Patients with neurological disorders can present the weakness of respiratory muscle and impaired cough function. Previous studies have shown that respiratory muscle strength training (RMT) is an effective method of improving the strength of respiratory muscle. The effects of RMT on cough function remain controversial.
OBJECTIVE:
We aimed to analyze randomized controlled trials (RCTs) that investigated the effects of RMT on cough function of patients with neurological disorders.
METHODS:
Pubmed, Medline, Embase, and the Cochrane Library were searched electronically for RCTs. Two reviewers independently performed data extraction and quality assessment. Data were analyzed by using RevMan 5.3 software of The Cochrane Collaboration.
RESULTS:
Five studies with 185 participants were included. The mean PEDro score was 6.2 (range 5 to 7), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training improved peak expiratory cough flow of voluntary cough by 2.16 (95% CI 1.16 to 3.17) and involuntary cough by 2.84 (95% CI 1.29 to 4.39), with statistical significance (P < 0.0001, P = 0.0003). The experimental group had an improvement of 0.19 cmH2O (95% CI –0.12 to 0.5) on the maximal inspiratory pressure, 0.09 cmH2O (95% CI –0.23 to 0.42) on the maximal expiratory pressure, but with no statistical significance (P = 0.23, P = 0.58) between groups.
CONCLUSION:
Respiratory muscle training was considered as an effective method for improving cough function. However, this review was insufficient to conclude whether respiratory muscle training was effective in improving inspiratory and expiratory muscle strength, this was opposite with previous meta-analysis. These effects might due to the small samples and different diseases.
Alves,W. M., Alves,T. G., Ferreira,R. M., Lima,T. A., Pimentel,C. P., Sousa,E. C.,... Alves,E. A. (2019). Strength training improves the respiratory muscle strength and quality of life of elderly with Parkinson disease, J Sports Med Phys Fitness59(10), 1756–1762. doi: 10.23736/s0022-4707.19.09509-4
2.
Andrani,F., Aiello,M., Bertorelli,G., Crisafulli,E., & Chetta,A. (2019). Cough, a vital reflex. mechanisms, determinants and measurements, Acta Biomed89(4), 477–480. doi: 10.23750/abm.v89i4.6182
3.
Aslan,G. K., Gurses,H. N., Issever,H., & Kiyan,E. (2014). Effects of respiratory muscle training on pulmonary functions in patients with slowly progressive neuromuscular disease: a randomized controlled trial, Clin Rehabil28(6), 573–581. doi: 10.1177/0269215513512215
4.
Benditt,J. O. (2019). Respiratory Care of Patients With Neuromuscular Disease, Respir Care64(6), 679–688. doi: 10.4187/respcare.06827
5.
Elkins,M., & Dentice,R. (2015). Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review, J Physiother61(3), 125–134. doi: 10.1016/j.jphys.2015.05.016
6.
Feng,M. C., Lin,Y. C., Chang,Y. H., Chen,C. H., Chiang,H. C., Huang,L. C.,... Hung,C. H. (2019). The Mortality and the Risk of Aspiration Pneumonia Related with Dysphagia in Stroke Patients, J Stroke Cerebrovasc Dis28(5), 1381–1387. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.011
7.
Gomes-Neto,M., Saquetto,M. B., Silva,C. M., Carvalho,V. O., Ribeiro,N., & Conceicao,C. S. (2016). Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis, Arch Phys Med Rehabil97(11), 1994–2001. doi: 10.1016/j.apmr.2016.04.018
8.
Kulnik,S. T., Birring,S. S., Moxham,J., Rafferty,G. F., & Kalra,L. (2015a). Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial, Stroke46(2), 447–453. doi: 10.1161/STROKEAHA.114.007110
9.
Kulnik,S. T., Birring,S. S., Moxham,J., Rafferty,G. F., & Kalra,L. (2015b). Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial, Stroke; a Journal of Cerebral Circulation46(2), 447–453. http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/023/CN-01052023/frame.html doi:10.1161/STROKEAHA.114.007110
Lee,A. S., & Ryu,J. H. (2018). Aspiration Pneumonia and Related Syndromes, Mayo Clin Proc93(6), 752–762. doi: 10.1016/j.mayocp.2018.03.011
12.
Liaw,M. Y., Hsu,C. H., Leong,C. P., Liao,C. Y., Wang,L. Y., Lu,C. H., & Lin,M. C. (2020). Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial, Medicine (Baltimore)99(10), e19337. doi: 10.1097/MD.0000000000019337
13.
Maher,C. G., Sherrington,C., Herbert,R. D., Moseley,A. M., & Elkins,M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials, Phys Ther83(8), 713–721.
14.
