Respiratory Muscle Training Can Improve Cognition, Lung Function, and Diaphragmatic Thickness Fraction in Male and Non-Obese Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study

Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial

INTRODUCTION

Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life.

METHODS

Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale.

RESULTS

Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores.

CONCLUSION

Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.

Impact of exercise training on cognitive function in patients with COPD: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

The aim of this study was to describe the characteristics of exercise therapies in randomised controlled trials (RCTs) targeted at improving cognitive function and to assess their efficacy in COPD.

METHODS

We conducted a comprehensive search of eight databases, namely PubMed, Web of Science, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Weipu, covering the period from database construction to 23 April 2024. Our search specifically targeted RCTs studying the effects of exercise on cognitive functioning in COPD patients. Trials consisted of one or more exercise training interventions along with at least one cognitive outcome study. Two reviewers independently reviewed papers, extracted data and evaluated the research literature's quality using the Cochrane risk-of-bias assessment tool RoB 2.0 and the modified Jadad scale. Meta-analysis of Montreal Cognitive Assessment (MoCA) scores in the groups with and without exercise intervention was performed and subgroup analyses were undertaken to identify potential causes of heterogeneity.

RESULTS

We included a total of nine studies that included 578 COPD patients (69% male). Each study demonstrated that patients improved significantly in at least one cognitive component following training. All current research focuses on attention, executive function, motor ability, mental capacity, verbal fluency, visuoconstructive abilities and memory. The results revealed that exercise significantly improved MoCA scores in COPD patients (standardised mean difference (SMD) 0.576 (95% CI 0.054-1.097); p=0.029). A subgroup analysis of the duration of each intervention revealed that exercise training with an intervention duration of >30 min significantly improved overall cognitive performance in COPD patients (SMD 0.499 (95% CI -0.165-1.163); p=0.000, I2=0.0%). A subgroup analysis of varied intervention durations revealed that 4 weeks of exercise training significantly improved overall cognitive performance in COPD patients (SMD 0.202 (95% CI -0.238-0.641); p=0.000, I2=0.0%). In addition, just one study had a year-long follow-up period.

CONCLUSION

Participation in exercise training, whether aerobic exercise alone or in combination with resistance or muscular strength, healthy qigong, dance or breathing exercises, can improve cognitive performance to varying degrees in people with COPD. Nonetheless, the findings should be regarded with caution due to the limitations of the included studies.

Obesity and the Importance of Breathing

Obesity is a complex and non-communicable disease with a pandemic entity. Currently, multiple causes can lead to obesity, and it is not always easy to create a direct relationship between physical inactivity, poor quality of nutrients consumed, and calculation of excess calories. Among the associated comorbidities, obesity creates a dysfunctional environment of respiratory rhythms at the central and peripheral levels, with functional, morphological, and phenotypic alteration of the diaphragm muscle. This pathological adaptation of breathing is one of the most important causes of the dysregulation of the autonomic system, which will negatively affect the progression of comorbidities and chronic non-physiological adaptations in obese persons. Introducing a physical activity program involving diaphragm training could be a very valid strategy to restore the systemic autonomic response, delaying or avoiding the onset of pathologies in excess fat. This brief narrative review focuses on the importance of breathing in obese subjects.

Effects of proprioceptive neuromuscular facilitation combined with threshold inspiratory muscle training on respiratory function in neurocritical patients with weaning failure: a randomized controlled trial

The purpose of this study was to determine the effects of combining proprioceptive neuromuscular facilitation (PNF) with threshold inspiratory muscle training (TIMT), compared with TIMT alone, on respiratory function in neurocritical patients who experienced a weaning failure. Forty-seven participants (mostly after a stroke), were randomly divided into the experimental group ( n  = 24) and the control group ( n  = 23). The control group received usual care and TIMT, whereas the experimental group, in addition, underwent four 90-s periods of manual PNF. Both groups performed training in the ICU twice a day for 5 consecutive days. The main outcome measures included maximum inspiratory pressure, diaphragmatic excursions, diaphragm thickening fraction, oxygenation index, and forced expiratory volume in 1 s/forced vital capacity. The results showed a significant group-by-time interaction effect for maximum inspiratory pressure [ F (1, 45) = 17.84, η2  = 0.328, P  < 0.001] and oxygenation index [ F [1, 45) = 5.58, η2  = 0.11, P  = 0.023]. When compared with the control group, the experimental group showed overall significantly higher maximum inspiratory pressure [mean difference = 4.37 cm H 2 O, 95% confidence interval (CI) 0.25-8.50, P  = 0.038]. No other significant group differences were found. Combining PNF with TIMT may improve respiratory function in neurocritical patients with weaning failure. This combination approach may increase the likelihood of survival of neurocritical patients in the ICU.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

Purpose

Whether Internet of Things (IoT)-based home respiratory muscle training (RMT) benefits patients with comorbid chronic obstructive pulmonary disease (COPD) remains unclear. Therefore, this study aims to evaluate the effectiveness of IoT-based home RMT for patients with COPD.

