Resistive breathing training in patients with chronic obstructive pulmonary disease

In order to investigate the effect of resistive breathing training on ventilatory muscular endurance, we examined the maximal sustained ventilatory capacity in ten patients with chronic obstructive pulmonary disease (COPD) before and after a six-week program of resistive breathing training. In addition, we investigated the effect of altered breathing strategy on resistive breathing performance. The patients performed two 15-minute sessions of resistive breathing daily for six weeks using an inspiratory resistive device (Pflex). Before and after the training, we found no significant change in spirometric data, pulmonary volumes, maximal inspiratory pressure, and maximal expiratory pressure. Of the ten patients, seven failed to show an improvement in their performance of resistive breathing. Furthermore, the maximal sustained ventilatory capacity was unchanged after the resistive breathing training. After the completion of the training program, seven of the patients participated in an additional experiment in which they were instructed to take long slow inspirations while breathing through the resistive device. With this change in breathing pattern, five of the seven were able to improve their performance of resistive breathing. Analysis of the breathing strategy showed that a reduction in the peak mouth pressure, breathing frequency, and external resistive work with a longer inspiratory time was beneficial. We conclude that neither resistive breathing performance nor ventilatory muscular endurance, as measured by sustained hyperpnea, is improved by resistive breathing training performed according to the current instructions with the resistive device, and alterations in breathing strategy have a profound effect on the performance of resistive breathing. The lack of details of breathing strategy in previous studies of resistive breathing makes it difficult to determine if previously demonstrated improvements were due to a real enhancement of ventilatory muscular performance or merely secondary to a different strategy.