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. 2023 Jan 6;1(1):CD013778.
doi: 10.1002/14651858.CD013778.pub2.

Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD)

Omar Ammous  1 , Walid Feki  2 , Tamara Lotfi  3 , Assem M Khamis  4 , Rik Gosselink  5 , Ahmed Rebai  6 , Samy Kammoun  2
Affiliations

Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD)

Omar Ammous et al. Cochrane Database Syst Rev. .

Abstract

Background: Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle weakness. However, it remains unclear to what extent IMT is clinically beneficial, especially when associated with pulmonary rehabilitation (PR). OBJECTIVES: To assess the effect of inspiratory muscle training (IMT) on chronic obstructive pulmonary disease (COPD), as a stand-alone intervention and when combined with pulmonary rehabilitation (PR).

Search methods: We searched the Cochrane Airways trials register, CENTRAL, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Physiotherapy Evidence Database (PEDro) ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 20 October 2021. We also checked reference lists of all primary studies and review articles.

Selection criteria: We included randomized controlled trials (RCTs) that compared IMT in combination with PR versus PR alone and IMT versus control/sham. We included different types of IMT irrespective of the mode of delivery. We excluded trials that used resistive devices without controlling the breathing pattern or a training load of less than 30% of maximal inspiratory pressure (PImax), or both.

Data collection and analysis: We used standard methods recommended by Cochrane including assessment of risk of bias with RoB 2. Our primary outcomes were dyspnea, functional exercise capacity and health-related quality of life. MAIN RESULTS: We included 55 RCTs in this review. Both IMT and PR protocols varied significantly across the trials, especially in training duration, loads, devices, number/ frequency of sessions and the PR programs. Only eight trials were at low risk of bias. PR+IMT versus PR We included 22 trials (1446 participants) in this comparison. Based on a minimal clinically important difference (MCID) of -1 unit, we did not find an improvement in dyspnea assessed with the Borg scale at submaximal exercise capacity (mean difference (MD) 0.19, 95% confidence interval (CI) -0.42 to 0.79; 2 RCTs, 202 participants; moderate-certainty evidence). We also found no improvement in dyspnea assessed with themodified Medical Research Council dyspnea scale (mMRC) according to an MCID between -0.5 and -1 unit (MD -0.12, 95% CI -0.39 to 0.14; 2 RCTs, 204 participants; very low-certainty evidence). Pooling evidence for the 6-minute walk distance (6MWD) showed an increase of 5.95 meters (95% CI -5.73 to 17.63; 12 RCTs, 1199 participants; very low-certainty evidence) and failed to reach the MCID of 26 meters. In subgroup analysis, we divided the RCTs according to the training duration and mean baseline PImax. The test for subgroup differences was not significant. Trials at low risk of bias (n = 3) demonstrated a larger effect estimate than the overall. The summary effect of the St George's Respiratory Questionnaire (SGRQ) revealed an overall total score below the MCID of 4 units (MD 0.13, 95% CI -0.93 to 1.20; 7 RCTs, 908 participants; low-certainty evidence). The summary effect of COPD Assessment Test (CAT) did not show an improvement in the HRQoL (MD 0.13, 95% CI -0.80 to 1.06; 2 RCTs, 657 participants; very low-certainty evidence), according to an MCID of -1.6 units. Pooling the RCTs that reported PImax showed an increase of 11.46 cmH2O (95% CI 7.42 to 15.50; 17 RCTs, 1329 participants; moderate-certainty evidence) but failed to reach the MCID of 17.2 cmH2O. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. One abstract reported some adverse effects that were considered "minor and self-limited". IMT versus control/sham Thirty-seven RCTs with 1021 participants contributed to our second comparison. There was a trend towards an improvement when Borg was calculated at submaximal exercise capacity (MD -0.94, 95% CI -1.36 to -0.51; 6 RCTs, 144 participants; very low-certainty evidence). Only one trial was at a low risk of bias. Eight studies (nine arms) used the Baseline Dyspnea Index - Transition Dyspnea Index (BDI-TDI). Based on an MCID of +1 unit, they showed an improvement only with the 'total score' of the TDI (MD 2.98, 95% CI 2.07 to 3.89; 8 RCTs, 238 participants; very low-certainty evidence). We did not find a difference between studies classified as with and without respiratory muscle weakness. Only one trial was at low risk of bias. Four studies reported the mMRC, revealing a possible improvement in dyspnea in the IMT group (MD -0.59, 95% CI -0.76 to -0.43; 4 RCTs, 150 participants; low-certainty evidence). Two trials were at low risk of bias. Compared to control/sham, the MD in the 6MWD following IMT was 35.71 (95% CI 25.68 to 45.74; 16 RCTs, 501 participants; moderate-certainty evidence). Two studies were at low risk of bias. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. Six studies reported theSGRQ total score, showing a larger effect in the IMT group (MD -3.85, 95% CI -8.18 to 0.48; 6 RCTs, 182 participants; very low-certainty evidence). The lower limit of the 95% CI exceeded the MCID of -4 units. Only one study was at low risk of bias. There was an improvement in life quality with CAT (MD -2.97, 95% CI -3.85 to -2.10; 2 RCTs, 86 participants; moderate-certainty evidence). One trial was at low risk of bias. Thirty-two RCTs reported PImax, showing an improvement without reaching the MCID (MD 14.57 cmH2O, 95% CI 9.85 to 19.29; 32 RCTs, 916 participants; low-certainty evidence). In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. None of the included RCTs reported adverse events.

Authors' conclusions: IMT may not improve dyspnea, functional exercise capacity and life quality when associated with PR. However, IMT is likely to improve these outcomes when provided alone. For both interventions, a larger effect in participants with respiratory muscle weakness and with longer training durations is still to be confirmed.

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Conflict of interest statement

OA: none known RG: none known AK: none known WF: none known TL: none known AR: none known SK: none known

