Does Respiratory Muscle Training Improve Cough Flow in Acute Stroke? Pilot Randomized Controlled Trial. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Kulnik, Stefan Tino; Birring, Surinder Singh; Moxham, John; Rafferty, Gerrard Francis; Kalra, Lalit
• Is Part Of: Stroke. Volume 46:Issue 2(2015)
• Publication Date: 2015-02
• Subjects: Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.114.007110
• Languages: English
• ISSNs: 0039-2499

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background and Purpose—</title> <p>Cough protects the lungs from aspiration. We investigated whether respiratory muscle training may improve respiratory muscle and cough function, and potentially reduce pneumonia risk in acute stroke.</p> </sec> <sec> <title>Methods—</title> <p>We conducted a single-blind randomized placebo-controlled trial in 82 patients with stroke (mean age, 64±14 years; 49 men) within 2 weeks of stroke onset. Participants were masked to treatment allocation and randomized to 4 weeks of daily expiratory (n=27), inspiratory (n=26), or sham training (n=25), using threshold resistance devices. Primary outcome was the change in peak expiratory cough flow of maximal voluntary cough. Intention-to-treat analyses were conducted using ANCOVA, adjusting for baseline prognostic covariates.</p> </sec> <sec> <title>Results—</title> <p>There were significant improvements in the mean maximal inspiratory (14 cmH<sub>2</sub>O; <italic>P</italic><0.0001) and expiratory (15 cmH<sub>2</sub>O; <italic>P</italic><0.0001) mouth pressure and peak expiratory cough flow of voluntary cough (74 L/min; <italic>P</italic>=0.0002) between baseline and 28 days in all groups. Peak expiratory cough flow of capsaicin-induced reflex cough was unchanged. There were no between-group differences that could be attributed to respiratory muscle training. There were also no differences in the 90-day incidence of pneumonia between the groups (<italic>P</italic>=0.65).</p> </sec> <sec> <title>Conclusions—</title> <p>Respiratory muscle function and cough flow improve with time after acute stroke. Additional inspiratory or expiratory respiratory muscle training does not augment or expedite this improvement.</p> </sec> <sec> <title>Clinical Trial Registration—</title> <p>URL: <ext-link ext-link-type="uri" xlink:href="http://www.controlled-trials.com" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.controlled-trials.com</ext-link>. Unique identifier: ISRCTN40298220.</p> </sec> </abstract>