Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence?

Table 5

Inspiratory muscle rehabilitation training (IMRT) in children with asthma.

Citation	Study design	Population	Intervention	Outcomes
Lima et al. 2008 [52]	RCT	8–12-year-old patients with new referral for asthma and on no asthma treatment presenting with uncontrolled symptoms	Duration: 7 weeks	Significant improvements in IMRT versus control seen in MIP (∆MIP = 62 cmH20 [IMRT group] vs. 0 cmH20 [control group];  < 0.0001), MEP (∆MEP = 31 cmH20 [IMRT group] vs. 0 cmH20 [control group]), and PEF; daytime and nocturnal symptoms, activity limitation, and asthma attacks
		N = 50 (34 females, 16 males)	Frequency: 2 x/week Intensity: 40% MIP	IMRT effects on MIP, MEP, and PEF were generally durable after 7 weeks off IMRT
			Volume: 50 min sessions	No differences between groups in emergency room treatment and hospitalization
			Type: inspiratory pressure threshold resistance
			Equipment: respironics threshold IMT
			(Control intervention: education without IMRT; all participants started monthly visits and asthma education; participants could be started on ICS or ICS/LABA and adjusted monthly)
Elnaggar 2020 [53]	RCT	12–16-year-old patients with past diagnosis of asthma, clinically stable asthma on daily controller	Duration: 12 weeks	Significant improvement in IMRT vs. placebo seen in FEV1 ( = 0.003), FVC ( = 0.001), FEV1/FVC ( = 0.004), MIP (∆MIP = 17 cmH20 [IMRT group] vs. 11 cmH20 [placebo group];  = 0.002), MEP (∆MEP = 19 cmH20 [IMRT group] vs. 11 cmH20 [placebo group];  = 0.004), and asthma control test score ( = 0.001) adjusted to the pretreatment values
		N = 31 (11 females, 20 males)	Frequency: 3 x/week
			Intensity: 40% MIP, reassessed every week
			Volume: 15 breaths with 10 s rest intervals for 15 min + continuous breathing for 5 min for endurance (total: 20 min sessions)
			Type: inspiratory pressure threshold resistance
			Equipment: respironics threshold IMT
			(Placebo control: IMT at 5% MIP and similar frequency, volume, and duration)
			Both groups received a conventional respiratory rehabilitation program

Note. RCT–randomized controlled trial, IMT–inspiratory muscle training, ICS–inhaled corticosteroid, LABA–long-acting beta agonist, MIP–maximum inspiratory pressure, MEP–maximum expiratory pressure, PEF–peak expiratory flow, and SABA–short-acting beta agonist.