Figures

1
1
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2
Funnel plot of comparison 7, PR+IMT vs PR, outcome: 7.3 functional exercise capacity: 6‐minute walk distance (6MWD)
3
3
Funnel plot of comparison 7, PR+IMT vs PR, outcome: 7.12 respiratory muscle strength: PImax
4
4
Funnel plot of comparison 8, IMT vs control/sham, outcome: 8.8 functional exercise capacity: 6‐minute walk distance (6MWD)
5
5
1.1
1.1. Analysis
Comparison 1: PR+IMT vs PR, Outcome 1: Dyspnea: Borg (at submaximal exercise: 50% to 80% of Wmax)
1.2
1.2. Analysis
Comparison 1: PR+IMT vs PR, Outcome 2: Dyspnea: Modified Medical Research Council (mMRC)
1.3
1.3. Analysis
Comparison 1: PR+IMT vs PR, Outcome 3: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters)
1.4
1.4. Analysis
Comparison 1: PR+IMT vs PR, Outcome 4: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters) (subgroup analysis: duration of the intervention)
1.5
1.5. Analysis
Comparison 1: PR+IMT vs PR, Outcome 5: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters) (subgroup analysis: with or without respiratory muscle weakness)
1.6
1.6. Analysis
Comparison 1: PR+IMT vs PR, Outcome 6: Functional exercise capacity: 12‐minute walk distance (12MWD) (meters)
1.7
1.7. Analysis
Comparison 1: PR+IMT vs PR, Outcome 7: Functional exercise capacity: Wmax (watt)
1.8
1.8. Analysis
Comparison 1: PR+IMT vs PR, Outcome 8: Functional exercise capacity: exercise time (seconds)
1.9
1.9. Analysis
Comparison 1: PR+IMT vs PR, Outcome 9: Health‐related quality of life (HRQoL): St George's Respiratory Questionnaire (SGRQ)
1.10
1.10. Analysis
Comparison 1: PR+IMT vs PR, Outcome 10: Health‐related quality of life (HRQoL): Chronic Respiratory Disease Questionnaire (CRQ)
1.11
1.11. Analysis
Comparison 1: PR+IMT vs PR, Outcome 11: Health‐related quality of life (HRQoL): COPD Assessment Test (CAT)
1.12
1.12. Analysis
Comparison 1: PR+IMT vs PR, Outcome 12: Inspiratory muscle strength: PImax (cmH20)
1.13
1.13. Analysis
Comparison 1: PR+IMT vs PR, Outcome 13: Inspiratory muscle strength: PImax (cmH2O) (subgroup analysis: duration of the intervention)
1.14
1.14. Analysis
Comparison 1: PR+IMT vs PR, Outcome 14: Inspiratory muscle strength: PImax (cmH2O) (subgroup analysis: with or without respiratory muscle weakness)
1.15
1.15. Analysis
Comparison 1: PR+IMT vs PR, Outcome 15: Laboratory exercise test: VO2peak (L/min)
1.16
1.16. Analysis
Comparison 1: PR+IMT vs PR, Outcome 16: Respiratory muscle endurance: respiratory muscle endurance pressure (Pthmax) (cmH2O)
1.17
1.17. Analysis
Comparison 1: PR+IMT vs PR, Outcome 17: Respiratory muscle endurance time: Tlim (seconds) (sustained ventilation according to PImax)
1.18
1.18. Analysis
Comparison 1: PR+IMT vs PR, Outcome 18: Respiratory muscle endurance time: Tlim (seconds) (sustained ventilation according to MVV)
1.19
1.19. Analysis
Comparison 1: PR+IMT vs PR, Outcome 19: Maximal voluntary ventilation (MVV)
1.20
1.20. Analysis
Comparison 1: PR+IMT vs PR, Outcome 20: Respiratory function: forced expiratory volume at 1 second (FEV1) (%Pred)
1.21
1.21. Analysis
Comparison 1: PR+IMT vs PR, Outcome 21: Respiratory function: forced expiratory volume at 1 second (FEV1) (Liters)
2.1
2.1. Analysis
Comparison 2: IMT vs control/sham, Outcome 1: Dyspnea: Borg (at submaximal exercise capacity)
2.2
2.2. Analysis
Comparison 2: IMT vs control/sham, Outcome 2: Dyspnea: Baseline and Transition Dyspnea Indexes (BDI‐TDI)
2.3
2.3. Analysis
Comparison 2: IMT vs control/sham, Outcome 3: Dyspnea: Transition Dyspnea Index (TDI): Focal score (subgroup analysis: with or without respiratory muscle weakness)
2.4
2.4. Analysis
Comparison 2: IMT vs control/sham, Outcome 4: Dyspnea: Modified Medical Research Council (mMRC)
2.5
2.5. Analysis
Comparison 2: IMT vs control/sham, Outcome 5: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters)
2.6
2.6. Analysis
Comparison 2: IMT vs control/sham, Outcome 6: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters) (subgroup analysis: duration of the intervention)
2.7
2.7. Analysis
Comparison 2: IMT vs control/sham, Outcome 7: Functional exercise capacity: 6‐minute walk distance (6MWD) (meters) (subgroup analysis: with or without respiratory muscle weakness)
2.8
2.8. Analysis
Comparison 2: IMT vs control/sham, Outcome 8: Functional exercise capacity: 12‐minute walk distance (12MWD) (meters)
2.9
2.9. Analysis
Comparison 2: IMT vs control/sham, Outcome 9: Functional exercise capacity: Wmax (watt)
2.10
2.10. Analysis
Comparison 2: IMT vs control/sham, Outcome 10: Functional exercise capacity: exercise time (seconds)
2.11
2.11. Analysis
Comparison 2: IMT vs control/sham, Outcome 11: Functional exercise capacity: shuttle walk test (SWT) (meters)
2.12
2.12. Analysis
Comparison 2: IMT vs control/sham, Outcome 12: Health‐related quality of life (HRQoL): St George Respiratory Questionnaire (SGRQ)
2.13
2.13. Analysis
Comparison 2: IMT vs control/sham, Outcome 13: Health‐related quality of life (HRQoL): Chronic Respiratory Disease Questionnaire (CRQ)
2.14
2.14. Analysis
Comparison 2: IMT vs control/sham, Outcome 14: Health‐related quality of life (HRQoL): COPD Assessment Test (CAT)
2.15
2.15. Analysis
Comparison 2: IMT vs control/sham, Outcome 15: Inspiratory muscle strength: PImax (cmH2O)
2.16
2.16. Analysis
Comparison 2: IMT vs control/sham, Outcome 16: Inspiratory muscle strength: PImax (cmH2O) (subgroup analysis: duration of the intervention)
2.17
2.17. Analysis
Comparison 2: IMT vs control/sham, Outcome 17: Inspiratory muscle strength: PImax (cmH2O) (subgroup analysis: with or without respiratory muscle weakness)
2.18
2.18. Analysis
Comparison 2: IMT vs control/sham, Outcome 18: Inspiratory muscle strength: PImax (cmH2O) (subgroup analysis: method of measurement)
2.19
2.19. Analysis
Comparison 2: IMT vs control/sham, Outcome 19: Laboratory exercise test: VO2peak
2.20
2.20. Analysis
Comparison 2: IMT vs control/sham, Outcome 20: Respiratory muscle endurance: respiratory muscle endurance pressure (Pthmax) (cmH2O)
2.21
2.21. Analysis
Comparison 2: IMT vs control/sham, Outcome 21: Respiratory muscle endurance time: Tlim (seconds)
2.22
2.22. Analysis
Comparison 2: IMT vs control/sham, Outcome 22: Maximal voluntary ventilation (MVV)
2.23
2.23. Analysis
Comparison 2: IMT vs control/sham, Outcome 23: Respiratory function: forced expiratory volume at 1 second (FEV1) (%pred)
2.24
2.24. Analysis
Comparison 2: IMT vs control/sham, Outcome 24: Respiratory function: forced expiratory volume at 1 second (FEV1) (Liters)
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD013778

