How COPD Affects Breathing

One of the most common questions asked by people with COPD is how it affects breathing. To understand this, it’s first worth understanding how your lungs work.

How your lungs work

As you breathe in, you bring air down through your windpipe and into your airways. Your airways then branch out in your lungs into thinner tubes, called bronchioles. And at the end of your bronchioles are small air sacs.

Running along the walls of your air sacs are small blood vessels, or capillaries. When the air you breathe in reaches your air sacs, the oxygen passes through the air sac wall and into the blood in the capillaries. As this is happening the waste product carbon dioxide (CO2) moves from the capillaries and into the air sacs. This process is called gas exchange; bringing vital oxygen in to the body while removing the waste CO2.

How COPD affects breathing

Chronic Obstructive Pulmonary Disease is a group of lung conditions used to describe progressive lung diseases. These include emphysema, chronic bronchitis, non-reversible asthma, and some forms of bronchiectasis. All conditions cause breathing difficulties. If you have COPD you’ll know how difficult it is to empty air out of your lungs. This is because your airways have narrowed.

In a person without COPD, their healthy airways and air sacs are stretchy. After filling with air they will bounce back after being emptied. This elasticity helps to move air quickly in and out of the lungs.

However in a person with COPD, their airways and air sacs are no longer stretchy. They no longer bounce back. They also become swollen, thicker, and produce more mucus, making it harder to get air out of the lungs. This is what causes the symptoms of wheezing, chesty cough and breathlessness.

How COPD is treated

Unfortunately damage caused by COPD is permanent. However there are treatments that can help to stop it from progressing. Symptoms can also be managed. So with prevention the key to living with COPD, pulmonary rehabilitation is a hugely beneficial treatment.

Treatments include medication, inhalers and pulmonary rehab, including breathing exercises. Part of a Pulmonary Rehab Toolkit (Lung Foundation Australia) is Inspiratory Muscle Training (IMT), such as POWERbreathe. In fact there are many clinical studies showing the benefits of IMT for COPD. One such study concluded,

“…during IMT in patients with significant COPD, there is an increase in exercise capacity, improvement in quality of life, and decrease in dyspnea. The study also provides evidence that long-term IMT can decrease the use of health services and hospitalization days.”

Pulmonary Rehabilitation Toolkit
Pulmonary Rehabilitation Toolkit

Inspiratory Muscle Training (IMT)

A clinical study, published in the official journal of the American College of Chest Physicians, assessed The Effects of 1 Year of Specific Inspiratory Muscle Training in Patients With COPD.

Using POWERbreathe IMT it found improvements in patients with COPD, of:

  • Inspiratory muscle strength of 55%
  • Endurance of 86%
  • Quality of life by 21%
  • Dyspnoea (difficult or laboured breathing) by 36%

 

New Trial into Effects of IMT in COPD Patients

A new clinical trial will be looking at the effects of inspiratory muscle training (IMT) on shortness of breath (dyspnea) and postural control in patients with COPD.

Shortness of breath in patients with COPD

Patients with chronic obstructive pulmonary disorder (COPD) experience shortness of breath, or dyspnea, during physical activity. It is related to weakness of their respiratory muscles. There is much evidence of IMT improving breathing muscle function and reducing the intensity of dyspnea.

Balance impairment in patients with COPD

Patients with COPD and pronounced respiratory muscle weakness also show impaired postural balance. But improvements in respiratory muscle function might improve balance control in patients.

Purpose of the controlled trial

The trial will consider whether eight week’s of controlled IMT will reduce the intensity and feeling of dyspnea. It will also investigate if it improves postural control. And finally it will look to see if IMT improves blood flow and oxygen delivery to a patient’s limb muscles too.

Inspiratory muscle training intervention

The trial will use the POWERbreathe KHP2 Inspiratory Muscle Training device for monitoring breathing parameters. And patients will each use a POWERbreathe Medic Plus twice a day, mostly in their home and without supervision. However they will perform one training session each week under supervision, during which the training load will be increased. A sham group will perform three daily sessions of 30 breaths and will train at a constant inspiratory load of no more than 10% of their initial Pi,max.

The Principal Investigator is Rik Gosselink, PT, PhD. The trial is open to all sexes ageing from 40 to 90 years of age. It will take place at the University Hospital Leuven, Belgium. And the estimated completion date for the trial is January 31st 2018.

Impact Of IMT In Patients With COPD: What Is The Evidence?

“Meta-analysis including 32 randomised controlled trials on the effects of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients was performed.”

