FEATURE
Comparing Inspiratory Resistive Muscle Training with Incentive Spirometry on Rehabilitation of COPD Patients Abbas Heydari1, PhD, Marjan Farzad1, MSN & Seyed-hossein Ahmadi hosseini2, MD 1 School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Keywords
Abstract
COPD; incentive spirometry; inspiratory resistive muscle training; rehabilitation. Correspondence Abbas Heydari, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Ebn-e Sina Street, 9137913199 Mashhad, Iran. E-mail: [email protected] Accepted September 26, 2013. doi: 10.1002/rnj.136
Purpose: To examine the effect of incentive spirometry in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD) patients and compare its efficacy with inspiratory resistive muscle training (IMT) technique. Design: Randomized controlled trial. Methods: Thirty patients with COPD, from a general hospital in Mashhad, Iran, were randomly assigned to two study groups. All subjects trained daily in two 15-minute sessions, 4 days a week, for 4 weeks. Respiratory function tests were compared before interventions and at the end of weeks 2 and 4. Findings: Both techniques improved the mean values of all respiratory function tests (p ≤ .01). The IMT technique was more effective to improve MVV and PImax (p ≤ .05). PEFR was better improved in the incentive spirometry group (p ≤ .05). There was no significant difference for other spirometric parameters between two groups. Conclusions: Incentive spirometry can be considered as an effective component for pulmonary rehabilitation in COPD patients.
Introduction Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients (GOLD, 2013). COPD is the fourth most common cause of death in the United States and is expected to be the third by 2020 (Beckerman, Magadle, Weiner, & Weiner, 2005). The estimated direct cost of COPD is $29.5 billion and the indirect cost $20.4 billion in the United States (GOLD, 2013). Although COPD has been traditionally considered as a disease primarily affecting the lungs, its systemic effects have been increasingly recognized with diverse manifestations involving the other body systems (Eisner, Blanc, & Yelin, 2008). It also has been traditionally © 2013 Association of Rehabilitation Nurses Rehabilitation Nursing 2013, 0, 1–6
considered as a disease of the elderly, but can affect the working age population. Patients with COPD experience respiratory muscle weakness (Gosselink, Toosters, & Decramer, 2000), which may contribute to dyspnea as the most disabling symptom of the patients. Although the pathophysiology of dyspnea is complex, an imbalance between the load imposed on the respiratory muscle and the ability to sustain this load may play an important role in dyspnea feeling (Ottenheijm, Heunks, & Dekhuijzen, 2007). The rule of rehabilitation programs for improving health status in COPD patients has been well established, and guidelines for rehabilitation have also been published (Daheshia, 2005). Nurses play a key role in identifying potential candidates for pulmonary rehabilitation and in facilitating and reinforcing the material learned in the rehabilitation program. Not all patients have access to a formal rehabilitation program. However, nurses can be instrumental in teaching the patients and families as well as facilitating specific services, such as respiratory therapy
1
Comparing IMT & Incentive Spirometry in COPD Patients
education, physical therapy for exercise and breathing retraining, occupational therapy for conserving energy during activities of daily living, and nutritional counseling (Smeltzer, Bare, Hinkle, & Cheever, 2010). A common form of respiratory muscle training is inspiratory muscle training (IMT) (Crisafulli, Costi, Fabbri, & Clini, 2007). It has been demonstrated that placing a load on the respiratory muscle during contraction is sufficient for increasing strength of the respiratory muscles, causing a meaningful reduction in breathlessness (Lotters, Tol, Kwakkel, & Gosselink, 2002). Additionally, a more recent trial that evaluated the 1-year effects of IMT provides evidence that IMT decreases the use of health care services, which may translate into economic benefits (Beckerman et al., 2005). The use of IMT has also been shown to improve both muscle strength and endurance and sensation of dyspnea in COPD patients (Weiner, Magadle, Beckerman, Weiner, & Berar-Yanay, 2004). Incentive spirometer is another hand-held device that patients use to achieve effective inspiration. It is simple to use and provides patient visual feedback on flow and volume. Its use results in a prolonged phase of effective inspiration, more controlled flow, and greater enthusiasm to practice (Hough, 2001). There are no known side effects with the use of incentive spirometer; they are inexpensive and patients do not require supervision once trained in their use (Westwood et al., 2007). Incentive spirometry is commonly used to prevent postoperative pulmonary complications (American Association for Respiratory Care, 1991). However, its efficacy in COPD patients, apart from surgery, is not clear. It is shown that incentive spirometry did not change pulmonary function in patients during COPD exacerbations (Basoglu, Atasever, & Bacakoglu, 2005). However, another study showed its efficacy in improving pulmonary function in COPD patients (Scherer, Spengler, Owassapian, Imhof, & Boutellier, 2000). As findings are different in the previous studies, this study aimed to examine the effect of incentive spirometry on pulmonary rehabilitation in COPD patients and compare its efficacy to inspiratory muscle training using power breathe. Methods During a randomized controlled trial study, 30 patients (23 male, 7 female), with moderate COPD (FEV1/ FVC
Comparing Inspiratory Resistive Muscle Training with Incentive Spirometry on Rehabilitation of COPD Patients Abbas Heydari1, PhD, Marjan Farzad1, MSN & Seyed-hossein Ahmadi hosseini2, MD 1 School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Keywords
Abstract
COPD; incentive spirometry; inspiratory resistive muscle training; rehabilitation. Correspondence Abbas Heydari, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Ebn-e Sina Street, 9137913199 Mashhad, Iran. E-mail: [email protected] Accepted September 26, 2013. doi: 10.1002/rnj.136
Purpose: To examine the effect of incentive spirometry in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD) patients and compare its efficacy with inspiratory resistive muscle training (IMT) technique. Design: Randomized controlled trial. Methods: Thirty patients with COPD, from a general hospital in Mashhad, Iran, were randomly assigned to two study groups. All subjects trained daily in two 15-minute sessions, 4 days a week, for 4 weeks. Respiratory function tests were compared before interventions and at the end of weeks 2 and 4. Findings: Both techniques improved the mean values of all respiratory function tests (p ≤ .01). The IMT technique was more effective to improve MVV and PImax (p ≤ .05). PEFR was better improved in the incentive spirometry group (p ≤ .05). There was no significant difference for other spirometric parameters between two groups. Conclusions: Incentive spirometry can be considered as an effective component for pulmonary rehabilitation in COPD patients.