References

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Langer 2018 {published data only}
    1. Dacha S, Langer D, Ciavaglia C, Webb K, Preston M, O'Donnell DE. Effect of inspiratory muscle training (IMT) on static and dynamic respiratory muscle function in patients with COPD. European Respiratory Journal 2017;50 Suppl 61:OA2923. [DOI: 10.1183/1393003.congress-2017.OA2923] - DOI
    1. Dacha S, Langer D, Ciavaglia C, Webb K, Preston M, O'Donnell DE. Effect of inspiratory muscle training on respiratory muscle function and diaphragm activation in patients with COPD. American Journal of Respiratory and Critical Care Medicine 2017;195(Meeting Abstracts):A2860. [DOI: 10.1164/ajrccm-conference.2017.A109] - DOI
    1. Langer D, Charususin N, Jacome C, Hoffman M, McConnell A, Decramer M, et al. Efficacy of a novel method for inspiratory muscle training in people with chronic obstructive pulmonary disease. Physical Therapy 2015;95(9):1264-73. [DOI: 10.2522/ptj.20140245] - DOI - PubMed
    1. Langer D, Ciavaglia C, Faisal A, Webb KA, Neder JA, Gosselink R, et al. Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. Journal of Applied Physiology 2018;125(2):381-92. [DOI: 10.1152/japplphysiol.01078.2017] - DOI - PubMed
    1. Langer D, Ciavaglia C, Webb K, Preston M, Neder JA, Gosselink R, et al. Inspiratory muscle training reduces respiratory neural drive (RND) during exercise in patients with COPD. European Respiratory Journal 2014;44 Suppl 58:1912.
Larson 1988 {published data only}
    1. Larson JL, Kim MJ, Sharp JT, Larson DA. Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1988;138(3):689-96. [DOI: 10.1164/ajrccm/138.3.689] - DOI - PubMed
Larson 1999 {published data only}
    1. Larson JL, Covey MK, Wirtz SE, Berry JK, Alex CG, Langbein WE, et al. Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 1999;160(2):500-7. [DOI: 10.1164/ajrccm.160.2.9804067] - DOI - PubMed
Leelarungrayub 2017 {published data only}
    1. Leelarungrayub J, Pinkaew D, Puntumetakul R, Klaphajone J. REffects of a simple prototype respiratory muscle trainer on respiratory muscle strength, quality of life and dyspnea, and oxidative stress in COPD patients: a preliminary study. International Journal of Chronic Obstructive Pulmonary Disease 2017;12:1415-25. [DOI: 10.2147/COPD.S131062] - DOI - PMC - PubMed
Lisboa 1997 {published data only}
    1. Lisboa C, Villafranca C, Leiva A, Cruz E, Pertuze J, Borzone G. Inspiratory muscle training in chronic airflow limitation: effect on exercise performance. European Respiratory Journal 1997;10(3):537-42. - PubMed
Mador 2005 {published data only}
    1. Mador MJ, Deniz O, Aggarwal A, Shaffer M, Kufel TJ, Spengler CM, et al. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. Chest 2005;128(3):1216-24. [DOI: 10.1378/chest.128.3.1216] - DOI - PubMed
    1. Mador MJ, Deniz O, Aggarwal A, Shaffer M, Kufel TJ, Spengler CM. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. In: American Thoracic Society 99th International Conference; 2003 May 16-21; Seattle. 2003:B046 Poster D8. - PubMed
Magadle 2007 {published data only}
    1. Magadle R, McConnell AK, Beckerman M, Weiner P. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients. Respiratory Medicine 2007;101(7):1500-5. [DOI: 10.1016/j.rmed.2007.01.010] - DOI - PubMed
Majewska‐Pulsakowska 2016 {published data only}
    1. Majewska-Pulsakowska M, Wytrychowski K, Rozek-Piechura K. The role of inspiratory muscle training in the process of rehabilitation of patients with chronic obstructive pulmonary disease. Advances in Experimental Medicine and Biology 2016;885:47-51. [DOI: 10.1007/5584_2015_194] - DOI - PubMed
Masanga 2011 {published data only}
    1. Masanga L, Fernandez L. Additive effects of high-intensity inspiratory muscle training in pulmonary rehabilitation among COPD patients in the Philippines. Respirology 2011;16 Suppl 2:119 [1130]. [DOI: 10.1111/j.1400-1843.2011.02071.x] - DOI
Nikoletou 2016 {published data only}
    1. Nikoletou D, Backley JA, Gearing J, Man WD, Mustafa N, Johnson LC, et al. Inspiratory muscle strength and endurance training in moderate to severe COPD patients [Abstract]. In: American Thoracic Society 100th International Conference; 2004 May 21-26; Orlando. 2004:D96 Poster 115.
    1. Nikoletou D, Backley JA, Gearing J, Man WD, Mustfa N, Johnson LC, et al. A double-blind, randomised controlled trial of inspiratory muscle training in COPD patients [Abstract]. Thorax 2003;58 Suppl 3:iii77.
    1. Nikoletou D, Man WD-C, Mustfa N, Moore J, Rafferty G, Grant RL, et al. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disability and Rehabilitation 2016;38(3):250-9. [DOI: 10.3109/09638288.2015.1036171] - DOI - PubMed
Paneroni 2018 {published data only}
    1. Paneroni M, Simonelli C, Saleri M, Trainini D, Fokom G, Speltoni I, et al. Short-term effects of normocapnic hyperpnea and exercise training in patients with chronic obstructive pulmonary disease: a pilot study. American Journal of Physical Medicine and Rehabilitation 2018;97(12):866-72. [DOI: 10.1097/PHM.0000000000000988] - DOI - PubMed
Petrovic 2012 {published data only}
    1. NCT00469313. Efficacy of inspiratory muscle training on inspiratory capacity in patients with COPD. clinicaltrials.gov/show/NCT00469313 (first received 4 May 2007).
    1. Petrovic M, Reiter M, Zipko H, Pohl W, Wanke T. Effects of inspiratory muscle training on dynamichyperinflation in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease 2012;7:797-805. [DOI: 10.2147/COPD.S23784] - DOI - PMC - PubMed
Preusser 1994 {published data only}
    1. Preusser BA, Winningham ML, Clanton TL. The effects of high versus low-intensity inspiratory muscle interval training in patients with COPD. Chest 1994;106(1):110-17. - PubMed
    1. Preusser BA, Winningham ML, Clanton TL. High- vs low-intensity inspiratory muscle interval training in patients with COPD. Chest 1994;106(1):110-7. [DOI: 10.1378/chest.106.1.110] - DOI - PubMed
Ramirez Sarmiento 2002 {published data only}
    1. Ramirez-Sarmiento A, Orozco-Levi M, Guell R, Barreiro E, Hernandez N, Mota S, et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. American Journal of Respiratory and Critical Care Medicine 2002;166(11):1491-7. [DOI: 10.1164/rccm.200202-075OC] - DOI - PubMed
Saher 2021 {published data only}
    1. Saher T, Moiz JA, Bhati P, Ali MS, Talwar D. Effect of inspiratory muscle training in hypercapnic chronic obstructive pulmonary disease patients during acute care: a randomised clinical trial. Comparative Exercise Physiology 2021;17(1):55-63.
Saka 2021 {published data only}
    1. NCT03517839. Assessment of impact of inspiratory muscle training on movement fear due to dyspnea in chronic obstructive pulmonary disease. clinicaltrials.gov/show/nct03517839 (first received 7 May 2018).
    1. Saka S, Gurses HN, Bayram M. Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: a randomized controlled trial. Complementary Therapies in Clinical Practice 2021;44:101418. - PubMed
Sanchez Riera 2001 {published data only}
    1. Sanchez Riera H, Montemayor Rubio T, Ortega Ruiz F, Cejudo Ramos P, Del Castillo Otero D, Elias Hernandez T, et al. Inspiratory muscle training in patients with COPD: effect on dyspnea, exercise performance, and quality of life. Chest 2001;120(3):748-56. [DOI: 10.1378/chest.120.3.748] - DOI - PubMed
Scherer 2000 {published data only}
    1. Scherer TA, Spengler CM, Owassapian D, Imhof E, Boutellier U. Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life. American Journal of Respiratory and Critical Care Medicine 2000;162(5):1709-14. [DOI: 10.1164/ajrccm.162.5.9912026] - DOI - PubMed
Schultz 2018 {published data only}
    1. Schultz K, Jelusic D, Wittmann M, Kramer B, Huber V, Fuchs S, et al. Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial. European Respiratory Journal 2018;51(1):1702000. [DOI: 10.1183/13993003.02000-2017] - DOI - PubMed
    1. Schultz K, Kramer B, Fuchs S, Wingart S, Lehbert N, Huber V, et al. Effects of routine inspiratory muscle training (IMT) as add-on to pulmonary rehabilitation (PR) in COPD. European Respiratory Journal 2015;46 Suppl 59:PA544. [DOI: 10.1183/13993003.congress-2015.PA544] - DOI
Sykes 2005 {published data only}
    1. Sykes K, Hang HW. Inspiratory muscle training in the treatment of chronic obstructive pulmonary disease: randomized controlled trial. American Journal of Recreation Therapy 2005;4(2):39-48.
Tounsi 2021 {published data only}
    1. Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: randomized controlled trial. PLOS ONE 23 September 2023;16(9):e0257595. [DOI: 10.1371/journal.pone.0257595] - DOI - PMC - PubMed
Tout 2013 {published data only}
    1. Tout R, Tayara L, Halimi M. The effects of respiratory muscle training on improvement of the internal and external thoraco-pulmonary respiratory mechanism in COPD patients. Annals of Physical and Rehabilitation Medicine 2013;56(3):193-211. [DOI: 10.1016/j.rehab.2013.01.008] - DOI - PubMed
Wang 2017 {published data only}
    1. Wang K, Zeng G-Q, Li R, Luo Y-W, Wang M, Hu Y-H, et al. Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients. International Journal of Chronic Obstructive Pulmonary Disease 2017;12:2655-68. [DOI: 10.2147/COPD.S140093] - DOI - PMC - PubMed
    1. Yuwen L, Peng L, Yun L, Yitai C, Yuxia H, Kai W, et al. Effects of combined cycle ergometer and inspiratory muscle training in patients with stable chronic obstructive pulmonary disease. Respirology 2016;21 Suppl 3:176 (APSR6-0158). [DOI: 10.1111/resp.12939-15] - DOI
Weiner 1992 {published data only}
    1. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training combined with general exercise reconditioning in patients with COPD. Chest 1992;102(5):1351-6. [DOI: 10.1378/chest.102.5.1351] - DOI - PubMed
    1. Weiner P, Azgad Y, Weiner M, Ganem R. Inspiratory muscle training combined with general exercise reconditioning in chronic obstructive pulmonary disease. Harefuah 1993;124(7):396-400, 456. - PubMed
Weiner 2000 {published data only}
    1. Weiner P, Magadle R, Berar-Yanay N, Davidovich A, Weiner M. The cumulative effect of long-acting bronchodilators, exercise, and inspiratory muscle training on the perception of dyspnea in patients with advanced COPD. Chest 2000;118(3):672-8. [DOI: 10.1378/chest.118.3.672] - DOI - PubMed
Weiner 2003 {published data only}
    1. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest 2003;124(4):1357-64. [DOI: 10.1378/chest.124.4.1357] - DOI - PubMed
Weiner 2006 {published data only}
    1. Weiner P, Weiner M. Inspiratory muscle training may increase peak inspiratory flow in chronic obstructive pulmonary disease. Respiration 2006;73(2):151-6. [DOI: 10.1159/000088095] - DOI - PubMed
Wu 2017 {published data only}
    1. NCT03101774. Inspiratory muscle training on respiratory muscle function, quality of life and exercise capacity in stable COPD [Effects of respiratory physiology-oriented inspiratory muscle training on respiratory muscle function, quality of life and exercise capacity in stable COPD with inspiratory muscle weakness: a randomised controlled trial]. clinicaltrials.gov/show/nct03101774 (first received 5 April 2017).
    1. Wu W, Guan L, Zhang X, Li X, Yang Y, Guo B, et al. Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: a randomised controlled trial. Respiratory Medicine 2017;132:84-91. [DOI: 10.1016/j.rmed.2017.10.001] - DOI - PubMed
Xu 2018 {published data only}
    1. Xu W, Li R, Guan L, Wang K, Hu Y, Xu L, et al. Combination of inspiratory and expiratory muscle training in same respiratory cycle versus different cycles in COPD patients: a randomized trial. Respiratory Research 2018;19(1):225. [DOI: 10.1186/s12931-018-0917-6] - DOI - PMC - PubMed
ZhouL 2016 {published data only}
    1. Zhou L-Q, Li X-Y, Li Y, Guo B-P, Guan L-L, Chen X, et al. Inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease: a randomized controlled trial. Nan fang yi ke da xue xue bao [Journal of Southern Medical University] 2016;36(8):1069-74. - PubMed

