Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Motivational Interviewing: Preparing People for Change

ContextPostoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The prehospitalization period before CABG surgery may be used to improve a patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined.ObjectiveTo evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery.Design, Setting, and PatientsA single-blind, randomized clinical trial conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, with enrollment between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6%) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital.InterventionPatients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy.Main Outcome MeasuresIncidence of PPCs, especially pneumonia, and duration of postoperative hospitalization.ResultsBoth groups were comparable at baseline. After CABG surgery, PPCs were present in 25 (18.0%) of 139 patients in the IMT group and 48 (35.0%) of 137 patients in the usual care group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR, 0.40; 95% CI, 0.19-0.84). Median duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs 8 days (range, 6-70 days) in the usual care group by Mann-Whitney U statistic (z = –2.42; P = .02).ConclusionPreoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery.Trial Registrationisrctn.org Identifier: ISRCTN17691887

https://jamanetwork.com/journals/jama/articlepdf/203686/JOC60140.pdf

Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial.

Background: Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma.Methods: To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.Results: Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting β2-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β2-agonist before exercise, stron...

/pdf/an-official-american-thoracic-society-clinical-practice-2ev9b7wn92.pdf

An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction.

VOLIANITIS, S., A. K. MCCONNELL, Y. KOUTEDAKIS, L. MCNAUGHTON, K. BACKX, and D. A. JONES. Inspiratory muscle training improves rowing performance. Med. Sci. Sports Exerc., Vol. 33, No. 5, 2001, pp. 803‐ 809. Purpose: To investigate the effects of a period of resistive inspiratory muscle training (IMT) upon rowing performance. Methods: Performance was appraised in 14 female competitive rowers at the commencement and after 11 wk of inspiratory muscle training on a rowing ergometer by using a 6-min all-out effort and a 5000-m trial. IMT consisted of 30 inspiratory efforts twice daily. Each effort required the subject to inspire against a resistance equivalent to 50% peak inspiratory mouth pressure (PImax) by using an inspiratory muscle training device. Seven of the rowers, who formed the placebo group, used the same device but performed 60 breaths once daily with an inspiratory resistance equivalent to 15% PImax. Results: The inspiratory muscle strength of the training group increased by 44 6 25 cm H2O (45.3 6 29.7%) compared with only 6 6 11 cm H2O (5.3 6 9.8%) of the placebo group (P , 0.05 within and between groups). The distance covered in the 6-min all-out effort increased by 3.5 6 1.2% in the training group compared with 1.6 6 1.0% in the placebo group (P , 0.05). The time in the 5000-m trial decreased by 36 6 9 s (3.1 6 0.8%) in the training group compared with only 11 6 8 s (0.9 6 0.6%) in the placebo group (P , 0.05). Furthermore, the resistance of the training group to inspiratory muscle fatigue after the 6-min all-out effort was improved from an 11.2 6 4.3% deficit in PImax to only 3.0 6 1.6% (P , 0.05) pre- and post-intervention, respectively. Conclusions: IMT improves rowing performance on the 6-min all-out effort and the 5000-m trial. Key Words: RESPIRATORY MUSCLE TRAINING, PERFORMANCE ENHANCEMENT, INSPIRATORY MOUTH PRESSURE, RESPIRATORY FATIGUE, DYSPNEA

/pdf/inspiratory-muscle-training-improves-rowing-performance-28iul0czml.pdf

Inspiratory muscle training improves rowing performance

We evaluated the effects of specific inspiratory muscle training on simulated time-trial performance in trained cyclists Using a double-blind, placebo-controlled design, 16 male cyclists (VO2max = 64 +/- 2 ml x kg(-1) x min(-1); mean +/- s(x)) were assigned at random to either an experimental (pressure-threshold inspiratory muscle training) or sham-training control (placebo) group Pulmonary function, maximum dynamic inspiratory muscle function and the physiological and perceptual responses to maximal incremental cycling were assessed Simulated time-trial performance (20 and 40 km) was quantified as the time to complete pre-set amounts of work Pulmonary function was unchanged after the intervention, but dynamic inspiratory muscle function improved in the inspiratory muscle training group (P < or = 005) After the intervention, the inspiratory muscle training group experienced a reduction in the perception of respiratory and peripheral effort (Borg CR10: 16 +/- 4% and 18 +/- 4% respectively; compared with placebo, P < or = 001) and completed the simulated 20 and 40 km time-trials faster than the placebo group [66 +/- 30 and 115 +/- 38 s (38 +/- 17% and 46 +/- 19%) faster respectively; P = 0025 and 0009] These results support evidence that specific inspiratory muscle training attenuates the perceptual response to maximal incremental exercise Furthermore, they provide evidence of performance enhancements in competitive cyclists after inspiratory muscle training

