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吸气肌训练在哮喘和运动诱发支气管收缩管理中的作用。

The role of inspiratory muscle training in the management of asthma and exercise-induced bronchoconstriction.

作者信息

Shei Ren-Jay, Paris Hunter L R, Wilhite Daniel P, Chapman Robert F, Mickleborough Timothy D

机构信息

a Human Performance Laboratories, Department of Kinesiology, School of Public Health-Bloomington , Indiana University , Bloomington , IN , USA.

出版信息

Phys Sportsmed. 2016 Nov;44(4):327-334. doi: 10.1080/00913847.2016.1176546. Epub 2016 Apr 26.

Abstract

Asthma is a pathological condition comprising of a variety of symptoms which affect the ability to function in daily life. Due to the high prevalence of asthma and associated healthcare costs, it is important to identify low-cost alternatives to traditional pharmacotherapy. One of these low cost alternatives is the use of inspiratory muscle training (IMT), which is a technique aimed at increasing the strength and endurance of the diaphragm and accessory muscles of respiration. IMT typically consists of taking voluntary inspirations against a resistive load across the entire range of vital capacity while at rest. In healthy individuals, the most notable benefits of IMT are an increase in diaphragm thickness and strength, a decrease in exertional dyspnea, and a decrease in the oxygen cost of breathing. Due to the presence of expiratory flow limitation in asthma and exercise-induced bronchoconstriction, dynamic lung hyperinflation is common. As a result of varying operational lung volumes, due in part to hyperinflation, the respiratory muscles may operate far from the optimal portion of the length-tension curve, and thus may be forced to operate against a low pulmonary compliance. Therefore, the ability of these muscles to generate tension is reduced, and for any given level of ventilation, the work of breathing is increased as compared to non-asthmatics. Evidence that IMT is an effective treatment for asthma is inconclusive, due to limited data and a wide variation in study methodologies. However, IMT has been shown to decrease dyspnea, increase inspiratory muscle strength, and improve exercise capacity in asthmatic individuals. In order to develop more concrete recommendations regarding IMT as an effective low-cost adjunct in addition to traditional asthma treatments, we recommend that a standard treatment protocol be developed and tested in a placebo-controlled clinical trial with a large representative sample.

摘要

哮喘是一种包含多种症状的病理状态,这些症状会影响日常生活功能。由于哮喘的高患病率及相关医疗费用,确定传统药物治疗的低成本替代方案很重要。其中一种低成本替代方案是使用吸气肌训练(IMT),这是一种旨在增强膈肌和呼吸辅助肌力量及耐力的技术。IMT通常包括在休息时针对整个肺活量范围内的阻力负荷进行自主吸气。在健康个体中,IMT最显著的益处是膈肌厚度和力量增加、运动性呼吸困难减轻以及呼吸的氧耗降低。由于哮喘患者存在呼气气流受限和运动诱发的支气管收缩,动态肺过度充气很常见。由于部分因过度充气导致的操作肺容积变化,呼吸肌可能在长度 - 张力曲线的非最佳部分工作,因此可能被迫在低肺顺应性下工作。所以,这些肌肉产生张力的能力降低,与非哮喘患者相比,在任何给定的通气水平下,呼吸功都会增加。由于数据有限且研究方法差异很大,关于IMT是哮喘有效治疗方法的证据尚无定论。然而,已表明IMT可减轻哮喘患者的呼吸困难、增加吸气肌力量并提高运动能力。为了就IMT作为除传统哮喘治疗外有效的低成本辅助治疗方法制定更具体的建议,我们建议制定一个标准治疗方案,并在具有大量代表性样本的安慰剂对照临床试验中进行测试。

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