References to studies excluded from this review

Ahmad 2013 {published data only}
    1. Ahmad H, Justine M, Othman Z, Mohan V, Mirza FT. The outcomes of short term inspiratory muscle training (IMT) combined with chest physiotherapy in hospitalized COPD patients. Bangladesh Journal of Medical Science 2013;12(4):398-404. [DOI: 10.3329/bjms.v12i4.13302] - DOI
Aldrich 1985 {published data only}
    1. Aldrich TK. The application of muscle endurance training techniques to the respiratory muscles in COPD. Lung 1985;163(1):15-22. [DOI: 10.1007/BF02713802] - DOI - PubMed
Anand 2013 {published data only}
    1. Anand A, Narwal R, Sindhwani G. Accessory inspiratory muscles energy technique effect on pulmonary function in COPD subjects. Indian Journal of Physiotherapy and Occupational Therapy 2013;7(3):192-7. [DOI: 10.5958/j.0973-5674.7.3.091] - DOI
Baines 2005 {published data only}
    1. Baines SJ, Enright SJ. Does a threshold loading device maintain functional improvements following a programme of high intensity inspiratory muscle training in patients with chronic obstructive pulmonary disease? [Abstract]. European Respiratory Journal 2005;26 Suppl 49:4583.
Basso Vanelli 2016 {published data only}
    1. Basso-Vanelli R, Pantoni C, Borghi-Silva A, Labadessa I, Regueiro E, Di Lorenzo V, et al. Inspiratory muscle training improves thoracoabdominal asynchronism during unsupported upper limb exercise in COPD patients-pilot study. European Respiratory Journal 2016;48 Suppl 60:PA1373. [DOI: 10.1183/13993003.congress-2016.PA1373] - DOI
    1. Basso-Vanelli RP, Pires Di Lorenzo VA, Labadessa IG, Regueiro Eloisa MG, Jamami Mauricio. Effects of inspiratory muscle training and calisthenics-and-breathing exercises in COPD with and without respiratory muscle weakness. Respiratory Care 2016;61(1):50-60. [DOI: 10.4187/respcare.03947] - DOI - PubMed
    1. NCT01510041. Effects of respiratory muscle training and respiratory exercise in exercise tolerance, performing daily life activities and quality of life of patients with chronic obstructive pulmonary disease. clinicaltrials.gov/show/NCT01510041 (first received 13 January 2012).
Battaglia 2009 {published data only}
    1. Battaglia E, Fulgenzi A, Ferrero ME. Rationale of the combined use of inspiratory and expiratory devices in improving maximal inspiratory pressure and maximal expiratory pressure of patients with chronic obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation 2009;90(6):913-18. [DOI: 10.1016/j.apmr.2008.12.019] - DOI - PubMed
Belman 1994 {published data only}
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Bgin 1991 {published data only}
    1. Bégin P, Grassino A. Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease. American Review of Respiratory Disease 1991;143(5 Pt 1):905-12. [DOI: 10.1164/ajrccm/143.5_Pt_1.905] - DOI - PubMed
Bissett 2016 {published data only}
    1. Bissett B, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from prolonged mechanical ventilation: a randomized trial. American Journal of Respiratory and Critical Care Medicine 2016;193(Meeting Abstracts):A2613.
Bjerre Jepsen 1981 {published data only}
    1. Bjerre-Jepsen K, Secher NH, Kok-Jensen A. Inspiratory resistance training in severe chronic obstructive pulmonary disease. European Journal of Respiratory Diseases 1981;62(6):405-11. - PubMed
Cader 2010 {published data only}
    1. Cader SA, Vale RG, Castro JC, Bacelar SC, Biehl C, Gomes MC, et al. Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial. Journal of Physiotherapy 2010;56(3):171-7. [DOI: 10.1016/s1836-9553(10)70022-9] - DOI - PubMed
Chen 1985 {published data only}
    1. Chen H, Dukes R, Martin BJ. Inspiratory muscle training in patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1985;131(2):251-5. [DOI: 10.1164/arrd.1985.131.2.251] - DOI - PubMed
Daynes 2018 {published data only}
    1. Daynes E, Greening NJ, Harvey-Dunstan TC, Singh SJ. High-frequency airway oscillating device for respiratory muscle training in subjects with COPD. Respiratory Care 2018;63(5):584-90. [DOI: 10.4187/respcare.05837] - DOI - PubMed
de Andrade 2005 {published data only}
    1. Andrade AD, Silva TN, Vasconcelos H, Marcelino M, Rodrigues-Machado MG, Filho VC, et al. Inspiratory muscular activation during threshold therapy in elderly healthy and patients with COPD. Journal of Electromyography and Kinesiology 2005;15(6):631-9. [DOI: 10.1016/j.jelekin.2005.06.002] - DOI - PubMed
de Lucas Ramos 1998 {published data only}
    1. Lucas Ramos P, Rodriguez Gonzalez-Moro JM, Garcia de Pedro J, Santacruz Siminiani A, Tatay Marti E, Cubillo Marcos JM. Training of inspiratory muscles in chronic obstructive lung disease. Its impact on functional changes and exercise tolerance. Archivos de Bronconeumologia 1998;34(2):64-70. - PubMed
Di Mambro 2007 {published data only}
    1. Di Mambro TR, Figueiredo PH, Wanderley TR, Kristki AL, Guimaraes FS. Inspiratory muscle training in chronic obstructive pulmonary disease: impact on quality of life, exercise intolerance, and dyspnea. Fisioterapia e Pesquisa 2007;14(2):65-71.
DRKS00005637 {published data only}
    1. DRKS00005637. Respiratory muscle activation by respiratory muscle training in patients with advanced COPD [Respiratory muscle activation by respiratory muscle training in patients with advanced COPD - EMG-Train COPD]. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=DRKS00005637 (first received 4 February 2014).
DRKS00006021 {published data only}
    1. DRKS00006021. Influence of a controlled inspiratory muscle training on the course of COPD after acute exacerbation (AECOPD): a controlled study. www.drks.de/DRKS00006021 (first received 9 May 2014).
Elbouhy 2014 {published data only}
    1. Elbouhy MS, AbdelHalim HA, Hashem AM. Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis 2014;63(3):679-87. [DOI: ]
Elmorsi 2016 {published data only}
    1. Elmorsi AS, Eldesoky ME, Mona AA, Shalaby NM, Abdalla Dina A, et al. Effect of inspiratory muscle training on exercise performance and quality of life in patients with chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2016;65(1):41-6. [DOI: 10.1016/j.ejcdt.2015.10.006] - DOI
Enright 2005 {published data only}
    1. Enright SJ, Baines SJ. Evaluation of a new computerised method of high intensity inspiratory muscle training in patients with chronic airways obstruction [Abstract]. European Respiratory Journal 2005;26 Suppl 49:Abstract No. 4584.
Garcia 2008 {published data only}
    1. Garcia S, Rocha M, Pinto P, Lopes AM, Bárbara C. Treino de músculos inspiratórios em doentes com DPOC. Revista Portuguesa de Pneumologia 2008;14(2):177-94. - PubMed
    1. Garcia S, Rocha M, Pinto P, Lopes AM, Barbara C. Inspiratory muscle training in COPD patients. Revista Portuguesa de Pneumologia 2008;14(2):177-94. - PubMed
Goldstein 1989 {published data only}
    1. Goldstein R, De Rosie J, Long S, Dolmage T, Avendano MA. Applicability of a threshold loading device for inspiratory muscle testing and training in patients with COPD. Chest 1989;96(3):564-71. - PubMed
Gregg 1989 {published data only}
    1. Gregg BL. Inspiratory muscle training with a weighted incentive spirometer in subjects with chronic airways obstruction. Respiratory Care 1989;34(10):860-7.
Guyatt 1992 {published data only}
    1. Guyatt G, Keller J, Singer J, Halcrow S, Newhouse M. Controlled trial of respiratory muscle training in chronic airflow limitation. Thorax 1992;47(8):598-602. [DOI: 10.1136/thx.47.8.598] - DOI - PMC - PubMed
