Inspiratory Muscle Training for Patients With Chronic Obstructive Pulmonary Disease: A Narrative Review

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, despite being considered a partially preventable disease. COPD includes the presence of chronic bronchitis and/or pulmonary emphysema. Treatment for these patients involves multiple approaches, including pharmacological, surgical, and rehabilitative interventions. Pulmonary rehabilitation (PR), when properly implemented, is free of harmful effects compared to medications and surgery. PR can improve symptoms, quality of life, exercise tolerance, dyspnea, and delay mortality. Inspiratory muscle training (IMT) is recommended as part of PR or as an adjunctive therapy. There is disagreement in the literature regarding the usefulness of routinely adding IMT to PR, as it does not appear to add significant clinical benefits. Looking at the literature, there is great inhomogeneity in the parameters used for IMT, and conclusions are therefore elusive. The article reviews the importance of IMT as an integral part of PR and highlights the diaphragm as more than just a respiratory muscle. A respiratory work protocol is proposed to align with current training principles.