Spirometric Measurements Research Articles

Spirometric Changes in Patients of Allergic Rhinitis: A Prospective Study

Background: Allergy is a chronic inflammatory disease, which may affect the upper and lower airway in reversible airflow obstruction or asthma. Spirometry is a noninvasive way to assess lower airway function routinely and to detect reversible airflow obstruction. Objective: To find out prevalence of abnormal small airway function in allergic rhinitis patients without diagnosis of asthma Methods: This prospective study was conducted in the department of Pulmonary Medicine, SRMSIMS, Bareilly. Spirometric measurement of patients of allergic rhinitis. Results: One hundred and thirty nine patients of Allergic Rhinitis (AR)were included in this study.73 were males and 66 were females. Farmers and labors outnumbered the students.13/49 (26.53%) farmers and 8/20(40%) labours had decreased FEF25-75%. It was also observed that longer the duration of AR, more patients were having abnormal FEF25-75%. Conclusions: When patients with AR seek treatment, the lower airway status should always be evaluated. This study provided evidence that an early bronchial impairment might be detectable by considering the FEF25-75.

Efficacy of individualized homeopathy in bronchial asthma in adults: Double-blind, randomized, placebo-controlled, clinical trial in the context of usual care

BackgroundAsthma remains a major public health problem despite recent advances in management. Sizeable minorities of asthma patients prefer complementary therapies, including homeopathy, for treatment. This trial examines whether usual care plus individualized homoeopathy (UC + IH) can produce significantly different treatment effects compared to usual care plus placebo (UC + P) in adults suffering from bronchial asthma. MethodsIn this double-blind, randomized, placebo-controlled, parallel arm, efficacy trial, 140 adults suffering from bronchial asthma were randomized to receive either UC + IH (verum: n = 70) or UC + P (control: n = 70). The trial was of 3.5 years duration. Spirometric measures, blood eosinophil percentage and serum immunoglobulin E were primary outcomes and symptom severity and different questionnaire scores were secondary outcomes; measured at baseline, and after 3 and 6 months. ResultsEighteen patients dropped out (verum: 8, control: 10). Intention to treat sample (n = 140) was analyzed. The two trial arms were comparable at baseline. Group differences over 3 and 6 months showed significant differences in improvement in UC+IH compared to UC+P (P<0.01) with moderate to large effect sizes (Cohen’s d) for both primary and secondary outcome measures. ConclusionUC + IH produced significantly better effect than UC + P in this trial, indicating homeopathy seemed superior to placebo. Further evaluation involving a larger sample in a multi-centre design is necessary prior to making firm recommendations. [Trial registration: CTRI/2017/08/009192].

Effect of posture on pulmonary function in the third trimester of pregnancy of primigravid, nulliparous and multiparous women in Benin City

BACKGROUND: the advancing gravid uterus poses a limited lying down posture options in the third trimester. The supine position has been documented to have deleterious cardiovascular effect. This study is aimed at measuring pulmonary function of pregnant women in the third trimester of pregnancy with some lying down positions viz a viz parity.MATERIALS AND METHOD: It was a cross sectional study carried out at St Philomena's Catholic Hospital. A total of 150 third trimester pregnant subjects in 5 groups of parities with 30 in each group and in different lying down were studied. Spirometric measurements of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were performed in sitting position which served as the control, and the test positions were supine, left lateral and right lateral.RESULT: FVC and FEV1 values of all subjects in all positions studied were significantly lower than the sitting position. However, the FVC and FEV1 of subjects in the lateral positions were significantly higher (p &lt; 0.05) than the supine position across parities. There was no significant difference (p &gt; 0.05) between the left lateral position and the right lateral positions. Furthermore there was an increase in FVC and FEV1 of subjects as the parity increases across all lying down position.CONCLUSION: Supine position in the third trimester of pregnancy has a negative effect on pulmonary function and should be discouraged; parity however has a cumulative positive effect on pulmonary function across the postures studied.

