Geddes E Lynne, O'Brien Kelly, Reid W Darlene, Brooks Dina, Crowe Jean
School of Rehabilitation Science, Institute of Applied Health Science, Room 403, McMaster University, 1400 Main Street West, Hamilton, ON, Canada L8S 1C7.
Respir Med. 2008 Dec;102(12):1715-29. doi: 10.1016/j.rmed.2008.07.005. Epub 2008 Aug 15.
The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI(max), PI(max) % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve(max), Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.
目的是更新一项原始的系统评价，以确定吸气肌训练（IMT）对慢性阻塞性肺疾病（COPD）成人患者吸气肌力量和耐力、运动能力、呼吸困难及生活质量的影响。将原始检索截至2003年8月的MEDLINE和CINAHL数据库更新至2007年1月，并检索了EMBASE数据库自建库至2007年1月的文献。纳入以英文发表的、针对稳定期COPD成人患者的随机对照试验，比较IMT与假IMT或无干预、低强度与高强度IMT以及不同IMT模式。原始检索的274篇文章中有19篇符合纳入标准。更新后的检索又发现了17篇文章；其中6篇符合纳入标准，所有这些文章均将目标性、阈值性或等碳酸血症性过度通气IMT与假IMT进行了比较。对比较IMT与假IMT的亚组分析进行了更新，纳入了原始评价中的10项研究和更新后的6项研究。报告了16项荟萃分析。结果表明，吸气肌力量（最大吸气压[PI(max)]、预测的PI(max)百分比、吸气峰流速）、吸气肌耐力（最大运动负荷试验[RMET]、吸气阈值负荷、最大自主通气量[MVV]）、运动能力（最大运动通气量[Ve(max)]、呼吸努力的Borg评分、6分钟步行试验[6MWT]）、过渡性呼吸困难指数（焦点评分、功能障碍、任务量、努力程度）以及慢性呼吸系统疾病问卷（生活质量）均有显著改善。结果提示，目标性、阈值性或等碳酸血症性过度通气IMT可显著增加稳定期COPD成人患者的吸气肌力量和耐力，改善运动能力和一项生活质量指标，并减轻呼吸困难。