McGovern,A. E., Short,K. R., Kywe Moe,A. A., & Mazzone,S. B. (2018). Translational review: Neuroimmune mechanisms in cough and emerging therapeutic targets, J Allergy Clin Immunol142(5), 1392–1402. doi: 10.1016/j.jaci.2018.09.004
15.
Menezes,K. K., Nascimento,L. R., Ada,L., Polese,J. C., Avelino,P. R., & Teixeira-Salmela,L. F. (2016). Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review, J Physiother62(3), 138–144. doi: 10.1016/j.jphys.2016.05.014
16.
Menezes,K. K., Nascimento,L. R., Ada,L., Polese,J. C., Avelino,P. R., & Teixeira-Salmela,L. F. (2018). Corrigendum to ‘Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review’ [J Physiother 2016;62:138-144], J Physiother64(2), 73. doi: 10.1016/j.jphys.2018.02.005
17.
Morrow,B. M., Angelil,L., Forsyth,J., Huisamen,A., Juries,E., & Corten,L. (2019). The utility of using peak expiratory flow and forced vital capacity to predict poor expiratory cough flow in children with neuromuscular disorders, S Afr J Physiother75(1), 1296. doi: 10.4102/sajp.v75i1.1296
18.
Olivo,S. A., Macedo,L. G., Gadotti,I. C., Fuentes,J., Stanton,T., & Magee,D. J. (2008). Scales to assess the quality of randomized controlled trials: a systematic review, Phys Ther88(2), 156–175. doi: 10.2522/ptj.20070147
19.
Plowman,E. K., Tabor-Gray,L., Rosado,K. M., Vasilopoulos,T., Robison,R., Chapin,J. L.,... Gooch,C. (2018). Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized sham controlled trial. Muscle Nerve. doi: 10.1002/mus.26292
20.
Rao,A., Barrow,E., Vuik,S., Darzi,A., & Aylin,P. (2016). Systematic Review of Hospital Readmissions in Stroke Patients, Stroke Res Treat2016, 9325368. doi: 10.1155/2016/9325368
21.
Reyes,A., Castillo,A., Castillo,J., & Cornejo,I. (2018). The effects of respiratory muscle training on peak cough flow in patients with Parkinson’s disease: a randomized controlled study. Clin Rehabil, 269215518774832. doi: 10.1177/0269215518774832
22.
Reyes,A., Ziman,M., & Nosaka,K. (2013). Respiratory muscle training for respiratory deficits in neurodegenerative disorders: A systematic review, Chest143(5), 1386–1394. doi: 10.1378/chest.12-1442
23.
Silva,I. S., Pedrosa,R., Azevedo,I. G., Forbes,A. M., Fregonezi,G. A., Dourado Junior,M. E.,... Ferreira,G. M. (2019). Respiratory muscle training in children and adults with neuromuscular disease, Cochrane Database Syst Rev9, CD011711. doi: 10.1002/14651858.CD011711.pub2
24.
Sohn,D., Park,G. Y., Koo,H., Jang,Y., Han,Y., & Im,S. (2018). Determining Peak Cough Flow Cutoff Values to Predict Aspiration Pneumonia Among Patients With Dysphagia Using the Citric Acid Reflexive Cough Test, Arch Phys Med Rehabil99(12), 2532–2539.e2531. doi: 10.1016/j.apmr.2018.06.015
25.
Teh,W. H., Smith,C. J., Barlas,R. S., Wood,A. D., Bettencourt-Silva,J. H., Clark,A. B.,... Myint,P. K. (2018). Impact of stroke-associated pneumonia on mortality, Length of Hospitalization and Functional Outcome138(4), 293–300. doi: 10.1111/ane.12956
26.
Voulgaris,A., Antoniadou,M., Agrafiotis,M., & Steiropoulos,P. (2019). Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review, Pulm Med2019, 2734054. doi: 10.1155/2019/2734054
27.
Wang,M. H., & Yeh,M. L. (2019). Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials, World J Clin Cases7(18), 2760–2775. doi: 10.12998/wjcc.v7.i18.2760
28.
Wang,Z., Wang,Z., Fang,Q., Li,H., Zhang,L., & Liu,X. (2019). Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients With Neurological Diseases: A Meta-analysis, Am J Phys Med Rehabil98(12), 1060–1066. doi: 10.1097/phm.0000000000001242
29.
Ward,K., Seymour,J., Steier,J., Jolley,C. J., Polkey,M. I., Kalra,L., & Moxham,J. (2010). Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough, Eur Respir J36(6), 1383–1390. doi: 10.1183/09031936.00010510
30.
Wu,F., Liu,Y., Ye,G., & Zhang,Y. (2020). Respiratory Muscle Training Improves Strength and Decreases the Risk of Respiratory Complications in Stroke Survivors: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. doi: 10.1016/j.apmr.2020.04.017
