity. Case description: Four children and one adolescent who were diagnosed with OSA and classified as obesity underwent IMT with training load at 60% of the individual’s maximal inspiratory pressure (MIP) for 12 weeks. Results: No adverse effects occurred during evaluation and IMT. The participants’ compliance with IMT varied from 77.4% to 100%. After 12-week of IMT, MIP and maximal voluntary ventilation (MVV) increased from baseline, varying from 8.0% to 83.5% and 0.1% to 36.1%, respectively. Scores in the Sleep Related Breathing Disorder-Pediatric Sleep Questionnaire (SRBD-PSQ) tended to decrease rapidly at week 3. Thereafter, participants responded differently toward the end of IMT. Changes in pulmonary function variables were not observed. Conclusion: Improvements in respiratory muscle strength, endurance, and SRBD-PSQ scores occurred after IMT, suggesting the feasibility of IMT for increasing inspiratory muscle performance and for ameliorating sleep apnea symptoms in children and adolescents with OSA and obesity. However, pulmonary function was unaffected by IMT

Limb Hemodynamic Responses to a Single Bout of Inspiratory Muscle Strength Training

BackgroundInspiratory muscle strength training (IMST) has been shown to bring about improvements in respiratory muscle strength and reductions in blood pressure after 6 weeks of daily high intensity training. However, there has been little investigation into the effects of IMST on limb blood flow, and it is unclear how hemodynamics are altered within a single bout of training.PurposeTo investigate the acute effects of one session of either low or high intensity IMST on blood flow in the upper and lower limbs.MethodsParticipants (n=7, 57% female) aged 20 to 47 years completed two randomized laboratory visits wherein resting blood flow was measured via duplex Doppler ultrasound at the left brachial and popliteal arteries. Following baseline measures, participants' maximal inspiratory pressure (PImax) was measured using a PowerBreathe K3 device. Participants performed one session (30 breaths) of IMST at either 15% or 75% of their PImax, and blood flow was measured again at each artery for five breaths during the final ten breaths of the training. At their second visit, subjects performed whichever training level had yet to be completed and blood flow was assessed as described above.ResultsMean blood flow at the brachial artery appeared reduced during both 15% (p=0.070) and 75% training (p=0.078), which may be attributed to a significant increase in retrograde blood flow in both cases (p=0.014 and p=0.037, respectively). This increase in retrograde blood flow tended to be greater during the 75% training (p=0.066). Popliteal artery blood flow showed similar trends to brachial artery blood flow.ConclusionsWhile IMST appears to reduce brachial artery mean blood flow during a single training session, this may be due to alterations in retrograde blood flow, which tended to increase in an intensity‐dependent manner. Further investigation into the chronic hemodynamic effects of IMST is warranted.

The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial

BackgroundStroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia.MethodsRetornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up.DiscussionIEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect.Trial registrationClinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist=WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2.

Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial

BackgroundThe major symptom of chronic obstructive pulmonary disease (COPD) is dyspnea, which causes dyspnea-related kinesiophobia resulting in avoidance of activities associated with dyspnea or compensation by reducing the rate of activity. The aim of this study was to assess dyspnea-related kinesiophobia and determine the effect of inspiratory muscle training (IMT) on dyspnea-related kinesiophobia in COPD. MethodsForty COPD subjects were randomly allocated to either the IMT or sham group. Both groups' maximal inspiratory pressure (MIP) was assessed weekly. All patients were instructed to perform the training exercises for 15 min twice a day, 5 days a week for a total of 8 weeks. In the IMT group, intensity was set at 30% of MIP and adjusted according to weekly MIP value. In the sham group, intensity remained constant at 15% of initial MIP. Pulmonary function test (PFT), respiratory muscle strength, 6-min walk test (6 MWT), Breathlessness Beliefs Questionnaire (BBQ), Modified Medical Research Council scale (MMRC), modified Borg scale, Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) were assessed before and after the intervention. ResultsBBQ scores ranged from 18 to 51, with mean values in the IMT and sham groups of 39.80 ± 7.62 and 43.00 ± 6.58, respectively. When between-group differences of all outcome scores were compared, there was a statistically significant improvement in the IMT group than in the sham group (p < 0.05). After IMT, statistically significant decreases in BBQ and modified Borg scores were observed in within groups (p ≤ 0.001). These decreases were significantly greater in the IMT group (p ≤ 0.001). MMRC decreased significantly only in the IMT group (p < 0.001). There was a statistically significant increase in PFT values in the IMT group (p = 0.007–0.045), but no difference in the sham group (p = 0.129–0.886). Both groups showed statistically significant improvement in respiratory muscle strength, 6 MWT distance, and CAT score after 8 weeks (p < 0.05). All HADS and SGRQ scores decreased significantly in the IMT group (p < 0.001), whereas only the SGRQ activity score decreased significantly in the sham group (p = 0.017). ConclusionsOur study provides data on the presence and level of dyspnea-related kinesiophobia in COPD patients. All patients had BBQ scores higher than 11, indicating dyspnea-related kinesiophobia. IMT reduced BBQ score and improved respiratory function, and exercise capacity. Our results also support the other known benefits of IMT such as reduced dyspnea and symptom perception, decreased anxiety and depression, and improved quality of life.

