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Am Fam Physician. 2023;108(2):136-137

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Is inspiratory muscle training alone or in combination with pulmonary rehabilitation effective for the treatment of chronic obstructive pulmonary disease (COPD)?

Evidence-Based Answer

Inspiratory muscle training improves symptoms, physical fitness, and quality of life in patients with COPD. When combined with pulmonary rehabilitation, inspiratory muscle training makes no difference compared with pulmonary rehabilitation alone.1 (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Primary care physicians treat approximately 80% of patients with COPD in the United States.2 Pulmonary rehabilitation is an individualized, supervised program incorporating physiotherapy, nutritional and psychosocial care, and limb training. The Global Initiative for Chronic Obstructive Lung Disease guideline recommends pulmonary rehabilitation because it improves symptoms, exercise capacity, and quality of life across all grades of COPD severity. Inspiratory muscle training uses targeted exercises and devices to increase the strength and endurance of the diaphragm and intercostal muscles because weakness of inspiratory muscles is associated with dyspnea and respiratory failure in COPD.3 Inspiratory muscle training is not typically included in pulmonary rehabilitation. The authors of the Cochrane review sought to determine if inspiratory muscle training alone or in combination with pulmonary rehabilitation can improve symptoms of COPD.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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