Pulmonary Rehabilitation in Patients with COPD: Discussion (1)
The performance of the inspiratory muscles, the general exercise capacity, and psychologic parameters in these patients with COPD with ventilatory limitation increased significantly in both the PR and the PR + IMT groups. However, additional TF-IMT resulted in a greater improvement in strength of the inspiratory muscles (PImax) and the endurance of the diaphragm, as measured by the rate of decline of the centroid frequency in the EMG (tgFcDIA) during the endurance test. Furthermore, the exercise endurance, as measured by means of the 12-minute walking distance, was significantly better in the PR + IMT group. buy cheap antibiotics
The patients in this study were selected on the criterion of a normal resting arterial Pco2 that increased during exercise. The performance of the inspiratory muscles in these patients may be one of the limiting factors of the exercise capacity. Therefore, these patients may be expected to benefit from IMT. In only one study, a (retrospective) distinction was made in a group of patients with COPD with or without EMG signs of inspiratory muscle fatigability during exercise. The patients with these signs showed a greater improvement of their exercise capacity after IMT than patients with COPD without EMG signs of fatigability during exercise. In other studies of the effects of IMT, however, patients were not selected because of exercise limitation. Therefore, it is possible that IMT was applied to patients in whom inspiratory muscle performance was not the limiting factor of the exercise capacity.