Hart 2000 {published data only}
    1. Hart N, Cramer D, Sylvester K, Nickol AH, Ward SP, Moxham J, et al. Effect of using powerbreathe™ on inspiratory muscle strength. Thorax 2000;55 Suppl 3:A51.
Heydari 2015 {published data only}
    1. Heydari A, Farzad M, Ahmadi Hosseini SH. Comparing inspiratory resistive muscle training with incentive spirometry on rehabilitation of COPD patients. Rehabilitation Nursing 2015;40(4):243-8. [DOI: 10.1002/rnj.136] - DOI - PubMed
Hopp 1996 {published data only}
    1. Hopp LJ, Kim MJ, Larson JL, Sharp JT. Incremental threshold loading in patients with chronic obstructive pulmonary disease. Nursing Research 1996;45(4):196–202. - PubMed
    1. Hopp LJ. Incremental threshold loading in chronic obstructive pulmonary disease patients. Nursing Research 1992;45:147p. - PubMed
Ibakordor 2013 {published data only}
    1. Ibakordor S, Dhillon DK, Saravanan S. A safe inspiratory threshold load in chronic obstructive pulmonary disease patients. Indian Journal of Physiotherapy and Occupational Therapy 2013;7(2):48-52. [DOI: 10.5958/j.0973-5674.7.2.011] - DOI
Ionescu 2005 {published data only}
    1. Ionescu AA, Mickleborough TD, Bolton CE, Lindley MR, Chatham K, Nixon LS, et al. Limb and inspiratory muscle dynamic strength in patients with moderate chronic obstructive pulmonary disease [Abstract]. Thorax 2005;2 Suppl II:ii50.
Izumizaki 2008 {published data only}
    1. Izumizaki M, Satake M, Takahashi H, Sugawara K, Shioya T, Homma I. Effects of inspiratory muscle thixotropy on the 6-min walk distance in COPD. Respiratory Medicine 2008;102(7):970-7. [DOI: 10.1016/j.rmed.2008.02.007] - DOI - PubMed
Johnson 1996 {published data only}
    1. Johnson PH, Cowley AJ, Kinnear WJ. Evaluation of the Threshold trainer for inspiratory muscle endurance training: comparison with the weighted plunger method. European Respiratory Journal 1996;9(12):2681-4. [DOI: 10.1183/09031936.96.09122681] - DOI - PubMed
Kivastik 2015 {published data only}
    1. Kivastik J, Arend M, Maestu J. Comparison of different inspiratory muscle warm-up protocols. European Respiratory journal 2015;46 Suppl 59:PA950.
Koch 2020 {published data only}
    1. Koch R, Augusto TR, Ramos AG, Muller PT. Inspiratory muscle training potentiates the beneficial effects of proportional assisted ventilation on exertional dyspnea and exercise tolerance in COPD: a proof-of-concept randomized and controlled trial. COPD 2020;17(4):1-8. [DOI: 10.1080/15412555.2020.1789085] - DOI - PubMed
Kolesnikova 2016 {published data only}
    1. Kolesnikova E, Arutyunov G, Kostyukevich O, Rylova A. Respiratory muscles trainings are effective in lowering the pneumonia frequency in patients with heart failure and chronic obstructive pulmonary disease. European Respiratory Journal 2016;48 Suppl 60:PA3773. [DOI: 10.1183/13993003.congress-2016.PA3773] - DOI
Levine 1986 {published data only}
    1. Levine S, Weiser P, Gillen J. Evaluation of a ventilatory muscle endurance training program in the rehabilitation of patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1986;133(3):400-6. [DOI: 10.1164/arrd.1986.133.3.400] - DOI - PubMed
Liao 2015 {published data only}
    1. Liao LY, Chen KM, Chung WS, Chien JY. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. International Journal of Chronic Obstructive Pulmonary Disease 2015;10(1):1703-9. [DOI: 10.2147/COPD.S90673] - DOI - PMC - PubMed
Lin 2012 {published data only}
    1. Lin W-C, Yuan S-C, Chien J-Y, Weng S-C, Chou M-C, Kuo H-W. The effects of respiratory training for chronic obstructive pulmonary disease patients: a randomised clinical trial. Journal of Clinical Nursing 2012;21:2870-8. [DOI: 10.1111/j.1365-2702.2012.04124.x] - DOI - PubMed
Lisboa 1994 {published data only}
    1. Lisboa C, Munoz V, Beroiza T, Leiva A, Cruz E. Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device. European Respiratory Journal 1994;7(7):1266-74. - PubMed
Lisboa 1995a {published data only}
    1. Lisboa C, Villafranca C, Pertuze J, Leiva A, Repetto P. Clinical effects of inspiratory muscle training in patients with chronic airflow limitation. Revista Medica de Chile 1995;123(9):1108-15. - PubMed
Lisboa 1995b {published data only}
    1. Lisboa C, Villafranca C, Leiva A, Repetto L, Cruz E, Pertuze R. Inspiratory muscle training in patients with chronic bronchial obstruction: factors related to the improvement of dyspnoea. Enfermedades respir. Cir. Torac 1995;11(1):7-15.
Lisboa 1998 {published data only}
    1. Lisboa C, Borzone G, Cruz E. Inspiratory muscle training in patients with chronic obstructive pulmonary disease. Revista Medica de Chile 1998;126(5):563-8. - PubMed
Madariaga 2007 {published data only}
    1. Madariaga VB, Iturri JB, Manterola AG, Buey JC, Sebastian NT, Pena VS. Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Archivos de Bronconeumologia 2007;43(8):431-8. [DOI: 10.1157/13108782] - DOI - PubMed
Madsen 1985 {published data only}
    1. Madsen F, Secher NH, Kay L, Rube N. Inspiratory resistance versus general physical training in patients with chronic obstructive pulmonary disease. European Journal of Respiratory Diseases 1985;67(3):167-76. - PubMed
Martin 2006 {published data only}
    1. Martin D, Davenport W, Gonzalez-Rothi J, Baz M, Banner J, Caruso L, et al. Inspiratory muscle strength training improves outcome in failure to wean patients [Abstract]. European Respiratory Journal 2006;28 Suppl 50:369s [E2204]. - PMC - PubMed
McKeon 1986 {published data only}
    1. McKeon JL, Turner J, Kelly C, Dent A, Zimmerman PV. The effect of inspiratory resistive training on exercise capacity in optimally treated patients with severe chronic airflow limitation. Australian and New Zealand Journal of Medicine 1986;16(5):648-52. [DOI: 10.1111/j.1445-5994.1986.tb00005.x] - DOI - PubMed
Meshcheriakova 2006 {published data only}
    1. Meshcheriakova NN, Belevskiy AS, Cherniak AV, Nekludova GV, Appaeva AA. Threshold PEP and IMT devices (PID) for COPD patient respiratory training [Abstract]. European Respiratory Journal 2006;28 Suppl 50:553s [P3187].
Minoguchi 2002 {published data only}
    1. Minoguchi H, Hibuya M, Miyagawa T, Kokubu F, Yamada M, Tanaka H, et al. Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training. Internal Medicine 2002;41(10):805-12. [DOI: 10.2169/internalmedicine.41.805] - DOI - PubMed
NCT01218295 {published data only}
    1. NCT01218295. Inspiratory muscle training with normocapnic hyperpnea in chronic obstructive pulmonary disease (COPD) [Efficacy of inspiratory muscle training by means of Spirotiger® in COPD patients]. clinicaltrials.gov/show/nct01218295 (first received 11 October 2010).
NCT01556139 {published data only}
    1. NCT01556139. Effectiveness of respiratory muscle training by Spirotiger in chronic patients [Evaluation of the effectiveness of respiratory muscle training by the technique of hypocapnia hyperpnea (Spirotiger) in COPD and CHF patients]. clinicaltrials.gov/show/NCT01556139 (first received 16 March 2012).
NCT01747694 {published data only}
    1. NCT01747694. Respiratory muscle exercise training in COPD patients. clinicaltrials.gov/show/nct01747694 (first received 12 December 2012).
NCT01945398 {published data only}
    1. NCT01945398. IMT in ventilatory muscle metaboreflex in COPD [Effect of inspiratory muscle training in the ventilatory muscle metaboreflex in chronic obstructive pulmonary disease patients]. clinicaltrials.gov/show/nct01945398 (first received 18 September 2013).
