In recent years, a number of studies have examined the role of IMT in patients with CAO. Some of these studies have suggested that IMT has a beneficial effect on exercise tolerance, whereas other studies have failed to demonstrate such an effect. One factor influencing the outcome of these various studies has been identified by Belman et al, who showed that patients can be coached to minimize the work of breathing through resistive orifices by reducing inspiratory flow and frequency.
The lack of detailed information regarding breathing pattern in some previous reports makes it difficult to ascertain whether improvement in resistive breathing performance was due to a real enhancement of ventilatory muscle performance or merely secondary to the adoption of a different breathing strategy. Use of a threshold pressure valve in which there is little change of inspiratory pressures over a wide range of flow would be one means of avoiding the possibility of apparent improvement following inspiratory muscle training being simply due to the adoption of a markedly altered breathing pattern. read
With a threshold pressure device, the work done across the external resistance (external work) is given by the product of an adjustable threshold pressure and the minute ventilation, and it is largely independent of inspiratory flow. Thus, patients are unable to avoid the work of breathing, and any observed training effect of an increased threshold pressure achieved is likely to be a real increase in work capacity.
Part of our hypothesis was that such a valve would encourage patients to maximize inspiratory flow and minimize inspiratory time during threshold pressure
breathing. We designed a pocket-size threshold pressure breathing valve, and used it in a supervised training program designed to increase inspiratory muscle strength and endurance, and to compare these changes with the effects on exercise tolerance.
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