Introduction Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients (GOLD, 2013). COPD is the fourth most common cause of death in the United States and is expected to be the third by 2020 (Beckerman, Magadle, Weiner, & Weiner, 2005). The estimated direct cost of COPD is $29.5 billion and the indirect cost $20.4 billion in the United States (GOLD, 2013). Although COPD has been traditionally considered as a disease primarily affecting the lungs, its systemic effects have been increasingly recognized with diverse manifestations involving the other body systems (Eisner, Blanc, & Yelin, 2008). It also has been traditionally © 2013 Association of Rehabilitation Nurses Rehabilitation Nursing 2013, 0, 1–6
considered as a disease of the elderly, but can affect the working age population. Patients with COPD experience respiratory muscle weakness (Gosselink, Toosters, & Decramer, 2000), which may contribute to dyspnea as the most disabling symptom of the patients. Although the pathophysiology of dyspnea is complex, an imbalance between the load imposed on the respiratory muscle and the ability to sustain this load may play an important role in dyspnea feeling (Ottenheijm, Heunks, & Dekhuijzen, 2007). The rule of rehabilitation programs for improving health status in COPD patients has been well established, and guidelines for rehabilitation have also been published (Daheshia, 2005). Nurses play a key role in identifying potential candidates for pulmonary rehabilitation and in facilitating and reinforcing the material learned in the rehabilitation program. Not all patients have access to a formal rehabilitation program. However, nurses can be instrumental in teaching the patients and families as well as facilitating specific services, such as respiratory therapy
1
Comparing IMT & Incentive Spirometry in COPD Patients
education, physical therapy for exercise and breathing retraining, occupational therapy for conserving energy during activities of daily living, and nutritional counseling (Smeltzer, Bare, Hinkle, & Cheever, 2010). A common form of respiratory muscle training is inspiratory muscle training (IMT) (Crisafulli, Costi, Fabbri, & Clini, 2007). It has been demonstrated that placing a load on the respiratory muscle during contraction is sufficient for increasing strength of the respiratory muscles, causing a meaningful reduction in breathlessness (Lotters, Tol, Kwakkel, & Gosselink, 2002). Additionally, a more recent trial that evaluated the 1-year effects of IMT provides evidence that IMT decreases the use of health care services, which may translate into economic benefits (Beckerman et al., 2005). The use of IMT has also been shown to improve both muscle strength and endurance and sensation of dyspnea in COPD patients (Weiner, Magadle, Beckerman, Weiner, & Berar-Yanay, 2004). Incentive spirometer is another hand-held device that patients use to achieve effective inspiration. It is simple to use and provides patient visual feedback on flow and volume. Its use results in a prolonged phase of effective inspiration, more controlled flow, and greater enthusiasm to practice (Hough, 2001). There are no known side effects with the use of incentive spirometer; they are inexpensive and patients do not require supervision once trained in their use (Westwood et al., 2007). Incentive spirometry is commonly used to prevent postoperative pulmonary complications (American Association for Respiratory Care, 1991). However, its efficacy in COPD patients, apart from surgery, is not clear. It is shown that incentive spirometry did not change pulmonary function in patients during COPD exacerbations (Basoglu, Atasever, & Bacakoglu, 2005). However, another study showed its efficacy in improving pulmonary function in COPD patients (Scherer, Spengler, Owassapian, Imhof, & Boutellier, 2000). As findings are different in the previous studies, this study aimed to examine the effect of incentive spirometry on pulmonary rehabilitation in COPD patients and compare its efficacy to inspiratory muscle training using power breathe. Methods During a randomized controlled trial study, 30 patients (23 male, 7 female), with moderate COPD (FEV1/ FVC
