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Published ahead of print on July 19, 2002, doi:10.1164/rccm.200202-075OC

Am. J. Respir. Crit. Care Med., Volume 166, Number 11, December 2002, 1491-1497

A more recent version of this article appeared on December 1, 2002
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Submitted on February 4, 2002
Accepted on July 16, 2002

Inspiratory muscle training in patients with COPD: Structural and physiological outcomes

Alba Ramirez-Sarmiento1, Mauricio Orozco-Levi1*, Rosa Guell2, Esther Barreiro3, Nuria Hernandez4, Susana Mota2, Merce Sangenis3, Joan Ma Broquetas5, Pere Casan6, and Joaquim Gea1

1 Servei-Grup de Recerca de Pneumologia, Hospital del Mar, Barcelona, Spain; Unitat de Recerca Respiratòria i Ambiental (URRA), Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain; CEXS-Universitat Pompeu Fabra, Barcelona, Spain, 2 Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 3 Unitat de Recerca Respiratòria i Ambiental (URRA), Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain, 4 Servei-Grup de Recerca de Pneumologia, Hospital del Mar, Barcelona, Spain; Unitat de Recerca Respiratòria i Ambiental (URRA), Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain, 5 Servei-Grup de Recerca de Pneumologia, Hospital del Mar, Barcelona, Spain; Unitat de Recerca Respiratòria i Ambiental (URRA), Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain, 6 Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain

* To whom correspondence should be addressed. E-mail: morozco{at}imim.es.

The present study was aimed at evaluating the effects of a specific inspiratory muscle training protocol on the structure of inspiratory muscles in patients with chronic obstructive pulmonary disease (COPD). Fourteen patients (males, FEV1, 24±7 %pred) were randomised to either inspiratory muscle or sham training groups. Supervised breathing using a threshold inspiratory device was performed 30 min per day, five times a week during five consecutive weeks. The inspiratory training group was subjected to inspiratory loading equivalent to ~= 40-50% of their maximal inspiratory pressure. Biopsies from external intercostal muscles and vastus lateralis (control muscle) were taken prior to and following the training period. Muscle samples were processed for morphometric analyses using monoclonal antibodies against myosin heavy chain isoforms I and II. Increases in both the strength and endurance of the inspiratory muscles were observed in the inspiratory training group. This improvement was associated with increases in the proportion of type I fibers (by ~= 38%, p<0.05) and size of type II fibers (by ~= 21%, p<0.05) in the external intercostal muscles. No changes were observed in the control muscle. The study demonstrates that inspiratory training induces a specific functional improvement of the inspiratory muscles and adaptive changes in the structure of external intercostal muscles.




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