Patients and Methods

Seventy-eight patients with stable COPD were randomly divided into two groups. The control group received routine health education, while the intervention group received IoT-based home RMT (30 inspiratory muscle training [IMT] and 30 expiratory muscle training [EMT] in different respiratory cycles twice daily for 12 consecutive weeks). Assessments took place pre-intervention and 12 weeks post-intervention, including lung function tests, respiratory muscle strength tests, the mMRC dyspnea scale, CAT questionnaires, the HAMA scale, and 6-month COPD-related readmission after intervention.

Results

Seventy-four patients with COPD were analyzed (intervention group = 38, control group = 36), and the mean age and FEV1 of the patients were 68.65 ± 7.40 years, 1.21 ± 0.54 L. Compared to those of the control population, the intervention group exhibited higher FEV1/FVC (48.23 ± 10.97 vs 54.32 ± 10.31, p = 0.016), MIP (41.72 ± 7.70 vs 47.82 ± 10.99, p = 0.008), and MEP (42.94 ± 7.85 vs 50.29 ± 15.74, p = 0.013); lower mMRC (2.00 [2.00-3.00] vs 1.50 [1.00-2.00], p < 0.001), CAT (17.00 [12.00-21.75] vs 11.00 [9.00-13.25], p < 0.001), and HAMA (7.00 [5.00-9.00] vs 2.00 [1.00-3.00], p < 0.001) scores; and a lower incidence rate of 6-month readmission (22% vs 5%, p = 0.033).

Conclusion

Compared with no intervention, IoT-based home RMT may be a more beneficial intervention for patients with COPD.

Value of incentive spirometry in routine management of COPD patients and its effect on diaphragmatic function

Background

Incentive spirometry (IS) is mostly used postoperatively to avoid pulmonary complications, but its effect on COPD patients and its effect on diaphragmatic functions are still not fully studied. The current study aimed to evaluate the value of IS on arterial blood gases, mMRC dyspnea scale, spirometry, and diaphragmatic functions by ultrasound in patients hospitalized for COPD exacerbation.

Methods and patients

Forty patients (37 males, 3 females) were admitted for COPD exacerbations and divided randomly into 2 groups: Group1 (G1) =20 patients (mean age 60.7±5.99) used incentive spirometry (IS) for 2 months with medical treatment. Group 2 as a control group (G2) = 20 patients (mean age 60.3±6.44) were given medical treatment only. ABG, spirometry, mMRC dyspnea scale, and diaphragmatic ultrasound functions were assessed on admission and after 2 months of treatment in the groups.

Results

There were statistically significant differences between G1 and G2 after 2 months regarding PaCO2, FEV1/FVC (p=0.001 and 0.042, respectively), and Lt diaphragmatic excursion and diaphragm thickness ratio. There was a statistically significant increase in results of PaO2, PaCO2, FEV1/FVC, PEFR, and all diaphragmatic findings in group I before and after 2 months of IS but no difference in FVC and mMRC dyspnea scale.

Conclusion

Incentive spirometry in COPD patients seems to improve ABG, and spirometry functions together with improving diaphragmatic functions.

Trial registration

ClinicalTrials.gov NCT05679609. Retrospectively egistered on 10 January 2023

Cutting-Edge Approaches in Respiratory and Critical Care Medicine

The COVID-19 pandemic has affected health care across the world, with respiratory and critical care medicine being affected the most [...].

Effect of Liuzijue on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: study protocol for a multicenter, non-randomized, prospective study

Background

Traditional Chinese exercise as a new pulmonary rehabilitation technique has been increasingly used and achieved good results in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD). The aim of this study is to investigate the protective effects of Liuzijue on exercise tolerance, lung function, and quality of life in patients with COPD.

Methods

This study is a multicenter, non-randomized, prospective study. Patients will be divided into a control group (CG) and a Liuzijue group (LG) based on their willingness to learn Liuzijue. None of the outcome assessors will know the grouping of patients. Participants in this study will be collected from stable COPD patients who are outpatients or inpatients in 3 centers in China since September 2021. Patients will meet the diagnostic criteria for GOLD stage I-II COPD (FEV₁% ≥ 0.5 and FEV₁/FVC < 0.7) and be aged 40 years or older. Patients voluntarily will take part in the clinical study and sign an informed consent form. All participants will follow their existing medication. For LG patients, Liuzijue training has been added. Patients will practice Liuzijue for more than 30 minutes a day, more than 5 days a week, and adhere to the training for 3 months. Outcome indicators are 6-minute walk test (6MWT), lung function (FEV₁%, FEV₁/FVC, MMEF, PEF), modified British Medical Research Council (mMRC) score, COPD assessment test score (CAT), acute exacerbations and changes in drug treatment.