NCT01956565 {published data only}
    1. NCT01956565. Feasibility of inspiratory muscle training in people with chronic obstructive pulmonary disease (COPD) who decline pulmonary rehabilitation. clinicaltrials.gov/show/NCT01956565 (first received 8 October 2013).
NCT02186340 {published data only}
    1. NCT02186340. Effects of inspiratory muscle training on breathing pattern in patients with chronic obstructive pulmonary disease. clinicaltrials.gov/show/NCT02186340 (first received 10 July 2014).
NCT02278523 {published data only}
    1. NCT02278523. The respiratory physiology variation of COPD patients in inspiratory muscle training. clinicaltrials.gov/show/nct02278523 (first received 30 October 2014).
NCT02579200 {published data only}
    1. NCT02579200. Inspiratory muscle training for dyspneic patients with COPD-HF overlap: a multicenter, randomized controlled trial. clinicaltrials.gov/show/nct02579200 (first received 19 October 2015).
NCT02914093 {published data only}
    1. NCT02914093. IMT in hypercapnic patients with COPD (THYPISK-f) [Feasibility of inspiratory muscle training in patients with chronic hypercapnia and severe chronic obstructive pulmonary disease]. ClinicalTrials.gov/show/NCT02914093 (first received 26 September 2016).
NCT02935166 {published data only}
    1. NCT02935166. Innovations in respiratory muscles training in patients with chronic obstructive pulmonary disease (INNOTORIO) [INNOTORIO: Innovations in the training of the inspiratory muscles on patients with chronic obstructive pulmonary disease: design of a digital dual valve and evaluation of a new high-intensity training scheme of short duration]. clinicaltrials.gov/show/nct02935166 (first received 17 October 2016).
NCT03186092 {published data only}
    1. NCT03186092. Effects of respiratory muscle training on respiratory muscle strength, functional capacity and quality of life in pulmonary hypertension. clinicaltrials.gov/show/nct03186092 (first received 14 June 2017).
NCT03500042 {published data only}
    1. NCT03500042. Effects of different modes of respiratory muscle training on respiratory mechanics and NRD in patient with stable COPD [Effects of different modes of respiratory muscular threshold loads training on respiratory mechanics and neural respiratory drive (NRD) in patient with stable chronic obstructive pulmonary disease (COPD)]. clinicaltrials.gov/show/NCT03500042 (first received 17 April 2018).
NCT03739879 {published data only}
    1. NCT03739879. Effectivity of inspiratory muscle trainer in the chronic obstructive pulmonary disease rehabilitation program. clinicaltrials.gov/show/nct03739879 (first received 14 November 2018).
NCT03844711 {published data only}
    1. NCT03844711. Transcutaneous electrical diaphragmatic stimulation and inspiratory muscle training in patients with COPD exacerbated. clinicaltrials.gov/show/nct03844711 (first received 18 February 2019).
NCT03880630 {published data only}
    1. Inspiratory muscle activation pattern analysis in assisting precision in inspiratory muscle training in patients with chronic respiratory disease. clinicaltrials.gov/ct2/show/NCT03880630 (first received 19 March 2019).
NCT04084405 {published data only}
    1. NCT04084405. Effect of inspiratory muscle training on balance in chronic obstructive pulmonary disease patients. clinicaltrials.gov/show/nct04084405 (first received 10 September 2019).
NCT04117399 {published data only}
    1. NCT04117399. Effect of inspiratory muscle training on posture in chronic obstructive pulmonary disease patients. clinicaltrials.gov/show/nct04117399 (first received 7 October 2019).
NCT04460261 {published data only}
    1. NCT04460261. The effects of 'functional' inspiratory muscle training [The effects of a new integrated exercise program called 'functional' inspiratory muscle training in geriatric individuals with and without chronic obstructive pulmonary disease]. ClinicalTrials.gov/show/NCT04460261 (first received 7 July 2020).
Neves 2014a {published data only}
    1. Neves LF, Reis MH, Plentz RD, Matte DL, Coronel CC, Sbruzzi G. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. Respiratory Care 2014;59(9):1381-8. [DOI: 10.4187/respcare.02793] - DOI - PubMed
Neves 2014b {published data only}
    1. Neves L, Chiappa A, Da Silva V, Vieira P, Cipriano G Jr, Arena R, et al. Comparative effects of inspiratory muscle training and resistance training on respiratory and skeletal muscle strength in COPD: responses of the a pulmonary rehabilitation program. European Respiratory Journal 2014;44:P598.
Nield 2007 {published data only}
    1. Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. Journal of Cardiopulmonary Rehabilitation and Prevention 2007;27(4):237-44. [DOI: 10.1097/01.HCR.0000281770.82652.cb] - DOI - PubMed
Noseda 1987 {published data only}
    1. Noseda A, Carpiaux JP, Vandeput W, Prigogine T, Schmerber J. Resistive inspiratory muscle training and exercise performance in COPD patients. A comparative study with conventional breathing retraining. Bulletin Europeen de Physiopathologie Respiratoire 1987;23(5):457-63. - PubMed
O'Connor 2019 {published data only}
    1. O'Connor C, Lawson R, Waterhouse J, Mills GH. Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting. BMJ Open 2019;9(8):e028507. [DOI: 10.1136/bmjopen-2018-028507] - DOI - PMC - PubMed
Okura 2019 {published data only}
    1. Okura K, Kawagoshi A, Iwakura M, Shibata K, Furukawa Y, Sugawara K, et al. The effectiveness of inspiratory muscle training in patients with COPD. Journal of the Japan Society for Respiratory Care and Rehabilitation 2019;28(2):274-8. [DOI: 10.15032/jsrcr.28.2_274] - DOI
Okura 2020 {published data only}
    1. Okura K, Takahashi H, Shiotani T, Iida Y, Inagaki T, Ogawa T, et al. Inspiratory muscle training for patients with chronic obstructive pulmonary disease Effect on physical activity ─ Multicenter, randomized controlled trial ─ [─多施設による無作為化比較対照試験─]. 理学療法学 2020;47(6):551-9.
PACTR201703002095224 {published data only}
    1. PACTR201703002095224. Respiratory muscle training in chronic obstructive pulmonary disease [Comparative study between two different respiratory training protocols in patients with chronic obstructive pulmonary disease]. www.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201703002095224 (first received 12 March 2017).
Padula 2001 {published data only}
    1. Padula CA, Yeaw E. Inspiratory muscle training: an exploration of a home-based intervention. Journal of Applied Research 2001;1(2):85-94.
Perez 2010 {published data only}
    1. Perez ME, Guirao L, Martinez A, Ortega P, Pleguezuelos E, Samitier B. Effect of a specific respiratory exercise program on respiratory muscle strength. In: 71st Annual Assembly of the American Academy of Physical Medicine and Rehabilitation; 2010 Nov 4-7; Seattle. Vol. 2. 2010:S25.
Pescaru 2016 {published data only}
    1. Pescaru C, Oancea C, Tudorache E. New device used in COPD rehabilitation. TrainAir system. European Respiratory Journal 2016;48:PA695. [DOI: 10.1183/13993003.congress-2016.PA695] - DOI
Quintero 1999 {published data only}
    1. Quintero JI, Borzone G, Leiva A, Villafranca C, Lisboa C. Effects of inspiratory muscle training on the oxygen cost of breathing in patients with chronic obstructive pulmonary disease. Revista Medica De Chile 1999;127(4):421-8. - PubMed
Richardson 1989 {published data only}
    1. Richardson J, Dunn L, Pardy R. Inspiratory resistive endurance training in patients with chronic obstructive pulmonary disease: a pilot study. Physiotherapie Canada 1989;41(2):85-92.
