Inspiratory muscle training for asthma

 

Abstract

Background

In moderate to severe chronic obstructive pulmonary disease there is good evidence of a generalised loss of muscle bulk (including the respiratory muscles). It is possible that similar loss of respiratory muscle strength occur particularly in more severe asthma related in part to the effects of steroid therapy. Thus the respiratory muscle function may well be of relevance in asthma and if dysfunctional, may be a suitable target for training.

Objectives

To evaluate the efficacy of inspiratory muscle training with an external resistive device in patients with asthma.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2002), MEDLINE (January 1966 to March 2002), EMBASE (January 1985 to March 2002), CINAHL (to March 2002) and the UK National Research Register of trials (January 1982 to March 2002) and reference lists of articles. We also searched on line respiratory journals and contacted manufacturers of training devices to obtain trials.

Selection criteria

All randomised-controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion.

Data collection and analysis

Two reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data.

Main results

Five studies were included in the review with four of the studies being produced by the same group. PImax (maximum inspiratory pressure) reported in three studies with 76 patients showed significant improvement with inspiratory muscle training when compared to the control group (WMD 23.07 cmH2O, 95%CI 15.65 to 30.50). Unfortunately, due to the paucity of included studies and data no other outcome was reported by more than one study. Therefore it is not possible to confirm whether this increase seen with PImax translates into any measurable clinical benefit.

Authors' conclusions

Currently there is insufficient evidence to suggest that inspiratory muscle training provides any clinical benefit to patients with asthma. Due to the limited availability of studies in this area there is a need for further trials evaluating the efficacy of inspiratory muscle training devices in patients with asthma. These studies should investigate asthmatics with a range of severity. They should investigate clinically relevant outcomes such as lung function, symptoms, exacerbation rate and concomitant medications.

 

Plain language summary

Inspiratory muscle training for asthma

In moderate to severe chronic obstructive pulmonary disease, there is good evidence of a generalised loss of muscle bulk (including the respiratory muscles). It is possible that similar loss of respiratory muscle strength could occur in asthma, particularly in more severe asthma requiring high doses of steroid therapy. Thus respiratory muscle training may be useful in asthma but there is insufficient research at present to support this theory.

 

摘要

背景

以吸氣肌肉訓練治療氣喘

就中至重度慢性阻塞性肺病而言，已有良好的證據顯示有肌肉普遍消失(包括呼吸肌肉)的現象。類似的呼吸肌肉強度減退也可能會出現在較為嚴重的氣喘病患，部分是跟類固醇治療有關。因此，呼吸肌肉的功能可能與氣喘相關，而若有功能障礙，則可能是給予訓練的適應症。

目標

評估採用外部阻力設計的吸氣肌肉訓練對氣喘患者的效益。

搜尋策略

我們搜尋Cochrane Central Register of Controlled Trials(Cochrane Library 2002年第1期)、MEDLINE(1966年1月至2002年3月)、EMBASE(1985年1月至2002年3月)、CINAHL(至2002年3月)及UK National Research Register of trials(1982年1月至2002年3月)及文章索引用的參考文獻。我們亦搜尋線上呼吸學雜誌及聯絡訓練設備的製造商取得試驗的資訊。

選擇標準

所有涉及使用外部吸氣肌肉訓練設備與對照組(偽裝或沒使用吸氣訓練設備)之隨機對照試驗均考慮納入。

資料收集與分析

兩位審查者獨立地選擇納入之文章、評估研究的方法學及摘取數據。

主要結論

有五項研究被納入本回顧，其中四項由同一研究團隊執行，其中共涉及76名病人的三項研究顯示，吸氣肌肉訓練與對照組相較能顯著改善Pimax(最大吸氣壓力)(WMD 23.07 cmH2O，95%CI 15.655430.50)。不幸的是，由於納入分析的研究及數據均甚少，故無一項研究能呈現出其他的治療結果。因此，無法確定Pimax的增加能否轉譯為任何可測量的臨床效益。

作者結論

目前沒有足夠證據顯示吸氣肌肉訓練能對氣喘患者提供任何臨床效益。由於可取得的相關研究甚少，故有需要進一步對試驗來評估吸氣肌肉訓練設備對氣喘病人的效益。此等研究和評估不同嚴重度的氣管病患，亦須研究臨床相關的治療結果，如肺功能、症狀、惡化率及伴隨用藥等。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前沒有足夠證據建議採外部阻力呼吸設計的吸氣肌肉訓練對氣喘病人提供任何可見的臨床效益。就中至重度慢性阻塞性肺病而言，以有良好的證據顯示有肌肉普遍消失(包括呼吸肌肉)的現象。相同的呼吸肌肉強度減退也可能發生於氣喘，特別是需要高劑量類固醇治療較為嚴重的氣喘。因此，呼吸肌肉訓練可能對氣喘有幫助，但至今仍無充分研究支持此一理論。