Assessment of neck pain in chronic obstructive pulmonary disease

Supplementary respiratory muscles such as upper part of the trapezium and scalenes are used extensively in order to facilitate ventilation in Chronic Obstructive Pulmonary Disease (COPD). These situations cause pain restricting by the upper body mobility and neck movements. This study was planned to investigate the presence of neck pain in individuals with COPD. In this study, 30 patients (W: 5/M: 25) were evaluated with COPD. The severity of pain was determined according to Visual Analog Scale (VAS). Spirometric measurements were used to determine the respiratory parameters. Neck Disability Index was used to for severity of neck disability level. Mean age of patients was 69.93 ± 9.46 years. Mean of pain intensity was 2.35 ± 2.77 and pain duration 46.47 ± 123.64 weeks. The mean FEV1% of all patients was 58.96 ± 19.15, FVC% was 72.73 ± 25.78 and FEV1/FVC ratio was 64.43 ± 21.18. There was a positive correlation between pain intensity and FEV1 and FVC ( r = 0.368, P = 0.046), ( r = 0.382, P = 0.037). There was a positive mean moderate correlation between duration of pain and smoking and alcohol use ( r = 0.652, P = 0.005/ r = 0.655, P = 0.004). The mean of Neck Disability Index was 26.65 ± 19.70. All patients have a mild disability level. We did not find a significant correlation between Neck Disability Index and spirometric parameters. Individuals with COPD have neck pain. When these patients rehabilitate, musculoskeletal problems, such as neck pain should be considered.

Spirometric Measurements of Obese and Non-Obese Subjects in Recumbent Body Positions

Spirometric Measurements of Obese and Non-Obese Subjects in Recumbent Body Positions

Does the acute hemodynamic response to a maximum running exercise depend on the aerobic training status of the subjects?

BackgroundHigh-intensity training has become increasingly popular in recent years but the exact effects of high intensity running on the hemodynamic system are not entirely understood and it is unknown whether the aerobic training status of the subjects might influence these hemodynamic reactions. Therefore, the study aims to evaluate whether the acute reactions of peripheral and central blood pressure (BP) and arterial stiffness (AS) to a maximal running exercise depend the training status of the subjects. Methods41 healthy subjects were recruited. Of these were 21 aerobically trained (AE; 11 men) and 20 untrained (UN; 10 men). Aortic pulse wave velocity (PWV), peripheral and central BP was measured at rest and immediately after a maximal treadmill exercise using a ramp protocol including spirometric measurements. ResultsResting hemodynamic values were not different between the groups. Systolic central and peripheral BP, and PWV increased in both groups in response to the running exercise. Δ of all measured parameters showed no difference between the groups. ConclusionsThe acute increases of AS and BP to a maximal running regimen seem to be independent of the subjects’ training status and might therefore be an eligible training mode to maintain overall and vascular health.

Aging-related trajectories of lung function in the general population-The Doetinchem Cohort Study.

The objective of this study was to explore trajectories of lung function decline with age in the general population, and to study the effect of sociodemographic and life style related risk factors, in particular smoking and BMI. For this purpose, we used data from the Doetinchem Cohort Study (DCS) of men and women, selected randomly from the general population and aged 20–59 years at inclusion in 1987–1991, and followed until the present. Participants in the DCS are assessed every five years. Spirometry has been performed as part of this assessment from 1994 onwards. Participants were included in this study if spirometric measurement of FEV1, which in this study was the main parameter of interest, was acceptable and reproducible on at least one measurement round, leading to the inclusion of 5727 individuals (3008 females). Statistical analysis revealed three typical trajectories. The majority of participants followed a trajectory that closely adhered to the Global Lung Initiative Reference values (94.9% of men and 96.4% of women). Two other trajectories showed a more pronounced decline. Smoking and the presence of respiratory complaints were the best predictors of a trajectory with stronger decline. A greater BMI over the follow-up period was associated with a more unfavorable FEV1 course both in men (β = -0.027 (SD = 0.002); P < 0.001) and in women (β = -0.008 (SD = 0.001); P < 0.001). Smokers at baseline who quit the habit during follow-up, showed smaller decline in FEV1 in comparison to persistent smokers, independent of BMI change (In men β = -0.074 (SD = 0.020); P < 0.001. In women β = -0.277 (SD = 0.068); P < 0.001). In conclusion, three typical trajectories of age-related FEV1 decline could be distinguished. Change in the lifestyle related risk factors, BMI and smoking, significantly impact aging-related decline of lung function. Identifying deviant trajectories may help in early recognition of those at risk of a diagnosis of lung disease later in life.

