Inspiratory muscle training

Inspiratory muscle function may be impaired in patients with COPD, which may lead to dyspnoea [51], impaired exercise tolerance [23] and hypercapnia [52]. Several studies have therefore investigated the effects of inspiratory muscle training (IMT) on these parameters. IMT is generally started at a specific percentage of the maximal inspiratory pressure (PImax). The minimum load for achieving a real training effect is 30% of the PImax, which can be increased to 60-80%. Although most studies showed improved function of the inspiratory muscles after IMT [53-57], only a minority found a decrease in dyspnoea [55] or an improvement in exercise tolerance [54]. The reasons for these disappointing results might be an inadequate training protocol or not including appropriate patients in the study [58]. Gosselink and Decramer suggested that patients with ventilatory limitation might be ideal candidates [59]. In contrast to this, both Larson et al. [60] and Sanchez Riera et al. [61] recently showed positive results of IMT on both dyspnoea and exercise performance in patients with COPD in whom a ventilatory limitation was not established.

In summary, there is at present no strong evidence that IMT is beneficial in all patients with COPD. It might be beneficial in a specific group of patients with a ventilatory limitation. To further clarify the role of IMT in a rehabilitation programme, more needs to be known about the optimal candidates and how these patients should be trained.

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