Physical Activity and Sedentary Behavior as Treatable Traits for Clinical Control in Moderate-to-Severe Asthma

BACKGROUND

Physical activity and sedentary behavior are treatable traits that may impact asthma control in distinct manners, but this impact remains poorly understood.

OBJECTIVE

To evaluate the influence of physical activity and sedentary behavior on clinical control in adults with moderate-to-severe asthma.

METHODS

This cross-sectional, multicentric study included 426 individuals with moderate-to-severe asthma. Assessments included physical activity and sedentary time (actigraphy), clinical asthma control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), anthropometric data, and lung function. Participants were grouped according to physical activity levels and sedentary behavior.

RESULTS

Participants who walked ≥7500 steps/day presented better ACQ scores than those who walked <7500 steps/day (P < .05), independent of sedentary status. The percentage of patients with controlled asthma was higher in the active/sedentary (43.9%) and active/nonsedentary (43.8%) groups than in the inactive/sedentary (25.4%) and inactive/nonsedentary (23.9%) groups (P < .02). The likelihood of having uncontrolled asthma according to the treatable traits of physical inactivity (odds ratio [95% confidence interval]: 2.36 [1.55-3.59]), higher anxiety (2.26 [1.49-3.42]), and depression symptoms (1.95 [1.28-2.95]) was significant (P ≤ .002). Obesity and sedentary time were not associated with asthma control.

CONCLUSIONS

Our results show that ≥7500 steps/day is associated with better asthma control independent of sedentary time in adults with moderate-to-severe asthma. Physical inactivity, anxiety, and depression symptoms are associated with higher odds of uncontrolled asthma. These results suggest that interventions should mainly focus on increasing physical activity rather than reducing sedentary time.

Effectiveness of gamified exercise programs on the level of physical activity in adults with chronic diseases: a systematic review

PURPOSE

to assess the effects of supervised and unsupervised gamified exercise programs on physical activity level, sedentary behavior and quality of life in patients with non-communicable chronic diseases.

MATERIALS AND METHODS

Six database were searched. Methodological quality of included studies, the quality of reporting interventions and the quality of the applications were assessed using the PEDro, TIDieR and MARS, respectively.

RESULTS

Nine studies were included (n = 974; 60.2 ± 5.7 years). Three of them enrolled individuals with cancer, one with stroke, one with multiple sclerosis, one with COPD, two with Diabetes Mellitus, and one with knee and hip osteoarthritis. Gamification was performed via a smartphone application in three studies (MARS = 13.4 ± 9.75pts, ranging from 10.9 to 16.9pts). The intervention was supervised in six studies. The PEDro and TIDIeR scores were 5.5 ± 1.3 (ranging 0-8pts) and 16.11 ± 3.14 (ranging 10-20pts), respectively. Supervised gamified interventions increased the level of physical activity compared to usual supervised exercises. Quality of life was similar between groups. Unsupervised interventions were similar for all outcomes evaluated.

CONCLUSIONS

Supervised gamified exercise programs seem to increase the level of physical activity compared to usual exercises in patients with chronic diseases. However, studies with better methodological qualities and subgroup analyzes are needed.

Characteristics of individuals with moderate to severe asthma who better respond to aerobic training: a cluster analysis

OBJECTIVE

To determine the characteristics of individuals with asthma who are responsive to aerobic training.

METHODS

This post hoc analysis of pooled data from previous randomized controlled trials involved 101 individuals with moderate to severe asthma who underwent aerobic training. Participants underwent a maximal cardiopulmonary exercise test and completed the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire before and after a 24-session aerobic training program. Better and worse responders to aerobic training were identified by cluster analysis.

RESULTS

Two clusters were identified according to the improvement in peak VO2 after aerobic training (better and worse responders). Characteristics of the better responder group were being older, being female, having higher BMI, and having higher cardiac reserve at baseline when compared with the worse responder group. Also, better responders had worse clinical control, worse quality of life, and lower physical capacity at baseline. After training, worse responders, in comparison with better responders, showed half the improvement in Δpeak VO2 (7.4% vs. 13.6%; 95% CI, -12.1 to -0.92%; p < 0.05) and worse asthma control. A weak, negative, but significant association (r = -0.35; p < 0.05) was observed between clinical control and aerobic fitness only in the better responder group. Both groups showed significant improvement in quality of life.