Rocha 2015 {published data only}
    1. Rocha T, Souza H, Brandao DC, Rattes C, Ribeiro L, Campos SL, et al. The manual diaphragm release technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. Journal of Physiotherapy 2015;61(4):182-9. [DOI: 10.1016/j.jphys.2015.08.009] - DOI - PubMed
Sassoon 1992 {published data only}
    1. Sassoon CS, Lodia R, Rheeman CH, Kuei JH, Light RW, Mahutte CK. Inspiratory muscle work of breathing during flow-by, demand-flow, and continuous-flow systems in patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1992;145(5):1219-22. [DOI: 10.1164/ajrccm/145.5.1219] - DOI - PubMed
Serón 2005 {published data only}
    1. Serón P, Riedemann P, Muñoz S, Doussoulin A, Villarroel P, Cea X. Effect of inspiratory muscle training on muscle strength and quality of life in patients with chronic airflow limitation: a randomized controlled trial [Efecto del entrenamiento muscular inspiratorio sobre la fuerza muscular y la calidad de vida en pacientes con limitación crónica del flujo aéreo. Ensayo clínico aleatorizado]. Archivos de Bronconeumología 2005;41(11):601-6. [DOI: 10.1157/13081248] - DOI - PubMed
Shahin 2008 {published data only}
    1. Shahin B, Germain M, Kazem A, Annat G. Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease 2008;3(3):423-7. [DOI: 10.2147/copd.s1822] - DOI - PMC - PubMed
Shioya 2007 {published data only}
    1. Shioya T, Satake M, Takahashi H, Sugawara K, Kasai C, Kiyokawa N, et al. Combination of chest wall mobilization and respiratory muscle training in comprehensive outpatient pulmonary rehabilitation improves pulmonary function in patients with COPD [Abstract]. In: Respirology. Vol. 14 Suppl 3. 2009:A191 [PD 05-05].
    1. Shioya T, Satake M, Takahashi H, Sugawara K, Ksai C, Kiyokawa N, et al. Combination of chest wall mobilization and respiratory muscle training in comprehensive outpatient pulmonary rehabilitation improves pulmonary function in patients with COPD [Abstract]. In: European Respiratory Journal. Vol. 30 Suppl 51. 2007:188s [P1160].
Similowski 1994 {published data only}
    1. Similowski T, Derenne JP. Inspiratory muscle testing in stable COPD patients. European Respiratory Journal 1994;7(10):1871-6. - PubMed
Sivashanmugam 2019 {published data only}
    1. Sivashanmugam M, Vinod Kumar V, Sridhar R, Kumar R, Stanley G. Comparison of short term inspiratory muscle training and peripheral muscle training on lung function and quality of life in chronic obstructive pulmonary disease patients - a prospective observational study. Lung India 2019;9 Suppl:S107-8. [DOI: 10.4103/0970-2113.271103] - DOI
Soicher 1998 {published data only}
    1. Soicher J, Dechman G. Inspiratory muscle function in chronic obstructive pulmonary disease (COPD). Physical Therapy Reviews 1998;3(1):31-9. [DOI: 10.1179/ptr.1998.3.1.31] - DOI
Sonne 1982 {published data only}
    1. Sonne LJ, Davis JA. Increased exercise performance in patients with severe COPD following inspiratory resistive training. Chest 1982;81(4):436-9. [DOI: 10.1378/chest.81.4.436] - DOI - PubMed
Sudo 1997 {published data only}
    1. Sudo E, Ohga E, Matsuse T, Teramoto S, Nagase T, Katayama H, et al. The effects of pulmonary rehabilitation combined with inspiratory muscle training on pulmonary function and inspiratory muscle strength in elderly patients with chronic obstructive pulmonary disease. Nihon Ronen Igakkai zasshi [Japanese Journal of Geriatrics] 1997;34(11):929-34. [DOI: 10.3143/geriatrics.34.929] - DOI - PubMed
Sugiyama 2010 {published data only}
    1. Sugiyama N, Yokoyama T, Abe T, Kono Y, Sugiyama S, Setoguchi Y. Combined effects of short-term lower and upper extremity training plus inspiratory muscle training in patients with chronic obstructive pulmonary disease. Journal of Tokyo Medical University 2010;68(3):322-9.
Sun 2003 {published data only}
    1. Sun JX, Yin MX, Shao H, Li ZS, Li SW. Effect of respiratory muscle gymnastics on lung function and quality of life in the old patients with chronic obstructive pulmonary disease. Zhonghua Linchuang Kangfu Zazhi 2003;7(27):3698-9.
TCTR20191009004 {published data only}
    1. TCTR20191009004. Physiological change in lung function and respiratory muscle strength in chronic obstructive pulmonary disease patients; cause by pursed-lip breathing exercise using windmill toy model. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=TCTR20191009004 (first received 9 October 2019).
UMIN000030937 {published data only}
    1. UMIN000030937. Efficacy and applicability of respiratory muscle training on the balance of inspiratory-to-expiratory muscle strength and breathing timing in patients with chronic obstructive pulmonary disease: a preparatory research study. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=JPRN-UMIN000030937 1 February 2018.
Van't Hul 2006 {published data only}
    1. Van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Training with inspiratory pressure support in patients with severe COPD. European Respiratory Journal 2006;27(1):65-72. [DOI: 10.1183/09031936.06.00036505] - DOI - PubMed
Villafranca 1998 {published data only}
    1. Villafranca C, Borzone G, Leiva A, Lisboa C. Effect of inspiratory muscle training with an intermediate load on inspiratory power output in COPD. European Respiratory Journal 1998;11(1):28-33. [DOI: 10.1183/09031936.98.11010028] - DOI - PubMed
Wada 2016 {published data only}
    1. Wada JT, Borges-Santos E, Porras DC, Paisani DM, Cukier A, Lunardi AC, et al. Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial. International Journal of Chronic Obstructive Pulmonary Disease 2016;11:2691-700. [DOI: 10.2147/COPD.S114548] - DOI - PMC - PubMed
Wu 2006 {published data only}
    1. Wu X, Hou L, Bai W. Effects of breathing training on quality of life and activities of daily living in elderly patients with stable severe chronic obstructive pulmonary disease. Chinese Journal of Rehabilitation Medicine 2006;21(3-4):307-10.
Xi 2015 {published data only}
    1. Xi F, Wang Z, Qi Y, Brightwell R, Roberts P, Stewart A, et al. Long-term effect of respiratory training for chronic obstructive pulmonary disease patients at an outpatient clinic: a randomised controlled trial. Clinical and Translational Medicine 2015;4(1):31. [DOI: ] - PMC - PubMed
Yamaguti 2012 {published data only}
    1. Yamaguti WP, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge JM, et al. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2012;93(4):571-7. [DOI: 10.1016/j.apmr.2011.11.026] - DOI - PubMed
Yan 1996 {published data only}
    1. Yan Q, Sun Y. Quantitative research for improving respiratory muscle contraction by breathing exercise. Chinese Medical Journal 1996;109(10):771-5. - PubMed
Yang 2005 {published data only}
    1. Yang S-Y, Feng E-Z, Shen J-L, Zhang Y, Zhao L-H, Wu X-M, et al. Effect of suitable electrostimulation on phrenic nerve in ameliorating diaphragmatic fatigue and pulmonary function in patients with stable chronic cor pulmonale at high altitude area. Chinese Journal of Clinical Rehabilitation 2005;9(23):28-30.
Zhang 2008 {published data only}
    1. Zhang Z-Q, Chen R-C, Yang Q-K, Li P, Wang C-Z, Zhang Z-H, et al. Effects of respiratory training in relation to respiratory pathophysiology on respiratory muscle function and exercise tolerance in chronic obstructive pulmonary disease patients. [Chinese]. Journal of Clinical Rehabilitative Tissue Engineering Research 2008;12(20):3966-71.

