Original Investigation
Effect of Inspiratory Muscle Training in the Management
of Patients With Asthma
A RANDOMIZED CONTROLLED TRIAL
Neslihan Duruturk, PhD, PT; Manolya Acar, MSc, PT; Mustafa Ilgaz Doğrul, MD
Purpose: The aim of this study was to investigate the effects
of inspiratory muscle training (IMT) on respiratory muscle
strength, exercise capacity, dyspnea, fatigue, quality of life, and
daily living activities of asthmatic patients.
Methods: Thirty-eight asthmatic patients, between 18 and
65 years of age, were enrolled in the study and randomly divided
into 2 groups; IMT (n = 20) or control (n = 18). Participants
in the IMT group performed 30 breaths using a patient-specific
threshold pressure device, twice daily for 6 wk at 50% maximal
inspiratory pressure (MIP), in addition to “breathing training”
during this period. Participants in the control group performed
only the “breathing training” (sham or no threshold pressure
device). Outcome measurements, performed before and after the
intervention, included pulmonary function test, respiratory mus-
cle strength, 6-min walk test, modified Medical Research Coun-
cil dyspnea scale, St George’s Respiratory Questionnaire, Fatigue
Severity Scale, and London Chest Activity of Daily Living scale.
Results: Among the outcomes in the study, changes to key
variables including MIP (P < .01); MIP, percent predicted
(P < .01); maximal expiratory pressure (MEP), percent predicted
(P < .01); 6-min walk test walking distance (P = .001); modified
Medical Research Council scale (P = <.001); Fatigue Severity
Scale (P = .03); St George’s Respiratory Questionnaire symp-
toms (P = .03); London Chest Activity of Daily Living domestic
(P = .03); and London Chest Activity of Daily Living leisure (P
= .01) were significantly different in favor of IMT versus con-
trol.
Conclusion:  These findings suggest that IMT may be an effec-
tive modality to enhance respiratory muscle strength, exercise
capacity, quality of life, daily living activities, reduced perception
of dyspnea, and fatigue in asthmatic patients.
Key Words: asthma • breathing training • exercise capacity •
inspiratory muscle training • quality of life
A sthma is a chronic inflammatory disease of the airways
characterized by variable airflow limitation and air-
way hyperresponsiveness.1,2 The chronic airflow limitation
caused by chronic obstructive pulmonary disease (COPD)
or asthma changes the shape and position of the diaphragm.
This alteration is believed to be due to an increase in lung
Author Affiliations: Department of Physical Therapy and Rehabilitation,
Faculty of Health Sciences (Dr Duruturk and Ms Manolya Acar) and
Department of Chest Diseases, Faculty of Medicine (Dr Doğrul), Baskent
University, Ankara, Turkey.
The authors declare no conflicts of interest.
Correspondence: Neslihan Duruturk, PhD, PT, Department of Physiotherapy
and Rehabilitation, Faculty of Health Sciences, Baskent University, Eskisehir
Rd 18.km, 06790, Ankara, Turkey (nalkan@baskent.edu.tr).
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/HCR.0000000000000318
198    Journal of Cardiopulmonary Rehabilitation and Prevention 2018;38:198-203
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
volume. Increased lung volume modifies the chest wall ge-
ometry and shortens the inspiratory muscles, reducing their
capacity. A decline in the inspiratory muscle strength leads
to dyspnea and respiratory muscle fatigue.3 This leads to
reductions in key parameters such as maximal breathing
capacity and maximal exercise tolerance in these patients
over time.4
Treatment of asthma aims to control the clinical man-
ifestations of the disease, exacerbation risks, accelerated
decline in lung function, and drug-induced side effects. Al-
though clinical control of asthma can be achieved by phar-
macological treatment, pulmonary rehabilitation and inspi-
ratory muscle training (IMT) can be beneficial in improving
the overall functional capacity and reducing dyspnea and
thus reducing the need for health care intervention.5-7
Previous studies have shown that IMT promotes dia-
phragm hypertrophy in healthy people and in patients with
COPD and chronic heart failure.2,8 Inspiratory muscle train-
ing is a technique intended to improve the strength of the
diaphragm and other accessory muscles of respiration.2 Yet,
its effects on clinical outcomes in patients with asthma are
unclear.
