" The IN-SPIRED study investigates
if respiratory muscle training performed
after a hospitalization for a COPD flare-up
can decrease the number of readmissions. "
Why this study?
Worldwide, nearly 400 million people suffer of COPD. This disease not only has big consequences for the quality of life of the patient. It also has an important societal and economical impact.
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Depending the disease severity, a fairly large part of the patients have frequent flare-ups (exacerbations). These are accompanied by a faster deterioration of the lung function, persistent decrease of quality of life and intolerable shortness of breath.
An hospitalization can be necessary for severe exacerbations. In the first year after hospitalisation there is a considerable elevated risk of death and in addition a 20-50% change of readmission in the following months.​
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International guidelines advice on respiratory rehabilitation for patients with COPD, certainly after hospitalization. But in reality we see less than 10% of patients starting (in time) this rehabilitation. This because of various reasons:
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a limited knowledge about rehabilitation within healthcare professionals
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difficulties for the patient to frequently get to a healthcare facility
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fluctuations in complaints of the patient
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waiting lists to start rehabilitation
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Guided respiratory muscle training can offer a solution for these barriers:
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it is a fairly simple training
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the training is home based, the patient doesn't have to travel
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the training can start immediately in hospital, without waiting list
Effects of respiratory muscle training
Because the lung tissue of patients with COPD degrades and loses its elasticity, the chest expands and the ribs rise to a slightly higher position. This makes it easier for the airways to collapse when exhaling, leaving more air in the lungs (this is called hyperinflation). The main breathing muscle (called the diaphragm) sits like a dome at the bottom of the lungs and attaches to the ribs. It is the contraction of this muscle that allows us to breathe in. To do this optimally, the diaphragm must be able to contract from a resting position. In COPD, partly due to the high position of the ribs, the diaphragm cannot start from this resting position and may be weakened. This creates an imbalance between what this muscle has to do (load) and what it can actually handle (load capacity). This contributes to the feeling of shortness of breath and reduced exercise capacity.
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Respiratory muscle training can help to improve the imbalance between load and load capacity. In people with stable COPD, guided respiratory muscle training has been shown to have several benefits:
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improving the inspiratory muscle strength,
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enhancing the physical fitness and exercise capacity,
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improving quality of life,
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reducing shortness of breath.
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However, we do not yet know whether guided respiratory muscle training also works, or is better than respiratory rehabilitation in people who have had a severe COPD flare-up requiring hospitalization.
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Therefore, we investigate with this study if the addition of respiratory muscle training with professional guidance, on top of standard care, has an additional effect. We want to find out whether this add-on therapy after a severe COPD flare-up might help to:
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reduce the risk of readmission or death
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diminish complaints of shortness of breath
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enhance the quality of life
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improve exercise capacity
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strengthen breathing​
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