Inspiratory Muscle Training for Breathless Patients With Chronic Obstructive Pulmonary Disease and Heart Failure

October 14, 2016 updated by: Dr. J. Alberto Neder, Queen's University

Inspiratory Muscle Training for Dyspneic Patients With COPD-HF Overlap: a Multicenter, Randomized Controlled Trial

The purpose of this study is to determine whether inspiratory muscle training is effective to improve breathless and exercise intolerance in symptomatic patients with chronic obstructive pulmonary disease (COPD) plus chronic heart failure (HF).

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Chronic obstructive pulmonary disease (COPD) and heart failure with reduced left ventricular ejection fraction (HF) are leading causes of disability and death worldwide. Unfortunately, COPD and HF coexist in up to a third of elderly patients making the so-called COPD-HF overlap (CHO) a major challenge to Health Care Systems. In addition, population ageing anticipates that CHO prevalence will further increase in the next decades.

Intolerance to exertion due to disabling breathlessness is the hallmark of COPD and HF and these abnormalities are notoriously potentiated by diseases coexistence.

The inspiratory muscles are centrally related to the pathophysiology of exertional dyspnea in COPD and HF. In both populations a higher central motor command output is required to maintain adequate force generation in the face of weaker inspiratory muscles. This information is interpreted as "shortness of breath".

There is well established evidence gained from recent meta-analyses indicating that inspiratory muscle training (IMT), as a standalone therapy, significantly improves inspiratory muscle function (strength and endurance), dyspnea during daily activities, and functional exercise capacity in COPD and HF. Previous findings indicate that reduced pressure-generating capacity reflecting inspiratory muscle weakness is frequently observed in patients with COPD-HF and related to a clinically-relevant outcome: exertional dyspnea. These findings set the scene for a randomized controlled trial to investigate the potential role of IMT in dyspnea palliation in CHO patients.

Objectives

To determine the effects of IMT on:

  1. Dyspnea on daily life
  2. Inspiratory muscle strength and endurance
  3. Dyspnea on exertion and time to exercise intolerance

Study Type

Interventional

Enrollment (Anticipated)

50

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: J Alberto Neder, MD, PhD
  • Phone Number: 3198 (+1) 613-549-6666
  • Email: nederalb@gmail.com

Study Contact Backup

  • Name: Daniel M Hirai, PT, PhD
  • Phone Number: 3198 (+1) 613-549-6666
  • Email: dmh4@queensu.ca

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Previous diagnoses of COPD and HF under optimized clinical treatment as judged by the accompanying physician
  • Reduced left ventricular ejection fraction (<50%)
  • Non-reversible airway obstruction (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80 %)
  • Respiratory muscle weakness (Pi,max < 70cmH2O)
  • Persistent dyspnea on daily life (Baseline Dyspnea Index focal score <or= 8).

Exclusion Criteria:

  • Inability to perform exercise tests
  • Diagnosed psychiatric or cognitive disorders
  • Progressive neurological or neuromuscular disorders having a major impact on exercise capacity

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Inspiratory Muscle Training (IMT)
POWERbreathe®KHA (IMT group)
Device: POWERbreathe®KHA (IMT group)
2 training sessions/day consisting of 30 breaths (~50% maximal inspiratory pressure; Pi,max), 7 days/week (once/week supervised at research center), for 8 weeks using an electronic tapered flow resistive loading (TFRL) device (POWERbreathe®KH2, HaB International Ltd., Southam, UK). Measurements of PImax will be performed every week and training loads will be increased continuously to maintain the actual ~50% Pimax values.
Sham Comparator: Sham Training
POWERbreathe®KH2 (sham group)
Device: POWERbreathe®KH2 (sham group)
2 training sessions/day of 30 breaths at an inspiratory load of no more than 10% of their initial Pi,max (POWERbreathe®KH2, HaB International Ltd., Southam, UK). This training load will not be changed during the entire study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Dyspnea on daily life
Time Frame: 8 weeks
Measured by the Baseline Dyspnea Index (BDI)
8 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Inspiratory muscle strength as measured by spirometry
Time Frame: 8 weeks
Measured by Maximal Static Inspiratory Pressures (Pi,max)
8 weeks
Inspiratory muscle endurance as measured by a PowerBreathe device
Time Frame: 8 weeks
Assessed by Endurance Respiratory Muscle Protocol (Patients will breathe against 60% of Pi,max inspiratory load until task failure)
8 weeks
Dyspnea on exertion
Time Frame: 8 weeks
Measured by Borg score during high intensity constant load cycling exercise test
8 weeks
Time to exercise intolerance (Tlim)
Time Frame: 8 weeks
Evaluated by high intensity constant load cycling exercise test
8 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Lung hyperinflation
Time Frame: 8 weeks
Evaluated by serial measurements of inspiratory capacity during high intensity constant load cycling exercise test
8 weeks
Endothelial function as measured by non-invasive ultrasound images of the brachial artery.
Time Frame: 8 weeks
Measured by ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery
8 weeks
Autonomic function as measured by a 10 lead ECG (MASON-LIKAR Lead electrode placement)
Time Frame: 8 weeks
Measured by heart rate variability explored in the frequency domain
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Queen's University

Collaborators

KU Leuven
Federal University of Rio Grande do Sul
Federal University of São Paulo

Investigators

  • Study Chair: J Alberto Neder, MD, PhD, Queen's University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2015

Primary Completion (Anticipated)

June 1, 2017

Study Completion (Anticipated)

July 1, 2017

Study Registration Dates

First Submitted

March 10, 2015

First Submitted That Met QC Criteria

October 15, 2015

First Posted (Estimate)

October 19, 2015

Study Record Updates

Last Update Posted (Estimate)

October 18, 2016

Last Update Submitted That Met QC Criteria

October 14, 2016

Last Verified

October 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IMT COPD+HF

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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