Pulmonary Rehabilitation in Patients with COPD: Discussion (2)
The most effective method of IMT has not yet been established. Normocapnic hyperpnea has been shown to increase the endurance of the inspiratory muscles in patients with COPD.2 This resulted in an increase in the 12-minute walking distance and in arm and leg exercise. This training method, however, can be applied only in the laboratory because of the necessary technical facilities. birth control yasmin
Resistive breathing has often been used to train the inspiratory muscles. To improve the performance of these muscles, a target inspiratory flow or pressure has to be defined, as well as the duration of the inspiration and expiration. If these parameters are not defined, the patients can easily adopt a nonfatiguing breathing pattern with a low inspiratory flow rate. In that case, the inspiratory muscles are not exposed to a considerable work load and will hardly be trained. This may contribute to the conflicting results of IMT. Changes in the breathing pattern during resistive breathing may be prevented by using a pressure threshold device. In this way, a threshold inspiratory pressure has to be generated to create an inspiratory airflow. Other investigators used a target-pressure device with feedback on the generated inspiratory pressure and the inspiratory and expiratory duration. Similar principles were also included in our training method. An incentive flowmeter is considerably less expensive than a manometer.