Characterization of lymphangioleiomyomatosis patients with discordance between spirometric and diffusion measurements of pulmonary function.

Background: A subset of lymphangioleiomyomatosis (LAM) patients present with normal FEV1 and FVC but with reduced DLCO. Patients with an isolated reduction in DLCO in other diseases appear to be at higher risk for pulmonary hypertension and worse survival but this has not been previously described in LAM patients. Objective: To characterize the prevalence and clinical progression of LAM patients who present with discordantly low DLCO. Methods: This was a retrospective cohort study of LAM patients in two centers in the United States and Brazil. Discordant DLCO was defined as FEV1 >80% predicted, FVC >80% predicted, and DLCO<80% predicted. We compared the rate of decline in pulmonary function, pulmonary artery to aorta (PA-A) ratio, and VEGF-D levels in patients with concordant and discordant DLCO. Results: The overall prevalence of discordant DLCO was 26.0%. Patients with discordant DLCO did not have a higher rate of yearly decline in FEV1 (-1.0±0.6 vs -1.0±0.6, p=0.50), FVC (-1.0±0.7 vs -0.3±0.8, p=0.54), or DLCO (-2.2±0.9 vs -1.6±0.6, p=0.79). They did not have higher rates of PA-A ratio>1 (23.3% vs 20.1%, p=1.00). Patients with discordant DLCO did not have higher levels of VEGF-D (1214±1256 pg/mL vs 1706±1214 pg/mL, p=0.07). Conclusions: LAM patients who present with a discordantly low DLCO do not appear to have different rates of decline in pulmonary function. Additional biological and radiographic markers are needed to more fully characterize this population. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 206-212).

Early life determinants of lung function change from childhood to adolescence.

Little is known about how perinatal and childhood factors influence lung function change between childhood and adolescence. To investigate possible early life predictors of change in FEV1 between age 8 and 16 years. In addition, to investigate possible predictors of having persistently low lung function (FEV1 <25th percentiles both at age 8 and 16) up to adolescence. The BAMSE birth cohort study collected data throughout childhood on environmental factors, individual characteristics, and spirometric measures at 8 and 16 years (n = 1425). Associations between early life predictors (n = 31) and FEV1 increase between 8 and 16 years were assessed with linear regression. Predictors of having persistently low lung function were examined. Few factors were consistently associated with altered lung function growth, although low birth weight, asthma heredity (paternal), secondhand smoke in infancy, and season of birth had a significant impact (p-value ≤0.01). The majority of subjects stayed however within the same category of lung function between ages 8 and 16 years (in total 821/1425 = 58%). Predictors associated with having persistently low lung function were gestational age, secondhand smoke (at 2 and 8 years of age), and factors related to lower respiratory tract infections in infancy. In summary, rather few exposures in childhood were identified to have a significant impact on lung function growth between childhood and adolescence. Our data support previous study findings indicating that lung function development is influenced by factors before birth and in infancy, including second hand tobacco smoke.

