The case against inspiratory muscle training in COPD

摘要: Despite maximal medical therapy, many chronic obstructive pulmonary disease (COPD) patients remain breathless and this has led to persistent commendable efforts reduce symptoms improve exercise performance using nonpharmacological approaches; some of these, for example rehabilitation (PR) 1, comprising general fitness training, are proven benefit, while others controversial. Inspiratory muscle training (IMT), being cheap free side-effects, is intuitively attractive, since improving the capacity inspiratory muscles should “make breathing easier” so performance. Enthusiasts do not allow superficial attractiveness proposition be clouded by aspects data. These that diaphragm already working hard well trained in emphysema, with a shift towards fatigue resistant type I fibres 2, at single fibre level it energetically more efficient 3, (allowing hyperinflation) actually weak 4, 5 cannot elicited vivo 6, 7, even when sufficiently ill require mechanical ventilation 8. The question whether respiratory COPD seems particularly important context IMT. In current issue European Respiratory Journal , Gosselink et al. 9 cite our paper as evidence weak; fact, we concluded major reason reduced transdiaphragmatic pressures observed was hyperinflation, which course would expected They also state …