Expiratory Muscle Training in Bronchiectasis
Condition: Bronchiectasis
MeSH terms: Bronchiectasis
Study type: Interventional

Summary: 
      Reduced exercise tolerance is commonly reported in patients with bronchiectasis. The purpose
      of this study is to evaluate the effects of expiratory muscle training (EMT) and sham EMT
      (control) on exercise capacity, respiratory function and respiratory muscle strength, cough
      strength and health related quality of life in patients with bronchiectasis.
    

Detailed description: 
      Disruption of the mucociliary clearance mechanism in patients with bronchiectasis leaves the
      lungs vulnerable. With the accumulation of secretions, a vicious cycle of bacterial infection
      and inflammation begins. Intense inflammation causes damage and bronchial wall weakness.
      Problems arise with effective coughing. This leads to decreased clearance of secretions,
      resulting in decreased expiratory flow. Symptoms of bronchiectasis; often productive cough,
      dyspnea, fatigue and wheezing. Altered pulmonary mechanics, inadequate gas exchange,
      decreased muscle mass, and accompanying psychological problems can cause dyspnea and
      decreased exercise capacity, thus reducing quality of life. Exercise capacity may also
      decrease in individuals with bronchiectasis due to increased dyspnea perception and
      limitation of expiratory flow. The need for safe and viable exercise interventions to reduce
      the burden of the disease is evident in individuals with bronchiectasis. Respiratory muscle
      training is applied by using skeletal muscle training principles in order to increase
      respiratory muscle strength and endurance, to correct the length-tension relationship of
      respiratory muscles and to increase respiratory capacity. Decreased expiratory muscle
      strength is associated with decreased quality of life and exercise tolerance. In addition, in
      a study, it was shown that in addition to expiratory muscle weakness, expiratory muscle
      endurance decreases in respiratory patients. This decrease is closely related to the severity
      of airway obstruction and the decrease in the strength of other muscle groups.

      In order to meet the increased metabolic needs during exercise and to keep gas exchange at a
      sufficient level, patients with bronchiectasis; they must increase minute ventilation as
      appropriate. These patients with expiratory flow limitation at rest breathe at higher lung
      volumes to increase ventilation during exercise, and as a result, adverse conditions such as
      worsening of dynamic hyperinflation, increased intrinsic PEEP, increased workload on
      respiratory muscles and dyspnea are observed. As a result, these patients cannot achieve high
      levels of tidal volume and ventilation. In addition, significantly reduced maximal voluntary
      ventilation in patients with flow-limited bronchiectasis; It is also related to airway
      obstruction and mechanical deterioration. Decreased exercise capacity has also been shown to
      be associated with peak exercise desaturation. Those with abnormal lung mechanics (low FEV1,
      FVC, and tidal expiratory flow limitation) and high dyspnea score measured by MRC reflect a
      decrease in exercise capacity. In a study in bronchiectasis, maximal inspiratory and maximal
      expiratory respiratory muscle strengths evaluated with an intraoral pressure measurement
      device had similar demographic characteristics. significantly lower than in healthy
      individuals. However, in the respiratory muscle trainings, inspiratory muscle training was
      emphasized and expiratory muscle training was never given.
    

Intervention name(s): EMST150 (Expiratory muscle training); Sham EMST150 (Expiratory muscle training)
Intervention type(s): Other; Other
Intervention description(s): Respiratory exercise device (Expiratory muscle trainer) developed for the expiratory muscles, and resistant expiratory muscle training were applied. Threshold loading was applied to the cases at approximately 30% of the respiratory muscle strength values measured in the 1st week. In respiratory muscle training, the pressure value was increased according to the tolerance of the patient and training was given at a pressure value between 50-75%. The subjects were asked to do 10 vigorous expirations at the adjusted pressure value by doing normal inspiration for expiratory muscle training in a comfortable sitting position. This program was applied in 3 sets in the same way for approximately 30 minutes. It was continued 3 days a week for 8 weeks; The subjects were asked to perform normal inspiration and then exhale 10 times for expiratory muscle training without threshold loading. This program was applied in 3 sets in the same way for approximately 30 minutes. It will continue 3 days a week for 8 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Bronchiectasis; cough strength; expiratory muscle training; exercise capacity