Discussion

This study quantified the effect of Liuzijue on the pulmonary rehabilitation of COPD patients in the stable phase of the disease, and provided a basis for the use of Liuzijue in COPD patients.

Trial registration

Chinese clinical trial registry, ChiCTR2100048945. Date: 2021-07-19. http://www.chictr.org.cn/showproj.aspx?proj=129094

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03789-6.

The Efficacy and Safety of Budesonide/Glycopyrronium/Formoterol in the Treatment of COPD in the Elderly

Objective

Chronic obstructive pulmonary disease (COPD) is a major and difficult disease of the chronic respiratory system that is common and frequent, with a huge disease burden. The aim of this study was to investigate the efficacy and safety of budesonide/glyburide/formoterol fumarate (BGF) in the treatment of COPD.

Methods

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The basic features of the seven pieces of literature were identified using the search strategy. The sample size range was 130∼1264.

Results

The effects of BGF increased FEV1 in patients with COPD (mean difference = 2.86, 95%CI: 2.71–3.01, p < 0.00001). The effects of BGF improved in patients with ≥1 TEAE in patients with COPD, and was not statistically significant after treatment (Odds rate = 1.00, 95%CI: 0.85–1.17, p=0.97). The effects of BGF increased in patients with TEAEs related a to study treatment in patients with COPD (odds rate = 1.27, 95% CI: 1.03–1.57, p=0.02). The effects of BGF in decreased patients with serious TEAEs in patients with COPD (odds rate = −0.02, 95% CI: −0.03–−0.00, p=0.04). The effects of BGF decreased the death rate in patients with COPD, and were not statistically significant after treatment (odds rate = 0.77, 95% CI: 0.31–1.97, p=0.59). The effects of BGF decreased the hypertension rate in patients with COPD (odds rate = 0.92, 95% CI: 0.44–1.89, p=0.81), and was not statistically significant after treatment. The effects of BGF increased pneumonia in patients with COPD (odds rate = 1.55, 95% CI: 0.81–2.97, p=0.19), and were not statistically significant after treatment. The effects of BGF increased FEV1, increased patients with TEAEs related a to study treatment, and decreased patients with serious TEAEs in patients with COPD.

Conclusion

This study elucidates the efficacy and safety of BGF in the treatment of COPD with a view to providing a clinical reference.

Mapping the global research landscape and hotspot of exercise therapy and chronic obstructive pulmonary disease: A bibliometric study based on the web of science database from 2011 to 2020

Background: The application of exercise therapy (ET) in chronic obstructive pulmonary disease (COPD) is generating increasing clinical efficacy and social-economic value. In this study, research trends, evolutionary processes and hot topics in this field are detailed, as well as predictions of future development directions.

Methods: Search for literature in the field of COPD and ET and analyze data to generate knowledge graphs using VOSiewer and CiteSpace software. The time frame for the search was from 2011 to January 2021. Then we extracted full-text key information (such as title, journal category, publication date, author, country and institution, abstract, and keyword) and obtained the co-citation analysis. Use hierarchal clustering analysis software developed by VOSviewer to map common citations, and use Citespace software to plot trend networks.

Results: The United States topped the list with 27.91% of the number of articles posted, followed by the UK at 25.44%. Imperial College London was the highest number of article publications in institutions, followed by Maastricht University and the University of Toronto. The Royal Brompton Harefield NHS Foundation Trust was one of many research institutions and currently holds the highest average citations per item (ACI) value, followed by Imperial College London and the University of Leuven. Judging from the number of publications related to ET and COPD, it is mainly published in cell biology, respiratory pulmonary diseases, and rehabilitation experiments study medicine. The European Respiration Journal is the most widely published in this field, followed by the International Journal of Chronic Obstructive Pulmonary Disease and Respiratory Medicine.

Conclusion: COPD combined with ET is widely used in clinical practice and is on the rise. A distinctive feature of the field is multidisciplinary integration. Rehabilitation research for COPD involves multidisciplinary collaboration, tissue engineering, and molecular biology mechanism studies to help patients remodel healthy breathing. Multidisciplinary rehabilitation measures provide a solid foundation for advancing clinical efficacy in the field of COPD.