Assessment of circulating vascular endothelial growth factor in patients with stable and exacerbated chronic obstructive pulmonary disease

Objective This study aimed to evaluate the diagnostic value of serum vascular endothelial growth factor (VEGF) assessment during stable and acute exacerbations of chronic obstructive pulmonary disease (COPD). Background VEGF is a cytokine that has potent angiogenic and vascular permeability-enhancing activities. VEGF serum level was found to increase in a number of inflammatory disorders. Patient and methods This study was carried out in the Chest and Medical Biochemistry Departments, Faculty of Medicine, Menoufia University and El-Mahalla Chest Hospital in the period from July 2015 to March 2016. It included 75 patients, with a mean age of 54.7 ± 7.55 years. The patients were subjected to clinical examination and standard spirometric measures including percentage of predicted forced vital capacity, percentage of predicted forced expiratory volume in the first second, and forced expiratory volume in the first second/forced vital capacity ratio. Measurement of VEGF serum levels was done in patients with acute exacerbations of COPD on the first day of hospitalization, whereas for patients with stable COPD and for the healthy controls, the sample was taken on the same day of the spirometric maneuver. Results VEGF level was significantly elevated in patients with stable chronic obstructive pulmonary disease (COPD) compared with controls and also was significantly higher in patients with acute exacerbations of COPD compared with patients with stable COPD. Conclusion VEGF is significantly elevated in patients with acute exacerbations of COPD and is proportional to the severity of stable COPD. Therefore, it can be used as a biomarker for COPD.

Variability of CT Airways Measurements in COPD Patients Between Morning and Afternoon: Comparisons to Variability of Spirometric Measurements

Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements. Twenty patients had pulmonary function tests and CT around 8 am and 4 pm. Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements. Variability of LA3rd and LA4th was greater than that of spirometric measurements (P values ranging from <.001 to .033). There was no examination time effect on √WAPi10, WT3rd, LA4th, or WA%4th (P values ranging from .102 to .712). There was a reader effect on all CT airways measurements (P values ranging from <.001 to .028), except in WT3rd (P> .999). There was no effect of measurement session on any CT airway measurement (P values ranging from .535 to >.999). As the variability of LA3rd and LA4th is greater than that of spirometric measurements, clinical studies should include cohorts with larger numbers of patients when considering LA than when considering spirometric measurements as end points.

Impact of reduced forced expiratory volume on cardiac prognosis in patients with chronic heart failure.

In patients with chronic heart failure (CHF), comorbidity of airflow limitation is associated with poor outcomes. The forced expiratory volume in 1s (FEV1) is used to evaluate the severity of airflow limitation. However, the impact of FEV1 severity on prognosis has only been partially elucidated in patients with CHF. In total, 248 consecutive patients with CHF who successfully fulfilled spirometric measurement criteria were enrolled and prospectively followed. Percent predicted FEV1 (FEV1%predicted) was associated with the New York Heart Association Functional Classification. FEV1%predicted was significantly associated with diastolic dysfunction, evaluated using echocardiography; elevated inflammation markers; and increased pulmonary arterial pressure. There were 60 cardiac events, including 9 cardiac-related deaths and 51 re-hospitalizations due to the exacerbation of CHF during a follow-up period. Kaplan-Meier analysis revealed that the lowest FEV1%predicted group had the highest event rate, irrespective of the presence of smoking history. Multivariate Cox proportional hazard analysis showed that FEV1%predicted was an independent predictor of cardiac events after adjusting for confounders. The net reclassification improvement and integrated discrimination improvement were improved by the addition of FEV1%predicted to other cardiac risk factors. Decreased FEV1%predicted was independently associated with the poor cardiac outcomes in patients with CHF.

Year in review 2017: Chronic obstructive pulmonary disease and asthma.

Year in review 2017: Chronic obstructive pulmonary disease and asthma.

Validation of the portable Air-Smart Spirometer.

BackgroundThe Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet.MethodsIn this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively.Results200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94.ConclusionThe Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.

