Table 5.
Studies investigating the effects of regular assisted inflation in participants with NMD.
| Author/s | Year | Number of participantsa |
Population | Trial design | Therapy and follow-up period | Results |
|---|---|---|---|---|---|---|
| Houser and Johnson (214) | 1971 | 14 | DMD, paed | Randomised matched-pair study | 6 min IPPB 5 days/week (n = 7) vs. control (n = 7), for 3 months | No difference in rate of FVC decline |
| Adams and Chandler (215) | 1974 | 3 | DMD, paed | Case series | Swimming + IPPB programme for 11 months | VC improved during the programme, decreased during vacation periods |
| Huldtgren et al. (216) | 1980 | 12 | Sub-acute cervical SCI | Case series | 10 reps LVR inflations + EMST 10 reps EMST 10 reps IMST Training 5x/week for ∼6 weeks |
Improved VC, MIP, and MEP after respiratory rehabilitation training programme |
| Simonds et al. (203) | 1989 | 10 | Restrictive CWD | Prospective uncontrolled trial | 5 min MI (6 participants = volume, 4 = pressure NIV), ×2–3/day for 9 months. | No change in VC or TLC overall. Small, statistically significant increase in VC in volume group |
| Kang and Bach (163) | 2000 | 43 | MND, slow NMDs | Retrospective case series (date range not stated) | 108 cases (65 single Ax, 43 multiple visits) Prescribed LVR 10–15 inflations 3x/day if VC <2 L Follow-up period not stated |
All reported using at least 2×/day: 30/43 increased MIC over time ◊ VC unchanged, assisted PCF increased 13/43 decreased MIC over time ◊ VC and assisted PCF fell |
| Miske et al. (217) | 2004 | 62 | Slow NMD | Retrospective case series (1998–2001) | MI-E prescribed for home use as required (3–5 reps × 3–5 sets) | Descriptive study: MI-E well tolerated with minimal side effects in 90% of cohort |
| Bach et al. (174) | 2007 | 47 | DMD | Retrospective case series (1996—end date not stated) | 78 cases (31 single Ax, 47 multiple visits) Prescribed LVR 10–15 inflations 3x/day Follow-up period 7–169 months |
31/47 reported using at least 2×/day: MIC increased, VC fell over time in 31 patients; no comparison with 16 patients who did not perform routinely. |
| Bach et al. (164) | 2008 | 46 | MND, slow NMDs | Retrospective case series (2005—end date not stated) | 282 cases (204 single Ax, 78 multiple visits) Prescribed LVR 10–15 inflations 3x/day Follow-up period not stated |
46/78 had follow-up data: MIC and LIC increased, VC fell over time. |
| Laffont et al. (205) | 2008 | 14 | Recent SCI | Randomised cross-over trial | 20 min IPPB 2×/day, 5 days/week for 2 months vs. control | No difference in VC, lung volume, dynamic CL between IPPB or no IPPB periods |
| Nygren-Bonnier et al. (218) | 2009 | 11 | SMA (6–16 years) |
Prospective uncontrolled trial | GPB training 4×/week for 8 weeks 10 maximal inflations/session |
5/11 participants able to learn GPB. Improved chest expansion, PEF, and inspiratory VC in n = 4 completed participants |
| Nygren-Bonnier et al. (219) | 2009 | 25 | Chronic cervical SCI | Prospective uncontrolled trial | GPB training 4×/week for 8 weeks 10 maximal inflations/session |
20/25 participants able to learn GPB. Improved chest expansion, VC, and static lung volumes post 8 weeks |
| Johansson et al. (220) | 2011 | 7 | Chronic cervical SCI | Prospective uncontrolled trial | GPB training 4×/week for 8 weeks 10 maximal inflations/session |
No difference in VC pre and post 8 weeks. Some positive effects on speech |
| McKim et al. (40) | 2012 | 22 | DMD | Retrospective cohort study | Prescribed 2×/day LVR: 3–5 maximal inflations/session Compared RFT data pre-LVR (median 34 months) with post-LVR (45 months) |
22 reported adherent with 2×/day LVR Rate of FVC decline slowed post-LVR: pre-LVR 4.7 vs. post-LVR 0.5%pred/year |
| Srour et al. (175) | 2013 | 35 | Multiple sclerosis | Retrospective case series (1999–2010) | 79 cases (44 single Ax, 35 multiple visits) Prescribed 2×/day LVR: 5 maximal inflations/session if FVC <80% and trial of LVR improved RFT (MIC > VC) Median follow-up 13 months |
Of 35 patients prescribed regular LVR and multiple data: Rate of FVC decline slower in group who achieved PCFLVR > PCF at baseline |
| Moran et al. (221) | 2014 | 10 | Paed NMD | Retrospective cohort study | Home MI-E as prescribed by allied health professional | Fewer days hospitalised post MI-E, positive qualitative feedback |
| Phillips et al. (222) | 2014 | 6 | Paed NMD | Prospective cohort study | Home MI-E as prescribed by allied health professional | Fewer days hospitalised post MI-E, positive qualitative feedback |
| Marques et al. (171) | 2014 | 22 | Slow NMDs, paed | Prospective uncontrolled trial | 4–6 months of 3×/day LVR 3–4 maximal inflations/session |
18/22 completed No change in FVC or MIC. Unassisted and assisted PCF increased |
| Kaminska et al. (178) | 2015 | 24 | MND, slow NMDs | Prospective uncontrolled trial | 3 months of 2–4×/day LVR 3–5 maximal inflations/session |
19/24 completed ◊ 14 willing to continue LVR post study period FVC fell, LIC and LIC—FVC increased over time No change in PCF or QoL |
