Which pulmonary volume should be used in physiotherapy to obtain higher maximal inspiratory pressure in COPD patients?

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Background and PurposePatients with chronic obstructive pulmonary disease (COPD) present pulmonary hyperinflation as the main cause of mechanical disadvantages in respiratory muscles. Measurement of the force generated by those muscles is converted into pressure changes. The aim of the present study was to evaluate the maximal inspiratory pressure (MIP) from the residual volume (RV) and from the functional residual capacity (FRC), in patients with COPD, and to determine which pulmonary volume should be used in physiotherapy so as to obtain higher MIP results.MethodAn investigation of 18 male patients with stable COPD. Patients were examined using a manual vacuometer to measure the MIP of 20 daily manoeuvres. Ten measurements were taken from the RV and 10 from the FRC, taken alternately with an interval of 1 minute between each measurement, for five consecutive days.ResultsIncreases in MIP were obtained from the RV measurements (mean ± SE) from 59.7 (± 5.2) to 66.6 (± 5.3) cm Hf (F(4,64) = 3.34; p < 0.015) and from the FRC measurements, from 55.4 (± 4.9) to 64.4 (± 4, 8) cm H2O (F(4, 64) = 6.72; p < 0.001). Post hoc analysis showed an increase, over consecutive days, in both RV and FRC. For FRC, an increase was revealed on the second and third days, a fall was found on the fourth day and a new increase was found on the last day. MIP reached different levels, between RV and FRC, on the first (t = 2.888; p = 0.010) and fourth (t = 2.165; p = 0.045) days.ConclusionIn the present study, MIP reached higher levels at FRC during the five days of evaluation, and a learning effect occurred in the patients. Motor units from the respiratory muscles may have been recruited in order to performe the manoeuvres during the days of evaluation. The study suggests that there is good evidence for the use of the FRC as a parameter to find the major MIP value.

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