Associations between vitamin D and pulmonary function in chronic spinal cord injury

Context/Objective: Individuals with chronic spinal cord injury (SCI) have an increased risk of morbidity and mortality attributable to respiratory diseases. Previous studies in non-SCI populations suggest that vitamin D may be a determinant of respiratory health. Therefore, we sought to assess if lower vitamin D levels were associated with decreased pulmonary function in persons with chronic SCI.Design: Cross-sectional study.Setting: Veterans Affairs Medical Center.Participants: 312 participants (260 men and 52 women) with chronic SCI recruited from VA Boston and the community participating in an epidemiologic study to assess factors influencing respiratory health.Methods: Participants provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma 25-hydroxyviatmin D and spirometric measures of pulmonary function.Outcome Measures: Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC.Results: Adjusted and unadjusted for a number of confounders, there was no significant association between plasma vitamin D levels and FEV1, FVC, or FEV1/FVC. For example, in fully adjusted models, each 10 ng/ml increase in vitamin D was associated with a 4.4 ml (95%CI −64.4, 73.2, P = 0.90) ml change in FEV1.Conclusion: There was no significant cross-sectional association between plasma vitamin D and FEV1, FVC, or FEV1/FVC in this cohort of individuals with chronic SCI.

Sarcopenia and Sarcopenic Obesity in Chronic Obstructive Pulmonary Disease Patients with Different Levels of Severity

Background: Sarcopenia is defined as loss of muscle mass with attendant loss of muscle strength and physical function and is associated with advancing age. Inflammatory condition of chronic disease leads to more rapid progression of this syndrome, which may adversely affect quality of life. The aim of this study was to determine the relationship between chronic obstructive pulmonary disease (COPD) and sarcopenia.Methods: This study included 108 COPD patients who were treated in the pulmonary clinic at Masih Daneshvari Hospital. Patients were categorized into three groups based on Global Initiative for Obstructive Lung Disease criteria. Sarcopenic parameters including muscle mass, muscle strength, and physical performance were measured by Bioimpedance Analysis, hand grip dynamometer, and the Short Physical Performance Battery test, respectively. According to the European Working Group on Sarcopenia in Older People cutoff points and the definition of sarcopenic obesity, sarcopenic patients were diagnosed and categorized based on different COPD severity scores.Results: The relationship between sarcopenia and COPD grading, which was assessed using multiple regression models with adjustment of confounding factors, including age, chronic diseases, and smoking, was statistically insignificant. However, by using forced expiratory volume in 1 second (FEV1) or ratio of FEV1 to forced vital capacity in this model, the results were significant (P = 0.026). A positive linear correlation was observed between skeletal muscle index (SMI) and spirometric data, which was assessed by Spearman’s correlation test. By exploring the association between sarcopenia and obesity with the one-way analysis of variance test, sarcopenic patients represented to have the minimal spirometric measures. However, this difference was only significant for actual measurements.Conclusion: This study showed that sarcopenic COPD patients had smaller spirometric measurements and that sarcopenia and magnitude of SMI were positively correlated with obstruction severity.

Anticholinergics for asthma: a long history.

To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options.

Non-astmatic Eosinophilic Bronchitis.

Non-asthmatic eosinophilic bronchitis (NAEB) is eosinophilic inflammation of the respiratory tract, without any bronchospasm. In this article, we want to draw attention to the NAEB. It should also be considered in differential diagnosis of chronic cough. Eosinophilia is present in all induced or spontaneous sputum samples of NAEB patients. NAEB patients and asthmatic patients have similar airway inflammation. Remarkably, NAEB mainly occurs in the lower airways. Unlike asthma, mast cells in NAEB are active in the bronchial epithelium. Diagnosis is based on the clinical, radiological, and spirometric measurements of other causes of chronic cough (Post-nasal discharge syndrome, asthma, gastroesophageal reflux etc.) and the assessment of inflammation in the lower respiratory tract. Airway inflammation can be assessed by sputum induction. The main treatment is anti-inflammatory therapy with inhaled corticosteroids and taking protective measures if inflammation is due to occupational exposure or allergen inhalation. If NAEB is untreated, it may be transient, episodic, or persistent; rarely, long-term oral steroid treatment may be required in patients. There is a requirement for studies that investigate the role of non-invasive markers of chronic inflammation associated with NAEB and the effectiveness of other treatments.

