Transdiaphragmatic Pressure and Neural Respiratory Drive Measured During Inspiratory Muscle Training in COPD

Overview

Inspiratory muscle training(IMT)was an rehabilitation therapy for stable patients with chronic obstructive pulmonary disease(COPD). However, its therapeutic effect remains undefined due to unclear of diaphragmatic mobilization during IMT. Diaphragmatic mobilization represented by transdiaphragmatic pressure(Pdi)and neural respiratory drive expressed as corrective root-mean-square(RMS) of diaphragmatic electromyogram(EMGdi) provide vital information to select the proper IMT device and loads in COPD, therefore make curative effect of IMT clarity. Pdi and RMS of diaphragmatic electromyogram (RMSdi%) was respectively measured and compared during inspiratory resistive training and threshold load training in stable patients of COPD.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Investigator)
  • Study Primary Completion Date: December 2016

Detailed Description

Subjects:The diagnosis and severity of all participants were measured using the pulmonary function test according to Global Initiative for Chronic Obstructive Lung Disease. Inclusion criteria: (1)Severe and very severe COPD (postbronchodilator FEV1/FVC under 70% and FEV1 under 50% of the predicted value (GOLD C and D group); (2)Inspiratory muscle weakness(Maximal Inspiratory Pressure under 60cmH2O); (3) Bronchial dilation test (BDT) negative. Exclusion criteria: (1) acute exacerbation in the previous 4 weeks; (2) using the oral corticosteroids within4 weeks; (3) history of other respiratory, cardiovascular, neuromuscular, musculoskeletal diseases that could interfere the study. Study design This was a single-centre, cross-sectional study. Intervention: Inspiratory resistive training All participants conducted inspiratory resistive training using inspiratory resistive trainer (PFLEX, Respironics Inc, USA). Pdi and EMGdi were recorded synchronously.Inspiratory resistive load was change from low intensity into moderate and high intensity randomly(inspiratory hole diameters was set to 5.3mm, 2.4mm and 1.8mm,respectively) Inspiratory threshold load training Inspiratory threshold load training was conducted by all participants using the inspiratory threshold load trainer (Threshold Inspiration Muscle Trainer, Respironics Inc, USA) .Inspiratory threshold pressure was set to low, medium and high intensity randomly(threshold pressure was 30%,60% and 80% of MIP, respectively). Measurements :transdiaphragmatic pressure and neural respiratory drive

Interventions

  • Device: Threshold IMT®
    • A device used to offer threshold load to inspiratory muscle
  • Device: PFLEX®
    • A device used to offer resisive to inspiratory muscle

Arms, Groups and Cohorts

  • Experimental: COPD(threshold IMT training)
    • COPD patient use Inspiratory muscle trainer (Threshold IMT®)
  • Experimental: COPD(resisive training)
    • COPD patient use Inspiratory muscle trainer (PFLEX®)

Clinical Trial Outcome Measures

Primary Measures

  • transdiaphragmatic pressure
    • Time Frame: half an hour

Secondary Measures

  • neural respiratory drive
    • Time Frame: half an hour

Participating in This Clinical Trial

Inclusion Criteria

1. Severe and very severe COPD (postbronchodilator FEV1/FVC under 70% and FEV1 under 50% of the predicted value (GOLD C and D group); 2. Inspiratory muscle weakness(Maximal Inspiratory Pressure under 60cmH2O); 3. Bronchial dilation test (BDT) negative Exclusion Criteria:

1. acute exacerbation in the previous 4 weeks; 2. using the oral corticosteroids within 4 weeks; 3. history of other respiratory, cardiovascular, neuromuscular, musculoskeletal diseases that could interfere the study.

Gender Eligibility: All

Minimum Age: 50 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Guangzhou Institute of Respiratory Disease
  • Provider of Information About this Clinical Study
    • Principal Investigator: Weiliang Wu, PHD – Guangzhou Institute of Respiratory Disease
  • Overall Official(s)
    • Rongchang Chen, Master, Study Chair, Guangzhou Institude of Respiratory Disease

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