CONCLUSIONS

Obese individuals with worse exercise capacity, clinical control, and quality of life showed improvement with aerobic training. Moreover, worse responders also improved with training, but to a lesser extent.

A study of the psychometric properties of the Brazilian...Portuguese version of Bronchiectasis Health Questionnaire

INTRODUCTION AND OBJECTIVE

The Bronchiectasis Health Questionnaire (BHQ) is a simple, repeatable, and self-reporting health status questionnaire for bronchiectasis. This study aims to cross-culturally adapt the BHQ into Brazilian Portuguese and evaluate its measurement properties.

METHODS

The participants answered the Saint George...s Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) scale for dyspnea. The Brazilian-Portuguese version of the Bronchiectasis Health Questionnaire (BHQ-Brazil) was used at baseline (test) and after 14 days (retest). The psychometric analyses included internal consistency, test-retest reliability, and construct validity: factorial validity, convergent validity, and discriminative validity, agreement, and ceiling and floor effects.

RESULTS

The BHQ-Brazil demonstrated adequate internal consistency (Cronbach...s alpha...=...0.92) and substantial reliability (intraclass correlation coefficient...=...0.86; 95%CI: 0.79...0.90). The exploratory factorial analysis was considered suitable. All items presented a factorial load >0.40. The convergent validity of the BHQ-Brazil with mMRC was moderate (r...=......0.53, p...<...0.001), while concurrent validity with the SGRQ was strong (symptoms: r...=......0.72, activities: r...=......0.60, impact: r...=......0.60, total score: r...=......0.75, all p...<...0.001). The standard error of measurement was 4.81 points. The discriminative validity demonstrated that individuals with more pulmonary exacerbations, colonization by Pseudomonas aeruginosa, worst dyspnea, and a higher number of affected lung lobes presented the lowest quality of life. No floor or ceiling effects were observed.

CONCLUSION

The BHQ-Brazil presents adequate measurement properties to evaluate the impact of bronchiectasis on health-related quality of life, and can be used in clinical and research settings.

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

BACKGROUND

Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19.

METHODS

This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO₂/FiO₂ ratio was used to assess the oxygenation response. The 20-point improvement in PaO₂/FiO₂ after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge.

RESULTS

Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality.

CONCLUSION

The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Reproducibility, validity, and reliability of the incremental step test for subjects with moderate to severe asthma

OBJECTIVE

We investigated the measurement properties of the incremental step test in subjects with moderate to severe asthma.

METHODS

Subjects with moderate to severe persistent asthma were recruited from a tertiary university hospital specializing in treating severe asthma. All subjects performed one cardiopulmonary exercise test (CPET) and two incremental step tests (IST) in random sequences. Pulmonary gas exchange was measured during all exercise tests. The measurement properties investigated were reliability by intraclass correlation coefficient (ICC), measurement error by the standard error of measurement and minimum detectable difference, construct validity by Pearson's correlation, and interpretability by the ceiling and floor effects.

RESULTS

Fifty subjects (38 females, mean [SD], age 43.7 [11.6] yr, % FEV1 70 [14.3], BMI 28.5 [5.3] kg/m2) completed the study. The peak oxygen uptake (peak VO2) for the CPET was 27.6 [±6.8] ml/kg/min, for the first IST was 22.3 [±5.3] ml/kg/min and for the second IST was 23.3 [±5.3] ml/kg/min. The IST presented excellent reliability (ICC=0.93, CI95% 0.88-0.96), very good measurement error (2.5%), and construct validity for peak VO2 measurement compared to the CPET (r = 0.85; p < 0.001) to assess exercise capacity in subjects with moderate to severe asthma, with appropriate ceiling (10%) and floor (0%) effects.

CONCLUSION

The IST presented excellent reliability and very good measurement error and validity to assess exercise capacity in subjects with moderate to severe asthma, without ceiling or floor effects.

Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients

Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD.

NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.

Measurement properties of the Human Activity Profile questionnaire in hospitalized patients

•

Inactivity is an important predictor of poor outcomes in inpatients.

•

The HAP has been used in healthy and symptomatic populations.

•

The HAP assesses physical activities ranging from very easy to very strenuous.

•

The HAP has adequate measurement properties to assess inpatients.

Objective

To test the measurement properties (reproducibility, internal consistency, ceiling and floor effects, and construct validity) of the Human Activity Profile (HAP) questionnaire in hospitalized patients.

Methods

This measurement properties study recruited one-hundred patients hospitalized for less than 48 h for clinical or surgical reasons. The HAP was administered at baseline and after 48 h in a test–retest design). The International Physical Activity Questionnaire (IPAQ-6) was also administered at baseline, aiming to assess the construct validity. We tested the following measurement properties: reproducibility (reliability assessed by type 2,1 intraclass correlation coefficient (ICC_2,1)); agreement by the standard error of measurement (SEM) and by the minimum detectable change with 90% confidence (MDC₉₀), internal consistency by Cronbach's alpha, construct validity using a chi-square test, and ceiling and floor effects by calculating the proportion of patients who achieved the minimum or maximum scores.

Results

Reliability was excellent with an ICC of 0.99 (95% CI = 0.98–0.99). SEM was 1.44 points (1.5% of the total score), the MDD₉₀ was 3.34 points (3.5% of the total score) and the Cronbach's alpha was 0.93 (alpha if item deleted ranging from 0.94 to 0.94). An association was observed between patients classified by HAP and by IPAQ-6 (χ² = 3.38; p = 0.18). Ceiling or floor effects were not observed.

Conclusion

The HAP shows adequate measurement properties for the assessment of the physical activity/inactivity level in hospitalized patients.

Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial

Background

Patients with COPD present a major recruitment of the inspiratory muscles, predisposing to chest incoordination, increasing the degree of dyspnea and impairing their exercise capacity. Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity; however, the systemic effects of stretching remain unknown.

Objective

The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD.

Design

This study was a randomized and controlled trial.

Participants

A total of 30 patients were allocated to a treatment group (TG) or a control group (CG; n=15, each group).

Intervention

The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching. Both groups performed 24 sessions (twice a week, 12 weeks) of aerobic training.

Evaluations

Functional exercise capacity (6-minute walk test), thoracoabdominal kinematics (optoelectronic plethysmography), and respiratory muscle activity (surface electromyography) were evaluated during exercise. Analysis of covariance was used to compare the groups at a significance level of 5%.

Results

After the intervention, the TG showed improved abdominal (ABD) contribution, compartmental volume, mobility, and functional exercise capacity with decreased dyspnea when compared with the CG (P<0.01). The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG (P<0.001).

Conclusion

Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional exercise capacity with decreased dyspnea in patients with COPD. These effects are associated with an increased efficacy of the respiratory muscles and participation of the ABD compartment.

Anxiety and depression are related to dyspnea and clinical control but not with thoracoabdominal mechanics in patients with COPD

OBJECTIVE

To investigate the relationship between the presence of symptoms of anxiety or depression with breathing pattern and thoracoabdominal mechanics at rest and during exercise in COPD.

METHODS

Cross-sectional study enrolled 54 patients with COPD ranked according to Hospital Anxiety and Depression Scale (HAD) score and compared to dyspnea, clinical control, hypercapnia, breathing pattern and thoracoabdominal mechanics at rest and during exercise.

RESULTS

Seventeen patients with COPD had no symptoms, 12 had anxiety symptoms, 13 had depressive symptoms and 12 had both symptoms. COPD with depressive symptoms presented greater degree of dyspnea (p<0.01). Poor clinical control was observed in COPD with anxious and/or depressive symptoms (p<0.05). Breathing pattern and thoracoabdominal mechanics were similar among all groups at rest and during exercise.

CONCLUSIONS

COPD with symptoms of depression report more dyspnea. Anxiety and depression are associated with poor clinical control without impact on breathing pattern and thoracoabdominal mechanics in COPD.

Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery

OBJECTIVE

Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior).

METHODS

We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique.

RESULTS

The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed.

CONCLUSIONS

Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.

Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review

BACKGROUND

Falls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventing falls; however, there is no consensus regarding the best method for increasing lower limb muscle strength.

OBJECTIVES

To analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventing falls in elderly subjects.

METHOD

We performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale.

RESULTS

The data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score ≥ 7/10 points).

CONCLUSIONS

The methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventing falls in elderly subjects, however the interventions in these studies were poorly reported.

Association between maximal aerobic capacity and psychosocial factors in adults with moderate-to-severe asthma

BACKGROUND

The symptoms of asthma impair health-related quality of life (HRQoL), increase anxiety and depression and may keep subjects from engaging in physical exercise. Physical inactivity has been related to poor asthma outcomes; however, the association between physical fitness and psychosocial disorders remains poorly understood.

OBJECTIVE

To verify the association between aerobic capacity, HRQoL, and psychological distress in adults with moderate or severe persistent asthma who were clinically stable.

METHODS

Eighty-eight participants (68 females) with either moderate or severe persistent asthma (age range, 20-60 years) who were under medical treatment for at least 6 months and considered clinically stable were studied. Participants were evaluated on two non-consecutive days. On the first day, the HRQoL, depression and anxiety levels and pulmonary function were assessed. On the second day, subjects underwent cardiopulmonary exercise testing.

RESULTS

Using the agglomerative cluster approach, two clusters were identified: 21 participants (24%) were grouped in Cluster 1, and 67 (76%) were grouped in Cluster 2. Asthmatic subjects from Cluster 1 exhibited increased aerobic capacity, better HRQoL and lower depression levels than did subjects in Cluster 2 (p < .05). No difference was observed between the clusters with respect to gender, age, body mass index (BMI) or pulmonary function (p > .05). The discriminant function model exhibits good accuracy (R(2) = 0.79) and predicted 93% of the case allocations.

CONCLUSION

Our results suggest an association between reduced exercise capacity, low HRQoL and increases in depressive symptoms in clinically stable asthmatic subjects. These results suggest the need to assess physical fitness and psychosocial distress during asthma treatment and the importance of a multidisciplinary approach.

Preoperative 6-min walking distance does not predict pulmonary complications in upper abdominal surgery

BACKGROUND AND OBJECTIVE

Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS).

METHODS

This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test.

RESULTS

Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs. 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs. 90.6 ± 20.9%; P > 0.05).

CONCLUSIONS

The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.

Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery

BACKGROUND AND OBJECTIVE

Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery.

METHODS

Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated.

RESULTS

The MNG showed expiratory muscle weakness (MNG 65 ± 24 vs CG 82 ± 22 cm H(2) O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02).

CONCLUSIONS

These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.

Incentive spirometry in major surgeries: a systematic review

OBJECTIVE

To conduct a systematic review to evaluate the evidence of the use of incentive spirometry (IS) for the prevention of postoperative pulmonary complications and for the recovery of pulmonary function in patients undergoing abdominal, cardiac and thoracic surgeries.

METHODS

Searches were performed in the following databases: Medline, Embase, Web of Science, PEDro and Scopus to select randomized controlled trials which the IS was used in pre- and/or post-operative in order to prevent postoperative pulmonary complications and/or recover lung function after abdominal, cardiac and thoracic surgery. Two reviewers independently assessed all studies. In addition, the studies quality was assessed using the PEDro scale.

RESULTS

Thirty studies were included (14 abdominal, 13 cardiac and 3 thoracic surgery; n=3,370 patients). In the analysis of the methodological quality, studies achieved a PEDro average score of 5.6, 4.7 and 4.8 points in abdominal, cardiac and thoracic surgeries, respectively. Five studies (3 abdominal, 1 cardiac and 1 thoracic surgery) compared the effect of the IS with control group (no intervention) and no difference was detected in the evaluated outcomes.

CONCLUSION

There was no evidence to support the use of incentive spirometry in the management of surgical patients. Despite this, the use of incentive spirometry remains widely used without standardization in clinical practice.