The effect of time-of-day and chest physiotherapy on multiple breath washout measures in children with clinically stable cystic fibrosis.

BackgroundIn this pilot study we investigated daytime variation of multiple breath nitrogen washout (N2MBW) measures in children with clinically stable cystic fibrosis. To our knowledge the effect of time-of-day on multiple breath washout measures in patients with cystic fibrosis has not previously been reported. Furthermore, we assessed the influence of chest physiotherapy on N2MBW measures.MethodsTen school children with cystic fibrosis performed N2MBW followed by spirometry and plethysmography in the morning and afternoon at three visits that were one month apart. Chest physiotherapy was performed immediately before the afternoon measurements at visit 2 and immediately before morning and afternoon measurements at visit 3. The influence of time-of-day and chest physiotherapy on the measures was evaluated using linear mixed models.ResultsThere were adequate quality data from 8 children with median age (range) 9.6 (6.0; 15.1) years. Baseline lung clearance index (LCI) (range) was 9.0 (7.1; 13.0) and baseline FEV1% predicted was 97.5 (78.5; 117.9). No N2MBW measures were significantly influenced by time-of-day or chest physiotherapy. LCI (95% confidence interval) decreased non-significantly 0.05 (-0.32; 0.22) during the day and increased non-significantly 0.08 (-0.26; 0.42) after chest physiotherapy. All spirometric measures were unaffected by time-of-day and chest physiotherapy. For plethysmographic measures FRCpleth decreased significantly (p<0.01) 110 mL during the day, whereas a borderline significant (p = 0.046) decrease in ΔFRCpleth-MBW during the day and a borderline significant (p = 0.03) increase in TLC after CPT were observed.ConclusionThis study demonstrated that the time-of-day as well as chest physiotherapy performed immediately prior to N2MBW had no consistent or significant influence on N2MBW measures. However, we emphasize that further studies of the effect of both daytime variation and the effect of chest physiotherapy on multiple breath washout measures are warranted.

The effectiveness of combining inspiratory muscle training with manual therapy and a therapeutic exercise program on maximum inspiratory pressure in adults with asthma: a randomized clinical trial

Objective: The objective of this study was to evaluate whether the addition of manual therapy and therapeutic exercise protocol to inspiratory muscle training was more effective in improving maximum inspiratory pressure than inspiratory muscle training in isolation. Design: This is a single-blinded, randomized controlled trial. Subjects: In total, 43 patients with asthma were included in this study. Interventions: The patients were allocated into one of the two groups: (1) inspiratory muscle training (n = 21; 20-minute session) or (2) inspiratory muscle training (20-minute session) combined with a program of manual therapy (15-minute session) and therapeutic exercise (15-minute session; n = 22). All participants received 12 sessions, two days/week, for six weeks and performed the domiciliary exercises protocol. Main measures: The main measures such as maximum inspiratory pressure, spirometric measures, forward head posture, and thoracic kyphosis were recorded at baseline and after the treatment. Results: For the per-protocol analysis, between-group differences at post-intervention were observed in maximum inspiratory pressure (19.77 cmH2O (11.49–28.04), P < .05; F = 22.436; P < .001; η2p = 0.371) and forward head posture (−1.25 cm (−2.32 to −0.19), P < .05; F = 5.662; P = .022; η2p = 0.13). The intention-to-treat analysis showed the same pattern of findings. Conclusion: The inspiratory muscle training combined with a manual therapy and therapeutic exercise program is more effective than its application in isolation for producing short-term maximum inspiratory pressure and forward head posture improvements in patients with asthma.