Conclusion:

“In conclusion, IMT is an effective treatment modality in COPD patients to improve respiratory muscle strength and endurance, resulting in reductions of dyspnoea and improvement in functional exercise capacity and health-related quality of life. Patients with more advanced muscle weakness seem to be better responders, especially when considering IMT in addition to general exercise training.”

Read Impact of inspiratory muscle training in patients with COPD: what is the evidence? >

The Effects Of 1 Year Of Specific Inspiratory Muscle Training In Patients With COPD

“The aim of this study was to assess the long-term benefits of inspiratory muscle training (IMT) on inspiratory muscle strength, exercise capacity, the perception of dyspnea, quality of life, primary care use, and hospitalizations in patients with significant COPD.”

Conclusion:

“The study showed that during IMT in patients with significant COPD, there is an increase in exercise capacity, improvement in quality of life, and decrease in dyspnea. The study also provides evidence that long-term IMT can decrease the use of health services and hospitalization days.”

Read The effects of 1 year of specific inspiratory muscle training in patients with COPD >

Inspiratory Muscle Training In Pulmonary Rehabilitation Program In COPD Patients

“Most pulmonary rehabilitation programs do not currently incorporate Inspiratory Muscle Training (IMT) in their pulmonary rehabilitation programs for COPD patients. The aim of the present study was to assess the influence of adding IMT to the patients already involved in a rehabilitation program.”

Conclusion:

“IMT provides additional benefits to patients undergoing pulmonary rehabilitation program and is worthwhile even in patients who have already undergone a general exercise reconditioning (GER) program.”

Read Inspiratory muscle training in pulmonary rehabilitation program in COPD patients >

Measurement Validity Of KH1 During Breathing Task In Patients With COPD

This paper studies the validity of the POWERbreathe KH1 – a recently introduced, handheld, electronic loading device. It looks at how well it provides automatically processed information on external inspiratory work, power and breathing pattern during loaded breathing tasks in patients with COPD.

Intervention: POWERbreathe KH1

Conclusion:

“The handheld device provides automatically processed and valid estimates of physical units of energy during loaded breathing tasks. This enables health care providers to quantify the load on inspiratory muscles during these tests in daily clinical practice.”

Measurement validity of an electronic inspiratory loading device during a loaded breathing task in patients with COPD >

Comparing Inspiratory Resistive Muscle Training with Incentive Spirometry on Rehabilitation of COPD Patients

“The purpose of this randomised controlled trial was to examine the effect of incentive spirometry in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD) patients and compare its efficacy with inspiratory resistive muscle training (IMT) technique.”

Conclusion:

“Both techniques improved the mean values of all respiratory function tests (p≤.01). The IMT technique was more effective to improve MVV and PImax (p≤.05). PEFR was better improved in the incentive spirometry group (p≤.05). There was no significant difference for other spirometric parameters between two groups. Incentive spirometry can be considered as an effective component for pulmonary rehabilitation in COPD patients.”

Read Comparing Inspiratory Resistive Muscle Training with Incentive Spirometry on Rehabilitation of COPD Patients >

Effects of IMT on Dyspnea in COPD During Pulmonary Rehabilitation: Randomized Controlled Trial

The purpose of this trial is to demonstrate that Inspiratory Muscle Training associated with a conventional pulmonary rehabilitation program allows a significant improvement of dyspnea in subjects with severe or very severe COPD than a conventional pulmonary rehabilitation program alone.”

Go to Effects of IMT on Dyspnea in COPD During Pulmonary Rehabilitation: Randomized Controlled Trial >

Effects of IMT and Calisthenics-and-Breathing Exercises in COPD

STUDY:

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness.

Published in Respiratory Care (Nov 10 2015), the aim of this study was to “compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion.”

CONCLUSIONS:

Both the inspiratory muscle training group and the calisthenics-and-breathing exercises group increased their exercise capacity and decreased dyspnea during physical effort.

Inspiratory muscle training however was more effective in increasing inspiratory muscle strength and endurance which could result in a decreased sensation of dyspnea. Also, subjects with respiratory muscle weakness who performed inspiratory muscle training showed higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity.

 

Effects of IMT on Breathing Pattern in Patients With COPD

The purpose of this clinical trial, sponsored by Katholieke Universiteit Leuven, Belgium, is based on how improvement in inspiratory muscle function might result in beneficial changes in breathing pattern during whole body exercise. The hypothesis is the effect of inspiratory muscle training as an adjunct to a pulmonary rehabilitation program improves the breathing pattern during an incremental cycle exercise.

Read the clinical trial, Effects of Inspiratory Muscle Training on Breathing Pattern in Patients With Chronic Obstructive Pulmonary Disease

Check out more Inspiratory Muscle Training Research here >

Discover POWERbreathe used in Research here >