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Previous issue date: 2012-12-17 / In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a
suboptimal position in length-tension relationship, reducing the capacity of to
generate tension. The increase in transversal section area of the inspiratory muscles
could reverse or delay the deterioration of inspiratory muscle function. Objective: To
evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an
external resistive device in patients with asthma. Methods: A systematic review with
meta-analysis was carried out. The sources researched were the Cochrane Airways
Group Specialised Register of trials, Cochrane Central Register of Controlled Trials
(The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO,
CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were
searched from their inception up to November 2012 and there was no restriction on
the language of publication. Randomised controlled trials that involved the use of an
external inspiratory muscle training device versus a control (sham or no inspiratory
training device) were considered for inclusion. Two reviewers independently selected
articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A
total of five studies involving 113 asthmatic patients were included. Three clinical
trials were produced by the same group. The included studies showed a significant
increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98),
although the confidence intervals were wide. There was no statistically significant
difference between the IMT group and the control group for maximal expiratory
pressure, peak expiratory flow rate, forced expiratory volume in one second, forced
vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies
describing exacerbation events that required a course of oral and inhaled
corticosteroids or emergency department visits, inspiratory muscle endurance,
hospital admissions and days of work or school. Conclusions: There is no
conclusive evidence in this review to support or refute inspiratory muscle training for
asthma, once the evidence was limited by the small number of studies included,
number of participants in them together with the risk of bias. More well conducted
randomized controlled trials are needed, such trials should investigate respiratory
muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the
context of more severe asthma / No paciente asm?tico, a hiperinsufla??o pulmonar coloca os m?sculos
inspirat?rios em uma posi??o desfavor?vel na rela??o comprimento-tens?o,
reduzindo a capacidade de gerar tens?o. O aumento na ?rea de sec??o transversa
dos m?sculos inspirat?rios poderia reverter ou atrasar a deteriora??o da fun??o
muscular inspirat?ria. Objetivo: Avaliar a evid?ncia da efic?cia do treinamento
muscular inspirat?rio (TMI) com um dispositivo externo em pacientes com asma.
M?todos: O tipo de estudo utilizado foi uma revis?o sistem?tica com metan?lise. As
fontes pesquisadas foram o Cochrane Airways Group Specialised Register of trials,
Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12,
2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov e lista de
refer?ncias dos artigos. Todas as bases de dados foram pesquisadas desde seu
in?cio at? novembro de 2012 e n?o houve restri??o de idioma. Foram considerados
para inclus?o ensaios cl?nicos controlados e randomizados envolvendo o uso de um
aparelho de treinamento muscular inspirat?rio externo versus um controle (placebo
ou sem aparelho). Dois revisores independentemente selecionaram os artigos para
inclus?o, avaliaram o risco de vi?s e extra?ram os dados dos estudos inclu?dos.
Resultados: Um total de cinco estudos envolvendo 113 pacientes asm?ticos foram
inclu?dos na revis?o, sendo 3 destes ensaios desenvolvidos pelo mesmo grupo. Os
estudos inclu?dos mostraram que o TMI aumenta significativamente a press?o
inspirat?ria m?xima (DM 13.34 cmH2O, 95% IC 4.70 ? 21.98), contudo existiu um
largo intervalo de confian?a. N?o houve diferen?a significativa entre o grupo TMI e o
grupo controle para press?o expirat?ria m?xima, taxa de pico de fluxo expirat?rio,
volume expirat?rio for?ado no primeiro segundo, capacidade vital for?ada, sensa??o
de dispneia e uso de beta2-agonista. Nenhum estudo investigou os seguintes
desfechos: exacerba??es que requereram o uso de corticosteroides inalado ou oral
ou visita ao servi?o de emerg?ncia m?dica, endurance dos m?sculos inspirat?rios,
admiss?o no hospital e dias de falta ao trabalho ou escola. Conclus?es: N?o existe
evid?ncia conclusiva para apoiar ou refutar o uso do TMI para a asma, uma vez que
a evid?ncia foi limitada pelo pequeno n?mero de ensaios inclu?dos, reduzido n?mero
de participantes e risco de vi?s. Mais estudos randomizados e controlados bem
xiv
conduzidos s?o necess?rios, tais ensaios devem investigar a for?a muscular
respirat?ria, exacerba??es, fun??o pulmonar, sintomas, admiss?o no hospital, uso
de medicamentos e dias de falta ao trabalho ou escola. O TMI deve tamb?m ser
avaliado no contexto de asma mais grave
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/16727 |
| Date | 17 December 2012 |
| Creators | Silva, Ivanizia Soares da |
| Contributors | CPF:21268843334, http://lattes.cnpq.br/4934425482168899, Mendon?a, Karla Morganna Pereira Pinto de, CPF:72298863415, http://lattes.cnpq.br/1736384836028397, Andriolo, Brenda Nazar? Gomes, CPF:77466187234, http://lattes.cnpq.br/8839044871234164, Ferreira, Gard?nia Maria Holanda |
| Publisher | Universidade Federal do Rio Grande do Norte, Programa de P?s-Gradua??o em Fisioterapia, UFRN, BR, Movimento e Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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