Pulmonary Disease, Chronic Obstructive Clinical Trial
Official title:
Inspiratory Muscle Training for Dyspneic Patients With COPD-HF Overlap: a Multicenter, Randomized Controlled Trial
The purpose of this study is to determine whether inspiratory muscle training is effective to improve breathless and exercise intolerance in symptomatic patients with chronic obstructive pulmonary disease (COPD) plus chronic heart failure (HF).
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced left ventricular
ejection fraction (HF) are leading causes of disability and death worldwide. Unfortunately,
COPD and HF coexist in up to a third of elderly patients making the so-called COPD-HF
overlap (CHO) a major challenge to Health Care Systems. In addition, population ageing
anticipates that CHO prevalence will further increase in the next decades.
Intolerance to exertion due to disabling breathlessness is the hallmark of COPD and HF and
these abnormalities are notoriously potentiated by diseases coexistence.
The inspiratory muscles are centrally related to the pathophysiology of exertional dyspnea
in COPD and HF. In both populations a higher central motor command output is required to
maintain adequate force generation in the face of weaker inspiratory muscles. This
information is interpreted as "shortness of breath".
There is well established evidence gained from recent meta-analyses indicating that
inspiratory muscle training (IMT), as a standalone therapy, significantly improves
inspiratory muscle function (strength and endurance), dyspnea during daily activities, and
functional exercise capacity in COPD and HF. Previous findings indicate that reduced
pressure-generating capacity reflecting inspiratory muscle weakness is frequently observed
in patients with COPD-HF and related to a clinically-relevant outcome: exertional dyspnea.
These findings set the scene for a randomized controlled trial to investigate the potential
role of IMT in dyspnea palliation in CHO patients.
Objectives
To determine the effects of IMT on:
1. Dyspnea on daily life
2. Inspiratory muscle strength and endurance
3. Dyspnea on exertion and time to exercise intolerance
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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