A limited number of studies have investigated the effects
of IMT in patients with asthma and have found improve-
ments in inspiratory muscle strength, pulmonary function,
and a decrease in asthma symptoms.2,9-13 However, the im-
pact of IMT on exercise tolerance, quality of life, exertional
dyspnea, fatigue, and daily living activities in people with
asthma remains unknown. Moreover, it is important to
identify low-cost alternatives to asthma treatment due to
an increasing prevalence of asthma and rising health care
costs. Inspiratory muscle training is emerging as a low-
cost alternative,13 and more evidence is being generated
supporting IMT as a viable treatment option in managing
chronic diseases such as asthma. The purpose of this study
was to determine the effects of IMT on inspiratory muscle
strength, pulmonary function, exercise capacity, quality of
life, dyspnea, fatigue, and daily living activities of asthmatic
patients.
METHODS
PATIENTS
Thirty-eight participants with asthma were selected from
Baskent University Hospital, Department of Chest Diseas-
es. Among them, 30 patients completed all aspects of the
study (Figure). Inclusion criteria were age between 18 and
65 y and diagnosed with asthma according to the Global
Initiative for Asthma criteria.14 All individuals in the study
had mild to moderate persistent asthma and were in stable
condition, with a resting forced expiratory volume in the
first second of expiration (FEV1) >70% of predicted, and
were taking prescribed maintenance medications. Patients
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Figure. Flow diagram of the study participants. Abbreviation: IMT, inspiratory muscle training.
were excluded if they were considered clinically unstable or
had a neuromuscular disease, unstable cardiovascular dis-
ease, or musculoskeletal disease that may interfere with ex-
ercise. The study was approved by the Medical Ethics Com-
mittee of Baskent University (#KA13\239), and all patients
gave their informed consent before participation.
STUDY DESIGN AND INTERVENTION
Patients were randomly assigned to either the IMT group
(n = 20) or the control group (n = 18), followed by mea-
surement of baseline variables. Patients were randomized to
either of the 2 groups by an independent therapist selecting
patient information from an envelope in blinded fashion.
Subsequently, clinical assessments were conducted by a
physiotherapist, followed by treatment/interventions that
were administered by a different physiotherapist assigned
to the treatment arm of the study.
At the beginning of the study, a formal educational ses-
sion, lasting about 30 min, was given by the physiotherapist
dealing with the treatment/interventions. The education ses-
sion informed subjects about bronchial hygiene techniques
and breathing training, which included breathing control,
pursed-lip breathing, diaphragmatic breathing exercises, and
thoracic expansion exercises. While subjects in the control
group received only the education session, subjects in the
IMT group made additional hospital visits, 3 times per week
for 6 wk for breathing training and the IMT program using
a patient-specific threshold pressure device (POWERbreathe,
HaB International). The POWERbreathe was applied for
30 dynamic inspiratory efforts, twice daily, at a pressure
threshold load that was 50% of maximal inspiratory pres-
sure (MIP). In addition, heart rate and peripheral arterial
saturation were measured by pulse oximeter, and blood
pressure was measured using a sphygmomanometer to help
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Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
ensure patient safety. These exercises were provided to the
participants under the supervision of a physiotherapist.
OUTCOME MEASURES
Physical and sociodemographic characteristics of all pa-
tients were recorded at admission (Table 1). Pulmonary
function testing was performed using a clinical spirometer
(Vmax 229; Sensor Medics) according to the guidelines
of the American Thoracic Society.15 Parameters including
FEV1, forced vital capacity (FVC), ratio of FEV1 to FVC
(FEV1/FVC), and forced expiratory flow at 25% to 75%
of FVC were measured. To determine respiratory muscle
strength, MIP and maximal expiratory pressure (MEP)
were evaluated using the spirometer.16,17
Six-min walk test (6MWT) was used to determine func-
tional exercise capacity. The 6MWT was chosen because it
is easier to administer, better tolerated, and better reflects
activities of daily living than other walk tests. It has been
widely used for measuring the response to therapeutic in-
terventions for pulmonary diseases.18 The 6MWT was con-
ducted in a 30-m flat corridor and participants were asked
to walk at their own walking speed for 6 min. The 6MWT
was administered twice on the same day with a 30-min in-
terval between tests and the greatest 6MWT walking dis-
tance was recorded.19
The modified Medical Research Council dyspnea scale
was used to assess the severity of dyspnea during activi-
ty. The modified Medical Research Council scale consists
of 5 statements that describe the complete range of dys-
pnea, starting with grade 0 (absence of dyspnea during
strenuous exercise) to grade 4 (dyspnea during daily living
activities).20,21
Perceived fatigue was assessed using the Turkish ver-
sion of Fatigue Severity Scale (FSS).22 The FSS consists of
Effect of IMT in Patients With Asthma     199
 Table 1 difference between pre- and post-intervention values) were
made using the Mann-Whitney U test and the comparisons
Baseline Characteristics of the Patientsa
between baseline and post-training values were made using
IMT Group Control Group P Valueb the nonparametric Wilcoxon test for each group.