12-Week Inspiratory Muscle Training Improves Respiratory Muscle Strength in Adult Patients with Stable Asthma: A Randomized Controlled Trial.

This study aims to investigate and compare the effects of conventional breathing exercises and an inspiratory muscle training intervention on clinical symptoms in asthma patients. Sixty asthma patients (40–65 years old) were randomly assigned to either the conventional breathing exercises (BTE) or inspiratory muscle training (IMT) group for a 12-week intervention period. Outcome measurements were performed before and after the intervention, including the spirometry data, maximal inspiratory and expiratory pressures (PImax and PEmax), asthma control test, asthma control questionnaire, six-minute walk test, and three-day physical activity log, were recorded. PImax expressed as % of predicted value controlled for age and gender in healthy subjects (% predicted) increased by 16.92% (82.45% to 99.38%, p < 0.05) in the BTE group and by 29.84% (71.19% to 101.03%, p < 0.05) in the IMT group. Except for forced vital capacity, which was reduced in the BTE group, all other measured variables improved in both groups, and no statistically significant between-group differences were found. IMT appears to be more effective than breathing exercise intervention in promoting improvements in respiratory muscle strength. IMT may act as an alternative to conventional breathing exercises for middle-aged and elderly asthma patients.

Beneficios de un programa de reacondicionamiento físico y uso de mecanismos instrumentales sobre la mecánica ventilatoria del adulto mayor con enfermedad pulmonar crónica

Introducción: la enfermedad pulmonar crónica está asociada a la debilidad de los músculos respiratorios que origina disnea y limitan la capacidad de ejercicio. Hay limitada evidencia a nivel nacional de los efectos de un programa de ejercicio y uso de mecanismos instrumentales en la mecánica pulmonar de las personas adultas mayores con problema pulmonar crónico. El propósito de este análisis fue conocer la efectividad de un programa de reacondicionamiento físico y uso de mecanismos instrumentales sobre la mecánica ventilatoria del adulto mayor con enfermedad pulmonar crónica. Metodología: se condujo un análisis observacional descriptivo de los efectos del Programa de Reacondicionamiento Físico del Adulto Mayor con Enfermedad Pulmonar Crónica (PRFAMEPC), el cual incluye el uso de varios mecanismos instrumentales, desarrollado en el Hospital Nacional de Geriatría y Gerontología, de la Caja Costarricense de Seguro Social, entre enero 2012 y mayo 2018. Se analizó el resultado de la mecánica pulmonar pre y post programa. Los resultados se expresan como promedio ± desviación estándar. Para el análisis estadístico se utilizó la prueba de t de student para medidas pareadas; también se hizo uso de la t de student para analizar por separado los grupos obstructivo y no obstructivo sugestivo de restricción. El nivel de significancia fue establecido en p≤0,05. Se utilizó el programa estadístico SPSS 21.0. Resultados: se reclutaron un total de 53 adultos mayores. Se identificaron diferencias estadísticamente significativas en la fuerza (t= -3,66; p&lt;0,05) y resistencia (t= -2,80; p&lt;0,05) de los músculos respiratorios de los participantes con problema pulmonar obstructivo y no obstructivo sugestivo de restricción. En los participantes con problema obstructivo se identificaron diferencias estadísticamente significativas en la fuerza (t= -2.92; p&lt;0,05) y la resistencia (t= -3,13; p&lt;0,05) de los músculos respiratorios. En los participantes con problema no obstructivo sugestivo de restricción se identificaron diferencias estadísticamente significativas en la fuerza (t= -2.82; p&lt;0,05) de los músculos. Conclusión: se concluye que en las personas adultas mayores con enfermedad pulmonar crónica el PRFAMEPC produjo mejoras en la fuerza y resistencia muscular respiratoria.

