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February 5, 2026

Effect of Inspiratory Muscle Training on Aerosol Deposition and Pulmonary Perfusion in Post-COVID-19 Syndrome: A Gamma Scintigraphy Study

JJJames JuniorUniversidade Federal de Pernambuco SBSimone Soares BrandãoUniversidade Federal de Pernambuco JFJames B. Fink

Key Points

To evaluate the impact of inspiratory muscle training on aerosol deposition and pulmonary perfusion in individuals with post-COVID-19 syndrome after 8 weeks of training.
Conducted a randomized controlled trial with 19 participants divided into IMT (n=10) and control (n=9) groups.
IMT group trained at 50% of maximal inspiratory pressure, while the control group used a non-resistance device.
Aerosol deposition and pulmonary perfusion were assessed using gamma scintigraphy with specific technetium-labeled isotopes.
Quantified total lung activity pre- and post-intervention.
IMT group showed significant improvement in total lung activity for aerosol deposition (p=0.028) and perfusion (p=0.013).
Right lung activity significantly increased for aerosol deposition (p=0.005) and perfusion (p=0.005).
Left lung perfusion also increased significantly (p=0.007).
Control group showed no significant changes; between-group analysis revealed higher activity in the IMT group for both metrics.

Abstract

Background: Pulmonary dysfunction in individuals with post-coronavirus disease-2019 (COVID-19) syndrome may impair aerosol deposition and pulmonary perfusion, compromising respiratory efficiency. Inspiratory muscle training (IMT) has been proposed as a strategy to improve respiratory mechanics and lung function. Objective: To compare aerosol deposition and pulmonary perfusion in individuals with post-COVID-19 syndrome before and after 8 weeks of IMT. Methods: This was a randomized controlled clinical trial involving 19 participants, divided into an IMT group ( n = 10) and a control group ( n = 9). The IMT group performed training with a load adjusted to 50% of maximal inspiratory pressure, while the control group used a device without resistance. Aerosol deposition and pulmonary perfusion were evaluated by gamma scintigraphy using the radioisotopes technetium-labeled diethylene-triamine-pentaacetic acid and technetium99-labeled macroaggregated human serum albumin, respectively. Total radiopharmaceutical activity in both lungs, as well as in the right and left lungs separately, was quantified pre- and post-intervention. Results: After 8 weeks, the IMT group showed a significant increase in total lung activity for both aerosol deposition ( p = 0.028) and perfusion ( p = 0.013). In the right lung, activity increased significantly for aerosol deposition ( p = 0.005) and perfusion ( p = 0.005). In the left lung, significant increases were also observed for perfusion ( p = 0.007). No significant increases were observed in the control group. In the between-group analysis, the IMT group showed higher activity in both lungs combined and separately, compared with controls, for aerosol deposition (all p < 0.05) and in the right lung for perfusion ( p = 0.010). Conclusion: IMT improved total aerosol deposition and perfusion in individuals with post-COVID-19 syndrome. These findings support the use of IMT as a rehabilitation strategy to enhance pulmonary deposition of inhaled agents and increase pulmonary perfusion in this population.

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