Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD

Abstract

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (Post_PRE), FBG obtained lower values in oxygen consumption (VO₂, mean = -435.6 mL/min, Bayes Factor (BF₁₀) > 100), minute ventilation (VE, -8.5 L/min, BF₁₀ = 25), respiratory rate (RR, -3.3 breaths/min, BF₁₀ = 2), heart rate (HR, -13.7 beats/min, BF₁₀ > 100) and carbon dioxide production (VCO₂, -183.0 L/min, BF₁₀ = 50), and a greater value in expiratory time (Tex, 0.22 s, BF₁₀ = 12.5). At the maximum value recorded in the post-training test (Post_FINAL), FBG showed higher values in the total time of the test (T_t, 4.3 min, BF₁₀ = 50) and respiratory exchange rate (RER, 0.05, BF₁₀ = 1.3). Regarding inter group differences at Pre_POST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO₂ (EqCO₂, -3.8 L/min, BF₁₀ = 1.1) and compared to CG in VE (-8.3 L/min, BF₁₀ = 3.6), VCO₂ (-215.9 L/min, BF₁₀ = 3.0), EqCO2 (-3.7 L/min, BF₁₀ = 1.1) and HR (-12.9 beats/min, BF₁₀ = 3.4). FBG also showed a greater Pre_POST positive increment in Tex (0.21 s, BF₁₀ = 1.4) with respect to CG. At Pre_FINAL, FBG presented a greater positive increment compared to CG in T_t (4.4 min, BF₁₀ = 3.2) and negative in VE/VCO₂ intercept (-4.7, BF₁₀ = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO₂. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

Keywords: cardiopulmonary exercise test; chronic pulmonary obstructive pulmonary disease; inspiratory muscle training; physical exercise.

Figure 1

Flowchart of the study.

Figure 2

Types (left) and positioning (right) of the FeelBreathe device.

Figure 3

Graphical representation of temporal points selected for statistical analyses.

Figure 4

Significant intra-group differences for FBG in VO₂ (A), VE (B), BF (C), VCO₂ (D), HR (E), Tex (F), RER (G) and T_t (H). %_Change indicates percentage of change; Δ, increment; BF₁₀, Bayes Factor; HDI, highest density interval. Significant differences are highlighted in bold.

Figure 5

Significant intra-group difference for ONBG in HR. %_Change indicates percentage of change; Δ, increment; BF₁₀, Bayes Factor; HDI, highest density interval. Significant differences are highlighted in bold.

Figure 6

Significant intra-group difference for CG in VE/VCO₂ intercept. %_Change indicates percentage of change; Δ, increment; BF₁₀, Bayes Factor; HDI, highest density interval. Significant differences are highlighted in bold.

Figure 7

Significant inter-group differences between FBG and ONBG in EqCO₂ at Post_PRE (A); between FBG and CG in VE (B), VCO₂ (C), EqCO₂ (D), HR (E) and Tex (F) at Post_PRE; and between FBG and CG in T_t (G) and VE/VCO₂ intercept (H). %_Change indicates percentage of change; Δ, increment; BF₁₀, Bayes Factor; HDI, highest density interval. Significant differences are highlighted in bold.