Влияние силовых и аэробных тренировок на функцию внешнего дыхания и силу респираторных мышц спортсменов

The aim of the study was to compare the respiratory muscle strength and ventilatory function variables in power and endurance athletes and their age-matched and sex-matched control group. The study showed that maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the dynamic ventilatory variables in endurance athletes were superior to those in power athletes and controls. MIP was shown to have greater positive correlations with maximal voluntary ventilation (MVV) for both control and power athletes (r = 0.64 &amp; r = 0.57 respectively, p &lt; 0.01 for both). Similarly, MEP was positively and significantly correlated with MVV in both control and power athletes (r = 0.6 &amp; r = 0.58 respectively, p &lt; 0.01). However, MIP and MEP showed weak and statistically insignificant correlation with MVV in endurance athletes (p &gt; 0.05). It is possible that intense endurance training leads to the maximal improvement of respiratory muscle strength and may contribute to the improvement of certain functional reserves of respiratory muscles. We conclude that the adaptation of the respiratory system to the exercise depends on the training routine. The biggest changes in the ventilatory function variables and an increase in the functional reserves of the respiratory muscles are observed in athletes whose training routine is dominated by intense aerobic exercise.

The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial

BackgroundInspiratory muscle training (IMT) and oropharyngeal exercises (OE) have different advantages and disadvantages and a comparison of these modalities has been recommended. The aim of this study was to compare the effects of IMT and OE on important outcomes for patients with OSAS. MethodsThis was a randomized controlled clinical trial. Forty-one clinically stable OSAS patients not receiving CPAP therapy were randomly divided into three groups. Patients in the IMT group (n = 15) trained with a threshold loading device 7 days/week for 12 weeks. Patients in the OE group (n = 14) practiced exercises 5 days/week for 12 weeks. Twelve patients served as control group. Apnea–hypopnea index (AHI), respiratory muscle strength, snoring severity and frequency (Berlin Questionnaire), daytime sleepiness (Epworth Sleepiness Scale; ESS), sleep quality (Pittsburg Sleep Quality Index; PSQI), impact of sleepiness on daily life (Functional Outcomes of Sleep Questionnaire; FOSQ), and fatigue severity (Fatigue Severity Scale; FSS) were evaluated before and after the interventions. ResultsAHI and sleep efficiency did not change significantly in any of the groups. Significant decreases in snoring severity and frequency, FSS and PSQI total scores were found in the IMT and OE groups after the treatments (p < 0.05). There was a significant reduction in neck and waist circumference and significant improvement in respiratory muscle strength (MIP and MEP) in IMT group compared to control group (p < 0.05). The%MEPpred value and FOSQ total score significantly increased and ESS score reduced after the treatment in OE group compared to control group (p < 0.05). ConclusionsOur results indicate that both OE and IMT rehabilitation interventions are applicable in rehabilitation programs for OSAS patients who do not accept CPAP therapy. Our findings could lead to increase these methods’ use among rehabilitation professionals and decrease in cost of CPAP treatment in OSAS.

Respiratory Muscle Strength and Ventilatory Function Outcome: Differences Between Trained Athletes and Healthy Untrained Persons.

