Original articleRespiratory Muscle Training in Restrictive Thoracic Disease: A Randomized Controlled Trial
Section snippets
Participants
Between October 2003 and October 2004, consecutive patients with restrictive thoracic disorders and current intermittent nocturnal NPPV who were regularly admitted for a 2-day follow-up visit at the Donaustauf Hospital, University of Regensburg, Germany, were screened for participation in our RCT. Inclusion criteria comprised impaired respiratory muscle function (Pimax <70% of predicted), arterial partial pressure of carbon dioxide (Paco2) less than 50mmHg, and arterial partial pressure of
Results
There were no significant differences in the baseline characteristics of the 28 patients who completed the trial (RMT, n=13; control, n=15) (see table 1). In the majority of patients (86%), lung restriction was due to kyphoscoliosis (idiopathic in 16 patients, congenital in 3 patients, postpoliomyelitis in 2 [1 in each group], post rachitis in 3 patients). Two subjects had a fibrothorax (1 in each group) and 2 patients (in the control group) had post-tuberculosis syndrome. The daily (total)
Discussion
The data from this study indicate that in patients with restrictive thoracic disorders who were treated with NPPV, inspiratory muscle strength as assessed by Pimax increased after 3 months of RMT compared with results in patients who performed a sham procedure. Improvements in exercise performance or HRQOL, however, were very small and significant only when compared with the slight deteriorations observed in the control group. Overall, RMT appears to be a safe and feasible treatment option in
Conclusions
The data of this randomized, controlled, double-blind trial provided some evidence that in severe restrictive thoracic disorders, RMT performed as isocapnic hyperpnea over 3 months can improve respiratory muscle function. It is probable that in patients with restrictive thoracic disorders and severe pulmonary impairment, even RMT that is primarily targeted on endurance necessarily includes a significant component of resistive training. This improvement, however, was not directly translated in
Acknowledgments
We thank Joerg Marienhagen, MD, and Peter Johannes Wild, MD, University of Regensburg, for their support in the statistical analysis; Rolf Suchy, MD, for valuable comments on cardiopulmonary exercise testing; and Uta Brückner and Günther Schilhabel for technical assistance.
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