| Rafiq et al. (88) | 2015 | 40 | MND | Randomised controlled trial | 1 year of LVR or MI-E 3–5 maximal inflations 2×/day |
Primary outcome = RTI. No difference b/w groups in RTI rate No difference in survival, QoL Adherence: 71% LVR, 53% MI-E |
| Jeong and Yoo (223) | 2015 | 14 LVR 12 IS control |
Recent SCI | Randomised controlled trial | 5 days/week for 6 weeks of LVR or IS 20 repetitions 2×/day |
FVC and PCF increased over time in both groups, but PCF improvement greater with LVR > IS |
| Stehling et al. (224) | 2015 | 21 | Slow NMD, paed | Retrospective cohort study (2009–2012) | 3 maximal inflations via MI-E repeated in sets for 10 min, 2×/day. Analysed VC for 2 years pre and 2 years post initiating MI-E at home |
VC increased within the first year post MI-E initiation (mean relative improvement = 28%) |
| Moran et al. (225) | 2015 | 7 | Paed DMD or SMA | Qualitative research | Home MI-E as prescribed by allied health professional | Positive and negative impacts of home MI-E on lifestyle identified |
| Mahede et al. (226) | 2015 | 37 | Slow NMD | Cohort study (2007–2011) | Home MI-E as prescribed by allied health professional. Mean duration 2.3 years | MI-E at home improved self-reported health and reduced ED presentations (qualitative data, health record linkage) |
| Katz et al. (39) | 2016 | 16 | DMD | Retrospective cohort study (1991–2008) | Prescribed 2×/day LVR: 3–5 maximal inflations/session Median follow-up = 6.1 years |
LIC-VC increased 0.02 L/year LIC increased and FVC stable/rate of FVC decline slowed post-LVR: pre-LVR 4.5 vs. post-LVR 0.5%pred/year |
| Chiou et al. (227) | 2017 | 151 | DMD | Retrospective case series (1996–2015) | 232 cases (81 single Ax, 151 multiple visits) Prescribed LVR 10–15 inflations 3x/day once VC plateaued (53 cases) |
151 patients: rate of VC decline = 8.8% of plateau VC/year (includes 53 below) 53 patients prescribed LVR: rate of VC decline = 8.5% of plateau VC/year |
| An and Shin (228) | 2018 | 24 | SCI (mean onset ∼1 month post injury) |
Randomised controlled trial | 3 days/week for 4 weeks of LVR + IMST or IS + IMST LVR or IS: 15 reps × 3 sets, plus IMST = 15 min |
Improvement in FVC and MIP with both groups, but greater with LVR + IMST > IS + IMST. PCF improved over time, with no difference between groups |
| Chatwin and Simonds (181) | 2020 | 181 | Slow NMD | Retrospective case series (2014–2018) | 181 patients with MI-E at home and prescribed daily use (includes service provision, MI-E criteria, use, settings) | Yearly adherence data on 137: median days used = 60%, 1.8 sessions/day, 2.3 min/session. |
| Veldhoen et al. (229) | 2020 | 37 | Paed NMD (eg. SMA) | Retrospective case series | MI-E commenced for daily use as per local protocol. Recommended dosage: 5 resp × 3 sets 2×/day | Fewer RTI related admissions in period post initiation of MI-E. |
| Sawnani et al. (230) | 2020 | 31 | Congenital MDs (5–21 years) |
Randomised controlled trial | 1 year of Hyperinflation via MI-E device or control MI-E: 15 min 2×/day Control: Routine care Follow-up at 4, 8, and 12 months |
No difference in primary outcome (change in FVC) between groups at endpoint (1 year). No difference in QoL. Overall adherence 44% |
| Katz et al. (28) | 2022 | 66 | DMD (6–16 years) |
Multicentre randomised controlled trial | 2 years of conventional treatment + LVR or conventional treatment alone LVR: 3–5 maximal inflations 2×/day Follow-up 6, 12, 18, and 24 months |
No difference in primary outcome (change in FVC %pred) between groups at endpoint (2 years). Adherence 41% |
| Sheers et al.b (231, 232) | 73 | Slow NMD MND |
Randomised controlled trial | 3 months of LVR or control LVR: 5 reps × 5 sets maximal inflations 2×/day Control breathing exercises: 5 reps × 5 sets 2×/day Follow-up 1, 2, and 3 months |
Improvement in primary outcome (change in LIC) between groups at endpoint (3 months). No treatment effect on lung volumes, Crs, or QoL. LVR Adherence 45% |
DMD, Duchenne muscular dystrophy; paed, paediatric cohort; CWD, chest wall disease; MND, motor neurone disease; NMD, neuromuscular disease; SCI, spinal cord injury; MDs, muscular dystrophies; IPPB, inspiratory positive pressure breathing; MI, mechanical insufflation; NIV, non-invasive ventilation; LVR, lung volume recruitment; MI-E, mechanical insufflation-exsufflation; IS, incentive spirometry; IMST, inspiratory muscle strength training; EMST, expiratory muscle strength training; Ax, assessment; RFT, respiratory function test; VC, vital capacity; FVC, forced vital capacity; TLC, total lung capacity; MIC, maximum insufflation; Crs, respiratory system compliance; QoL, quality of life; PCF, peak cough flow; ED, emergency department.
The shaded rows highlight the studies employing an LVR kit. Trial design notes in bold signify prospective studies.
a
Number of participants with longitudinal data.
b
Abstract of conference proceedings; manuscript currently under review.