It is known that the maximum mouth inspiratory pressure (MIP) and expiratory pressure (MEP) vary with age, weight, height, and skeletal muscle mass. However, the influence of physical training on ventilatory function outcomes is an area of limited understanding. The aim of this study was to investigate the respiratory muscle strength and its relation to spirometry variables in untrained healthy persons versus trained athletes. MIP and MEP were assessed in 22 power athletes and 28 endurance athletes, and in 24 age- and sex-matched normal healthy subjects (control group). The measurement was done with a mouth pressure meter. We found that respiratory muscle strength and ventilatory function in endurance athletes were outstandingly superior to that in power athletes; the latter's muscle strength was better than that of healthy untrained controls. Both MIP and MEP significantly correlated with the maximum voluntary ventilation (MVV) in both power athletes and controls, but not so in endurance athletes. The corollary is that the intensive endurance training could result in the improvement of respiratory muscle strength, meeting the maximum upper limit of functional reserve of respiratory muscles and the corresponding ventilation. On the other hand, targeted training of respiratory muscle strength may be an effective strategy to increase ventilatory function in power athletes, particularly those having a low maximum inspiratory and expiratory pressure, and in less physically fit healthy persons.

Mechanisms of improved exercise capacity following respiratory muscle training in athletes with cervical spinal cord injury.

Mechanisms of improved exercise capacity following respiratory muscle training in athletes with cervical spinal cord injury.

Respiratory muscle training in individuals with spinal cord injury: effect of training intensity and -volume on improvements in respiratory muscle strength.

Retrospective cohort study. To investigate the effect of training intensity and -volume on improvements in respiratory muscle strength in individuals with spinal cord injury (SCI). SCI rehabilitation center in Switzerland. Inpatients with SCI, lesion level C4-T12, who had at least 10 individualized inspiratory muscle training sessions with respiratory function measurements before and after the training period. Multiple regression analysis with natural logarithmic (ln) transformation of the outcome values was used to examine the effect of training intensity and -volume, lesion level and completeness, and baseline respiratory muscle strength on improvements in respiratory muscle strength. Overall, 67 individuals were analyzed. Variation in PImax was explained by PImax at baseline and training intensity. This adjusted effect size suggested a 7% (95% CI 2.8 to11.6%) increase in PImax per 10 units of increase in training intensity. Controlling for the variation in baseline PEmax, the effect of training intensity on PEmax was conditional on AIS (p < 0.021). While individuals with motor complete lesions showed a 6.8% (95% CI 2.1 to11.7%) increase in PEmax per 10 units of increase in training intensity, the corresponding adjusted effect size in those with motor incomplete lesions was 0.1% (95% CI -4.3 to4.5%). The full models explained 57 and 60% of the variance of lnPImax and lnPEmax, respectively. The intensity of inspiratory muscle training was more relevant than training volume for the improvement of respiratory muscle strength in individuals with SCI. Thus, training intensity should be chosen as high as possible.

Effects of a Physiotherapeutic Protocol in Respiratory Function, Aerobic Capacity and Quality of Life After Kidney Transplantation

IntroductionChronic kidney disease can lead to dysfunction of the respiratory, cardiac, and musculoskeletal systems, altering the body's metabolism. Renal transplantation and hospital physiotherapy, through specific protocols, can improve these dysfunctions. ObjectivesThis study evaluates the impact of a hospital physiotherapeutic protocol in quality of life (QoL), respiratory muscle strength, peak expiratory flow, and 6-minute walk test (6MWT) in the preoperative, first, and fifth days after renal transplantation. MethodsWe evaluated 39 patients who received a renal transplant at Clinics Hospital of University of Campinas for respiratory muscle strength, expiratory peak flow, and functional capacity by the 6MWT. The short form–36 quality of life questionnaire was applied to 12 patients. ResultsWe observed a significant reduction in respiratory muscle strength and peak expiratory flow in the first postoperative day. On postoperative day 5, there was improvement in respiratory muscle strength and expiratory peak flow. However, aerobic capacity measured by 6MWT remained below predicted. Analysis of QoL showed an improvement in almost all analyzed domains after transplantation. ConclusionA specific physiotherapeutic protocol applied early after transplantation provided recovery of respiratory muscle strength and QoL. However, longer training is necessary to obtain adequate aerobic rehabilitation.

