Inspiratory muscle training in interstitial lung disease

Koulopoulou, Maria (2015) Inspiratory muscle training in interstitial lung disease. (MSc(R) thesis), Kingston University, .


Background The interstitial lung diseases (ILDs) are a diverse group of pulmonary disorders classified together because they share similar physiological, clinical and pathological characteristics. Exercise intolerance and dyspnoea are the most common symptoms among these lung pathologies, which, as the disease progresses, impact profoundly on patients' quality of life. The role of Plumonary Rehabilitation programmes is becoming established as a therapeutic option for disease management in ILD. Inspiratory muscle training (IMT), a component of Pulmonary Rehabilitation, has been shown to improve dyspnoea and functional capacity in patients with COPD, Cystic Fibrosis and Bronchiectasis and has been proposed as an available therapeutic option for symptom management for these diseases. However, the effects of IMT in ILD have never been investigated before. Aim of the study: To investigate the effect of high intensity inspiratory muscle training, on patients with Interstitial Lung disease, and to explore feasibility of this rehabilitation intervention in this group of patients. Methods Seventeen patients with interstitial lung disease and established pulmonary fibrosis were recruited from a university hospital specialist interstitial lung disease clinic in London.The study design was a single bling randomised controlled trial, in which patients were randomly allocated to either a high intensity training group (n=9) exercised at 60% of sustained maximal inspiratory pressure, or a control group (n=8), exercised at 15% of sustained maximal inspiratory pressure. An 8-week, twice a week, outpatient inspiratory muscle training programme took place at the research facilities of the recruitment centre. Primary outcome was the six minute walk test (6MWT) and secondary outcomes were: quality of life (CAT, Dyspnoea-12 questionnaires), dyspnoea (Modified Borg scale), maximal inspiratory pressure (MIP), sniff nasal inspiratory pressure (SNIP) and peripheral strength (Handgrip strength-HG). Comparisons were made between and within groups for the primary (6MWT) and secondary outcomes (MIP, Sniff P, SGQoL-I, CAT, Dyspnoea-12, Borg score and HG) at baseline and immediately post-inspiratory muscle training. Results Eight out of the nine patients from the high intensity group and six out of eight from the control group completed the programme. There was no significant difference between the groups for the primary outcome (6MWT, p=0.9). There was significant difference for the MIP p=0.043. The high intensity group improved significantly on: exercise capacity (6MWT) 57.50m [IQR 11.25, 120] m, p=0.02; inspiratory muscle strength (MIP) 15 cm H2) [IQR, 11-25.50] P=0.012, and sniff pressure (SniffP) 15.00cm H2O [IQR, 5.50, 26.00], p=0.025; dyspnoea: (Modified M-Borg Scale) by 1 point [IQR 1, 2] (p=0.059); and Quality if Life (SGRQ-I) - 10.61[-14.5, (-5.05)], (p=0.025); but did not improve on (Dyspnea12 scale) [IQR, 0.75, 4] (p=0.462); quality of life: (CAT) -0.50 [IQR, -4.75, 1.50], (P=0.248) peripheral strength (HG) 1kg [IQR, -5.00-2.75]. (p=0.8). Control group significantly improved on exercise, and both dyspnoea score, but not on MIP and Quality of Life. Conclusion High intensity inspiratory muscle training is safe and well tolerated treatment for patients with interstitial lung disease. Inspiratory muscle strength, exercise capacity and dyspnoea improved significantly, following an 8-week high intensity IMT programme. This positive trend of improvement in primary and secondary outcomes of interest suggests that a bigger scale study is warranted to detect if statistically significant clinical difference exists.

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