Female/male, n 14/6 17/1
The primary outcome measure for this study was the
Age, y .447
change in MIP values. We found that group sample size of
46.50 ± 13.38 42.72 ± 18.85
17 and 14 achieved 99% power to show an improvement
(22.00-64.00) (20.00-65.00)
in primary outcome measurement and having a significance
Body mass index, 27.44 ± 6.15 24.60 ± 5.21 .135 level (α) of .05, using a 2-sided Mann-Whitney U test, as-
  kg/m2 (18.90-44.37) (15.01-33.00) suming normal distribution.26-28
FEV1, % predicted 92.95 ± 25.70 91.66 ± 22.03 .870
(43.00-136.00) (54.00-134.00)
FEV1, L 2.89 ± 1.29 2.78 ± 0.91 .748 RESULTS
(1.01-7.32) (1.13-4.24) Forty-eight patients with asthma were screened for the
FVC, L 3.82 ± 1.31 3.34 ± 0.95 .206 study and 38 fulfilled the selection criteria and were ran-
(1.73-7.32) (1.68-5.30) domly assigned to 1 of the 2 groups; IMT group = 20
FEV1/FVC, % 73.54 ± 12.40 80.50 ± 15.35 .132 (14 females/6 males) and the control group = 18 (17 females/
(52.00-95.00) (52.00-105.00) 1 male) (Figure).
MIP, kPa .558 Compliance with the exercise intervention was very
5.11 ± 3.18 4.30 ± 1.86
good; the IMT group attended an average of 16 out of the
(0.40-12.30) (0.40-7.90)
18 (89%) breathing exercise sessions. There were no base-
MIP, % 59.90 ± 27.35 56.38 ± 23.11 .682
line differences in the characteristics and clinical profiles
(15.00-116.00) (15.00-113.00) between patients in the 2 groups (Table 1). In the control
MEP, kPa 6.75 ± 4.13 5.71 ± 3.03 .388 group, 2 patients had disease exacerbation and 1 partic-
(0.90-15.90) (2.20-11.80) ipant required hospital admission, whereas no such inci-
MEP, % 42.79 ± 17.18 50.22 ± 27.64 .482 dents occurred in the IMT group.
(16.00-80.00) (15.00-122.00)
6MWD, m 445.70 ± 130.07 426.00 ± 172.95 .650 CHANGES IN PULMONARY FUNCTION
(260.00-660.00) (135.00-780.00) Pulmonary function test results indicated no significant
Abbreviations: FEV1, forced expiratory volume in the first second of expiration; FVC, forced
differences between the IMT and control groups for either
vital capacity; IMT, inspiratory muscle training; MEP, maximal expiratory pressure; MIP, baseline or after the 6-wk intervention measurements. Al-
maximal inspiratory pressure; 6MWD, 6-min walk distance. though FVC was significantly lower in the control group
a
Data reported as mean ± standard deviation and range within parentheses unless (P = .041), no significant differences were observed between
otherwise noted. the IMT and control groups in other test results (Table 2).
b
P value calculated using Mann-Whitney U test.
CHANGES IN MAXIMAL RESPIRATORY PRESSURES
Relative to baseline values, the MIP (P = .001), MIP % pre-
9 validated questions that indicate a perception of fatigue dicted (P < .001), and MEP % predicted (P = .003) post-
based on the responses. It has a scale that ranges from 0 to 7 intervention values were significantly increased in the IMT
(0 = absolute disagreement to 7 = absolute agreement). An group, whereas in the control group there were no significant
FSS score of 36 or more indicates significant fatigue. improvements in any maximal respiratory pressure parame-
St George’s Respiratory Questionnaire (SGRQ), which is ters. When baseline and 6-wk values were compared between
validated for use with both patients with COPD and asth- groups, the changes were significantly different in favor of the
ma, was used to determine disease-specific quality of life.23 IMT versus the control groups; MIP (P < .001), MIP % pre-
It consists of 50 items divided into 3 parts that measure dicted (P < .001) and MEP % predicted (P = .002) (Table 2).
symptoms, activity limitation, and social/emotional im-
pact of the disease. Each item is recorded and subsequent-
CHANGES IN FUNCTIONAL CAPACITY, DYSPNEA,
ly weighted by the degree of distress associated with each
symptom. St George’s Respiratory Questionnaire scores AND FATIGUE
range from 0 (no impairment to quality of life) to 100 (poor Six-min walk test walking distance significantly improved
quality of life).24 in the IMT group (P < .001) and the walking distance was
Physical activity in daily life was evaluated by the London significantly different (P = .001) versus the control group
Chest Activity of Daily Living scale. This 15-item question- (Table 2). The improvement for the IMT group was 57.77
naire was designed to determine dyspnea during routine daily ± 37.54 m versus 10.79 ± 18.06 m for the control group.