Effect of pranayama on respiratory muscle strength in chronic asthmatics

Background: Pranayama is a breathing technique that produces many systemic and psychological effects in the body, specifically on the respiratory system. It is also an art which controls the life force of breath. Aims and Objectives: The current study is designed to assess the effect of pranayama on respiratory muscle strength of chronic asthmatics. Materials and Methods: This study is designed to observe the measurement of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in asthma patients before and after Pranayama practice. Maximum respiratory pressure is one of the important methods of diagnosing respiratory muscle dysfunction. The study group consisted of 100 asthmatics. The participants were asked to undergo Pranayama training for 30 min daily, for 12 weeks. In the beginning of the course, the first phase of the recording was done and the second phase was done after 12 weeks of the regular pranayama practice. Result: The results showed statistically significant improvement in MIP from 64.08 ± 8.162 to 70.38 ± 6.169 and MEP from 107.92 ± 9.897 to 113.68 ± 8.767 in asthma patients after pranayama. Conclusion: The current study shows that pranayama has a positive effect on respiratory system with evidence of improvement in respiratory muscle strength.

A study on the safety and efficacy of reveglucosidase alfa in patients with late-onset Pompe disease

BackgroundLate-onset Pompe disease is a rare genetic neuromuscular disorder caused by lysosomal acid alpha-glucosidase (GAA) deficiency that ultimately results in mobility loss and respiratory failure. Current enzyme replacement therapy with recombinant human (rh)GAA has demonstrated efficacy in subjects with late-onset Pompe disease. However, long-term effects of rhGAA on pulmonary function have not been observed, likely related to inefficient delivery of rhGAA to skeletal muscle lysosomes and associated deficits in the central nervous system. To address this limitation, reveglucosidase alfa, a novel insulin-like growth factor 2 (IGF2)-tagged GAA analogue with improved lysosomal uptake, was developed. This study evaluated the pharmacokinetics, safety, and exploratory efficacy of reveglucosidase alfa in 22 subjects with late-onset Pompe disease who were previously untreated with rhGAA.ResultsReveglucosidase alfa plasma concentrations increased linearly with dose, and the elimination half-life was <1.2 h. Eighteen of 22 subjects completed 72 weeks of treatment. The most common adverse events were hypoglycemia (63%), dizziness, fall, headache, and nausea (55% for each). Serious adverse events included hypersensitivity (n = 1), symptomatic hypoglycemia (n = 2), presyncope (n = 1), and acute cardiac failure (n = 1). In the dose-escalation study, all treated subjects tested positive for anti-reveglucosidase alfa, anti-rhGAA, anti-IGF1, and anti-IGF2 antibodies at least once. Subjects receiving 20 mg/kg of reveglucosidase alfa demonstrated increases in predicted maximum inspiratory pressure (13.9%), predicted maximum expiratory pressure (8.0%), forced vital capacity (−0.4%), maximum voluntary ventilation (7.4 L/min), and mean absolute walking distance (22.3 m on the 6-min walk test) at 72 weeks.ConclusionsAdditional studies are needed to further assess the safety and efficacy of this approach. Improvements in respiratory muscle strength, lung function, and walking endurance in subjects with LOPD may make up for the risk of hypersensitivity reactions and hypoglycemia. Reveglucosidase alfa may provide a new treatment option for patients with late-onset Pompe disease.Trial registrationISRCTN01435772 and ISRCTN01230801, registered 27 October 2011.

Effect of Aerobic Exercise Training on Ventilatory Efficiency and Respiratory Drive in Obese Subjects.