References to studies awaiting assessment

Barter 1987 {published data only}
    1. Barter C, Nosworthy J, Flynn M, Pretto JE. Effect of leg and inspiratory muscle training on exercise performance and minute ventilation in chronic airflow obstruction. [Abstract]. Australian and New Zealand Journal of Medicine 1987;17:511.
Bustamante 1997 {published data only}
    1. Bustamante V, Galdiz JB, Ruiz L, Cabriada V, Serrano L, Sobradillo V. Benefits evolution of inspiratory muscle training after 6 months discontinuation [Abstract]. European Respiratory Journal 1997;10 Suppl 25:7S.
Cassidy 2009 {published data only}
    1. Cassidy C. A study investigating the effects of inspiratory muscle training (IMT) in subjects with chronic obstructive pulmonary disease (COPD) following an acute exacerbation [Abstract]. Irish Journal of Medical Science 2009;178 Suppl 11:S435-6.
Cejudo 1998 {published data only}
    1. Cejudo P, Sanchez H, Ortega F, Toral J, Villagomez R, Montemayor T. Home ventilatory muscle training in patients with chronic obstructive pulmonary disease (COPD). European Respiratory Journal 1998;12 Suppl 28:3S. - PubMed
Chen 2017 {published data only}
    1. Chen X, Luo P, Chen Y, Huang Y, Wang K, Hu Y, et al. Effects of combined cycle ergometer and inspiratory muscle training in patients with stable chronic obstructive pulmonary disease. In: American Journal of Respiratory and Critical Care Medicine. Vol. 195. 2017:A2861. [DOI: 10.1164/ajrccm-conference.2017.A109] - DOI
    1. Chen X, Xu W-H. Combined use of inspiratory and expiratory threshold pressure training with data monitor in COPD. In: European Respiratory Journal. Vol. 52 Suppl 62. 2018:PA4046.
    1. NCT02200549. Effects of combined cycle training and inspiratory muscle training in patients with COPD [Effects of combined cycle training and inspiratory muscle training on exercise performance, health-related quality, dyspnoea, body composition, depressive symptomatology in patients with chronic obstructive pulmonary disease (COPD)]. clinicaltrials.gov/show/nct02200549 (first received 25 July 2014).
Croitoru 2013 {published data only}
    1. Croitoru A, Ionita D, Pele I, Marinescu L, Gologanu D, Dumitrescu A, et al. Inspiratory muscle training with threshold loading in a rehabilitation program of COPD patients. European Respiratory Journal 2013;42 Suppl 57:774s [P3732].
Del Castillo Otero 1998 {published data only}
    1. Del Castillo-Otero D, Sanchez-Riera H, Ortega-Ruiz F, Cejudo-Ramos P, Toral-Marin J, Elias-Hernandez T, et al. Home respiratory muscle training in COPD. Archivos de Bronconeumologia 1998;34 Suppl 1:33.
Di Marzo 2000 {published data only}
    1. Di Marzo A, Torrice M, Ciappi G. Inspiratory muscle training and relaxation therapy in advanced COPD patients. European Respiratory Journal 2000;16 Suppl 31:46s.
Di Marzo 2002 {published data only}
    1. Di Marzo A, Mancuso A, Bevignani G. Breathing reeducation with a pressure threshold device in advanced COPD patients. American Journal of Respiratory and Critical Care Medicine 2002;165 Suppl 8:A506.
Downes Vogel 2002 {published data only}
    1. Downes Vogel PJ. Effect of adding inspiratory muscle training to a pulmonary rehabilitation program for patients with COPD which includes upper extremity exercises. American Journal of Respiratory and Critical Care Medicine 2002;165 Suppl 8:A737.
Eastwood 2005 {published data only}
    1. Eastwood P, Hill K, Jenkins S, Philippe D, Shepherd K, Cecins N, et al. High intensity inspiratory muscle training (HIMT) improves dyspnea and health-related quality of life (QoL) in COPD [Abstract]. In: American Thoracic Society International Conference; 2005 May 20-25; San Diego. 2005:[C63] [Poster: H96].
Gething 2001 {published data only}
    1. Gething AD, Davies B, Williams EM. Improvements in cycling endurance following nine weeks of inspiratory muscle training. Thorax 2001;56 Suppl 3:iii50.
Göhl 2006 {published data only}
    1. Gohl O, Schacher C, Grensemann S, Worth H. Effects of inspiratory muscle training with the RESPIFIT S in addition to an outpatient exercise training program for patients with COPD [Abstract]. European Respiratory Journal 2006;28 Suppl 50:556s [P3202].
IRCT201104266299N1 {published data only}
    1. IRCT201104266299N1. The effect of inspiratory muscle training in COPD patients. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=IRCT201104266299N1 (first received 22 September 2011).
IRCT20180205038633N1 {published data only}
    1. IRCT20180205038633N1. The assessment of effectiveness of respiratory muscle training (IMT)and aerobic training in patients with pulmonary disease [The assessment of effectiveness of respiratory muscle training (IMT)and aerobic training on quality of life in patients with chronic obstructive pulmonary disease (COPD)]. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=IRCT20180205038633N1 (first received 21 March 2017).
ISRCTN19258620 {published data only}
    1. ISRCTN19258620. Inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD). ictrptest.azurewebsites.net/Trial2.aspx?TrialID=ISRCTN19258620 1 March 2000.
Jones 1985 {published data only}
    1. Jones DT, Thomson RJ, Sears MR. Physical exercise and resistive breathing training in severe chronic airways obstruction--are they effective? European Journal of Respiratory Diseases 1985;67(3):159-66. - PubMed
Koppers 2004 {published data only}
    1. Koppers R, Vos P, Folgering H. Endurance respiratory muscle training improves outcomes of pulmonary rehabilitation in COPD-patients [Abstract]. In: American Thoracic Society 100th International Conference; 2004 May 21-26; Orlando. 2004:B60 Poster K8.
Liu 1989 {published data only}
    1. Liu Y, Zhao ZS, Yang DC. Inspiratory muscle loading training compared with the breathing gymnastics in patients with COPD. Chinese Journal of Geriatrics 1989;8(2):112-14.
Manuel Vargas 1995 {published data only}
    1. Manuel Vargas D, Alonso Puig X, Pia de la Maza CM, Morales XP, Vargas BD, Bunout BD, et al. Effects of an inspiratory muscle training program and nutritional support in patients with chronic obstructive lung disease. Revista Medica de Chile 1995;123:1225-34. - PubMed
Mendoza 2007 {published data only}
    1. Mendoza L, Levia A, Jover E, Cavada G, Lisboa C. Effect of inspiratory muscle training on lung function, dyspnea, exercise tolerance, and quality of life in COPD patients [Abstract]. European Respiratory Journal 2007;30 Suppl 51:514s [E3083].
Meshcherykova 2018 {published data only}
    1. Meshcherykova N, Belevsky A, Cherniak A. The effect of inspiratory muscle training on lung hyperinflation in COPD patients. European Respiratory Journal 2018;52 Suppl 62:PA4139. [DOI: 10.1183/13993003.congress-2018.PA4139] - DOI
NCT01056081 {published data only}
    1. NCT01056081. Inspiratory muscle training in chronic obstructive pulmonary disease [I]. clinicaltrials.gov/show/nct01056081 26 January 2010.
NCT01903772 {published data only}
    1. NCT01903772. Effects of inspiratory muscle training in chronic obstructive pulmonary disease (COPD) (IMTCO). clinicaltrials.gov/show/NCT01903772 19 July 2013.
NCT02392715 {published data only}
    1. NCT02392715. Inspiratory muscle training combined with general exercise training in COPD (IMTGET) [Inspiratory muscle training combined with general exercise training, compared to general exercise training alone in patients with COPD: randomized controlled trial]. clinicaltrials.gov/show/nct02392715 19 March 2015.
NCT02673242 {published data only}
    1. NCT02673242. Inspiratory muscle training for patients with chronic obstructive pulmonary disorder. clinicaltrials.gov/show/NCT02673242 3 February 2016.
NCT03080662 {published data only}
    1. NCT03080662. Impact of inspiratory muscle training on daily physical activity (INAF). clinicaltrials.gov/show/nct03080662 15 March 2017.
NCT03438019 {published data only}
    1. NCT03438019. Inspiratory muscle training in COPD [Inspiratory muscle strength and endurance training in veterans with COPD]. clinicaltrials.gov/show/nct03438019 19 February 2018.
NCT03790410 {published data only}
    1. NCT03790410. The effect of inspiratory muscle training on postural control in chronic obstructive pulmonary disease. clinicaltrials.gov/show/nct03790410 31 December 2018.
Newall 1998 {published data only}
    1. Newall C, Caine MP, Stockley RA, McConnel AK, Hill SL. Inspiratory muscle training using a pressure threshold device in patients with COPD. European Respiratory Journal 1998;12 Suppl 28:267S.
Newall 2000 {published data only}
    1. Newall C, Richardson B, McConnell AK, Stockley RA, Hill SL. Inspiratory muscle training (IMT) as an adjunct to a pulmonary rehabilitation programme in COPD. American Journal of Respiratory and Critical Care Medicine 2000;161(3 Suppl):A753.
NTR2990 {published data only}
    1. NTR2990. Effects of inspiratory muscle training in patients with chronic obstructive pulmonary disease. ictrptest.azurewebsites.net/Trial2.aspx?TrialID=NTR2990 (first received 18 July 2011).
Pertuze 1994 {published data only}
    1. Pertuze J, Villafranca C, Leiva A, Reppeto P, Cruz E, Lisboa C. Improved quality of life of patients with chronic bronchial obstruction with inspiratory muscle training. Enfermedades Respir. Cir. Torac 1994;10(4):299.
Ramirez Sarmiento 2000 {published data only}
    1. Ramirez Sarmiento A, Orozo Levi M, Belalcazar V, Mendez R, Barreiro E, Guell R, et al. Structural basis of improved muscle function after inspiratory training in severe COPD patients. European Respiratory Journal 2000;16 Suppl 31:37s.
Reidi 2005 {published data only}
    1. Reidi C, Toledo A, Ribeiro KP, Silva MI, Costa D. Effects of a respiratory muscle training with or without load in patients with COPD. Rehabilitar 2005;7(27):4-10.
Valderramas 2009 {published data only}
    1. Valderramas S, Souza MC. Inspiratory muscle training in patients with chronic obstructive pulmonary disease submitted to a pulmonary rehabilitation program [Abstract]. In: European Respiratory Society Annual Congress; 2009 Sep 12-16; Vienna. 2009:[E4293].
Vargas 1995 {published data only}
    1. Vargas M, Puig A, la Maza M, Morales P, Vargas D, Bunout B, et al. Patients with chronic airflow limitation: effects of the inspiratory muscle training with threshold load valve, built with appropriate technology, associated to nutritional support. Revista Medica de Chile 1995;123(10):1225-34. - PubMed
Vargas 1998 {published data only}
    1. Vargas R, Sanchez H, Del Castillo D, Cejudo P, Ortega F, Montemayor T. Impact of ventilatory muscle training on dysnea, exercise and quality of life in COPD. Neumosur 1998;10(1):17.
Wang 2004 {published data only}
    1. Wang H, Wan S-Y. Effect of respiratory muscle training on pulmonary function and quality of life in patients with chronic obstructive pulmonary diseases in remission period. Chinese Journal of Clinical Rehabilitation 2004;8(18):3436-7.
Wanke 1994 {published data only}
    1. Wanke T, Formanek D, Lahrmann H, Brath H, Wild M, Wagner C, et al. Effects of combined inspiratory muscle and cycle ergometer training on exercise performance in patients with COPD. European Respiratory Journal 1994;7(12):2205-11. [DOI: 10.1183/09031936.94.07122205] - DOI - PubMed
Weiner 2006a {published data only}
    1. Weiner P, McConnell AK, Magadle R, Beckerman M. The addition of inspiratory muscle training to pulmonary rehabilitation program in patients with significant COPD [Abstract]. European Respiratory Journal 2006;28 Suppl 50:554s [P3194].
Wolstenholme 1998 {published data only}
    1. Wolstenholme RJ, Thomas E, Enright S. An evaluation of the clinical effectiveness of two respiratory muscle training devices in the rehabilitation of patients with chronic airflow obstruction. [Abstract]. European Respiratory Journal. Supplement 1998;12 Suppl 28:353S.

References to ongoing studies

CTRI/2020/11/029226 {published data only}
    1. CTRI/2020/11/029226. Effects of inspiratory muscle training v/s autogenic drainage in hospitalised COPD patient. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/11/029226 19 November 2020.
CTRI/2021/05/033469 {published data only}
    1. CTRI/2021/05/033469. To test the efficacy of inspiratory muscle training device Airofit in reducing breathlessness in COPD patients. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=54407 1 June 2021.
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