Effects of inspiratory muscle training on time-trial performance in trained cyclists

Specific respiratory muscle training offers the promise of improved exercise tolerance and athletic performance for a wide range of users However, the literature addressing respiratory muscle training in healthy people remains controversial Studies into the effect of respiratory muscle training upon whole body exercise performance have used at least one of the following modes of training: voluntary isocapnic hyperpnea, flow resistive loading, and pressure threshold loading Each of these training modes has the potential to improve specific aspects of respiratory muscle function Some studies have demonstrated significant improvements in either time to exhaustion or time trial performance, whilst others have demonstrated no effect We present an overview of the literature that rationalizes its contradictory findings Retrospective analysis of the literature suggests that methodological factors have played a crucial role in the outcome of respiratory muscle training studies We conclude that in most well controlled and rigorously designed studies, utilizing appropriate outcome measures, respiratory muscle training has a positive influence upon exercise performance The mechanisms by which respiratory muscle training improves exercise performance are unclear Putative mechanisms include a delay of respiratory muscle fatigue, a redistribution of blood flow from respiratory to locomotor muscles, and a decrease in the perceptions of respiratory and limb discomfort

/pdf/respiratory-muscle-training-in-healthy-humans-resolving-the-3nfb6zj2u2.pdf

Respiratory Muscle Training in Healthy Humans: Resolving the Controversy

ROMER, L. M., A. K. MCCONNELL, and D. A. JONES. Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training. Med. Sci. Sports Exerc., Vol. 34, No. 5, pp. 785–792, 2002. Purpose: This study evaluated the influence of simulated 20- and 40-km time trials upon postexercise inspiratory muscle function of trained competitive cyclists. In addition, we examined the influence of specific inspiratory muscle training (IMT) upon the responses observed. Methods: Using a double-blind placebo-controlled design, 16 male cyclists (mean SEM V u O2max 64 2 mL·kg 1 ·min 1 ) were assigned randomly to either an experimental (IMT) or sham-training control (placebo) group. Maximum static and dynamic inspiratory muscle function was assessed immediately pre- and 2, 10, and 30 min post-simulated 20- and 40-km time trials before and after 6-wk of IMT or sham-IMT. Results: Maximum inspiratory mouth pressure (P0) measured within 2 min of completing the 20- and 40-km time trial rides was reduced by 18% and 13%, respectively, and remained below preexercise values at 30 min. The 20- and 40-km time trials induced a reduction in inspiratory flow rate at 30% P0 by 14% and 6% in the IMT group versus 13% and 7% for the placebo group, and also remained below preexercise values at 30 min. There was also a significant slowing of inspiratory muscle relaxation rate postexercise; these trends were almost completely reversed by 30 min postexercise. Significant improvements in 20- and 40-km time trial performance were seen (3.8 1.7% and 4.6 1.9%, respectively; P 0.05) and postexercise reductions in muscle function were attenuated with IMT. Conclusion: These data support existing evidence that there is significant global inspiratory muscle fatigue after sustained heavy endurance exercise. Furthermore, the present study provides new evidence that performance enhancements observed after IMT are accompanied by a

Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training

ROMER, L. M., and A. K. MCCONNELL. Specificity and Reversibility of Inspiratory Muscle Training. Med. Sci. Sports Exerc., Vol. 35, No. 2, pp. 237–244, 2003.PurposeThe purpose of this study was to evaluate the pressure-flow specificity of adaptations to inspiratory muscle training (IMT), in addition

Alison K. McConnell

Papers

Inspiratory muscle training improves rowing performance

Effects of inspiratory muscle training on time-trial performance in trained cyclists

Respiratory Muscle Training in Healthy Humans: Resolving the Controversy

Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training

Specificity and reversibility of inspiratory muscle training.