Obese patients show a decline in exercise capacity and diverse degrees of dyspnea in association with mechanical abnormalities, increased ventilatory requirements secondary to the increased metabolic load, and a greater work of breathing. Consequently, obese patients may be particularly predisposed to the development of respiratory muscle fatigue during exercise. The aim of this study was to assess inspiratory muscle performance during incremental exercise in 19 obese male subjects (body mass index 41 ± 6 kg/m2) after aerobic exercise training using the noninvasive, inspiratory muscle tension-time index (TT0.1). Measurements performed included anthropometric parameters, lung function assessed by spirometry, rate of perceived breathlessness with the modified Borg dyspnea scale (0-10), breathing pattern, maximal exercise capacity, and inspiratory muscle performance with a breath-by-breath automated exercise metabolic system during an incremental exercise test. TT0.1 was calculated using the equation, TT0.1 = P0.1/PImax × TI/Ttot (where P0.1 represents mouth occlusion pressure, PImax is maximal inspiratory pressure, and TI/Ttot is the duty cycle). At rest, there was no statistically significant difference for spirometric parameters and cardiorespiratory parameters between pre- and post-training. At maximal exercise, the minute ventilation, the rate of exchange ratio, the rate of perceived breathlessness, and the respiratory muscle performance parameters were not significantly different pre- and post-training; in contrast, tidal volume (P = .037, effect size = 1.51), breathing frequency (P = .049, effect size = 0.97), power output (P = .048, effect size = 0.79), peak oxygen uptake (P = .02, effect size = 0.92) were significantly higher after training. At comparable work load, training induces lower minute ventilation, mouth occlusion pressure, ratio of occlusion pressure to maximal inspiratory pressure, TT0.1, and rate of perceived breathlessness. Aerobic exercise at ventilatory threshold can induce significant improvement in respiratory muscle strength, maximal exercise capacity, and inspiratory muscle performance and decreased dyspnea perception in obese subjects.

Fonoterapia vocal e fisioterapia respiratória com idosos saudáveis: revisão de literatura

RESUMO Este estudo tem como tema a fonoterapia vocal e a fisioterapia respiratória no idoso saudável. O objetivo do presente estudo foi revisar a literatura sobre fonoterapia vocal e sobre fisioterapia respiratória com idosos saudáveis. Foi realizado um levantamento bibliográfico de artigos publicados entre 2004 e 2014 nas bases de dados Lilacs, Bireme, MedLine, PubMed e Scielo. Descritores utilizados: physical therapy specialty; breathing; speech therapy; aged; therapeutics e voice. A literatura sobre fonoterapia vocal com idosos saudáveis mostrou que as intervenções têm sido feitas por meio de orientação vocal; terapia vocal tradicional para presbifonia, independente do tipo de intervenção; exercícios vocais específicos; e programas terapêuticos padronizados, havendo evidências de melhora de medidas vocais perceptivoauditivas, acústicas, de autoavaliação vocal e de imagem laríngea. Quanto à fisioterapia respiratória, a literatura evidenciou que as técnicas ou procedimentos utilizados com idosos saudáveis foram: uso do aparelho Threshold, técnicas de terapia manual, espirometria de incentivo, exercícios respiratórios associados ao movimento do tronco e membros inferiores e atividade física em geral, apresentando evidências de melhora na força muscular respiratória, função pulmonar e autonomia funcional dos idosos.

Magnesium in cystic fibrosis--Systematic review of the literature.

The metabolism of sodium, potassium, and chloride and the acid-base balance are sometimes altered in cystic fibrosis. Textbooks and reviews only marginally address the homeostasis of magnesium in cystic fibrosis. We performed a search of the Medical Subject Headings terms (cystic fibrosis OR mucoviscidosis) AND (magnesium OR hypomagnes[a]emia) in the US National Library of Medicine and Excerpta Medica databases. We identified 25 reports dealing with magnesium and cystic fibrosis. The results of the review may be summarized as follows. First, hypomagnesemia affects more than half of the cystic fibrosis patients with advanced disease; second, magnesemia, which is normally age-independent, relevantly decreases with age in cystic fibrosis; third, aminoglycoside antimicrobials frequently induce both acute and chronic renal magnesium-wasting; fourth, sweat magnesium concentration was normal in cystic fibrosis patients; fifth, limited data suggest the existence of an impaired intestinal magnesium balance. Finally, stimulating observations suggest that magnesium supplements might achieve an improvement in respiratory muscle strength and mucolytic activity of both recombinant and endogenous deoxyribonuclease. The first comprehensive review of the literature confirms that, despite being one of the most prevalent minerals in the body, the importance of magnesium in cystic fibrosis is largely overlooked. In these patients, hypomagnesemia should be sought once a year. Furthermore, the potential of supplementation with this cation deserves more attention.