Article

Reduced inspiratory muscle strength is common in people with chronic obstructive
pulmonary disease (COPD) and is associated with dyspnea and decreased exercise
capacity. Most studies of inspiratory muscle training (IMT) in COPD have
demonstrated increased inspiratory muscle strength. Many have also shown
improvements in dyspnea and exercise capacity. However, a persisting challenge
when translating and applying the findings of these studies in clinical practice
is the disparity in training loads, modalities, and outcomes measures used in the
different studies. This commentary summarizes our clinical and research
experience with a threshold IMT device with the aim of providing clinicians
interested in prescribing IMT in this population with practical recommendations
regarding patient selection, assessment, and implementation of training. We
propose using an interval-based high-intensity threshold IMT program for people
who are unable to participate fully in whole-body exercise training because of
comorbidities such as severe musculoskeletal problems. Initial training loads
equivalent to at least 30% of a person's maximum inspiratory pressure (PImax) are
required for all people undertaking IMT. Supervision, which includes monitoring
of oxygen saturation throughout the first training session, is recommended, and
patients are warned to expect transient delayed-onset muscle soreness, a
consequence of muscle adaptation to an unaccustomed activity. We recommend
training be undertaken 3 times a week for 8 weeks, with loads progressively
increased as symptoms permit. It is prudent to exclude people at risk of
pneumothorax or spontaneous rib fracture. Evaluation of IMT should include
measures of PImax, dyspnea, health-related quality of life, and exercise
capacity.

Langue : ANGLAIS