activities.25 It is divided into 4 components: self-care; domes- The dyspnea perception score during activity significant-
tic; physical; and leisure. For each activity, patients score from ly decreased only in the IMT group (P = .001). Also, the
0 (I would not do it anyway) to 5 (someone else does this for post-intervention modified Medical Research Council scale
me [or helps]). Total scores range from 0 to 75, with higher score was significantly lower in the IMT group than in the
scores indicating a greater limitation in daily living activity. control group (P < .001) (Table 2).
Fatigue perception decreased significantly in the IMT
STATISTICAL ANALYSIS group only (P = .028) following the intervention. Signifi-
Statistical analysis was performed using SPSS software, v. cant changes were found in the FSS score between the IMT
22 (IBM). Data only from participants who completed the and control groups (P = .037) (Table 2).
trial were included and reported as mean ± standard de-
viation. Homogeneity and normality tests determined the CHANGES IN QUALITY OF LIFE AND DAILY LIVING
statistical methods that were used. When data were nor- ACTIVITIES
mally distributed, paired t tests were employed. Otherwise, Based on quality of life measures using the SGRQ, no signifi-
the comparisons of change scores between the groups (the cant changes were observed as a result of the 6-wk intervention

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Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
 Table 2
Pulmonary Function, Respiratory Muscle Strength, Exercise Capacity, Dyspnea, Fatigue, Quality of Life, and Daily Living
Activities Scores Between IMT and Control Groupsa
IMT Group Control Group
Baseline 6 wk P Value b
Baseline 6 wk P b Value P c Value
Pulmonary function
 FEV1, % predicted 92.95 ± 25.70 92.41 ± 21.26 .447 91.66 ± 22.03 91.21 ± 17.09 .083 .181
 FEV1, L 2.89 ± 1.29 2.65 ± 0.84 .326 2.78 ± 0.91 2.54 ± 0.83 .479 .415
  FVC, % predicted 108.55 ± 21.63 108 ± 16.63 .866 96.17 ± 22.63 90.79 ± 15.35 .516 .513
  FVC, L 3.82 ± 1.82 3.78 ± 1.20 .239 3.34 ± 0.95 2.94 ± 0.82 .041 .755
 FEV1/FVC 73.54 ± 12.40 73.94 ± 14.73 .195 80.50 ± 15.35 83.85 ± 14.49 .905 .342
Respiratory muscle strength
  MIP, kPa 5.11 ± 3.19 8.72 ± 4.19 <.001 4.30 ± 1.86 3.94 ± 0.78 .171 <.001
  MIP, % 59.90 ± 27.36 92.71 ± 39.77 <.001 56.39 ± 23.11 60.14 ± 18.16 .976 <.001
  MEP, kPa 6.76 ± 4.13 8.17 ± 4.07 .149 5.71 ± 3.04 5.20 ± 2.42 .585 .168
  MEP, % 42.79 ± 17.19 57.94 ± 27.87 .003 50.22 ± 27.64 52.21 ± 29.19 .266 .002
Exercise capacity
  6MWD, m 445.70 ± 130.07 503.47 ± 92.53 .001 426.00 ± 172.95 436.79 ± 154.89 .527 <.001
Dyspnea
  mMRC score 2.10 ± 0.85 1.50 ± 0.52 <.001 2.00 ± 0.77 1.93 ± 0.73 .317 <.001
Fatigue
  FSS score 38.95 ± 12.91 31.00 ± 10.35 .028 43.61 ± 11.10 44.00 ± 13.17 .661 .037
Quality of life
  SGRQ impact score 21.95 ± 16.67 21.90 ± 13.81 .363 28.32 ± 19.47 27.99 ± 26.65 .861 .313
  SGRQ activity score 43.88 ± 22.18 34.85 ± 17.86 .057 54.09 ± 21.71 46.39 ± 26.51 .074 .372
  SGRQ symptoms score 43.88 ± 22.18 34.45 ± 19.26 .088 45.79 ± 17.93 43.93 ± 24.04 .594 .034
  SGRQ totals score 28.59 ± 19.48 27.24 ± 12.62 .199 37.59 ± 17.62 35.51 ± 21.80 .726 .220
Daily living activities
  LCADL self-care score 3.85 ± 4.03 3.50 ± 3.63 .556 3.11 ± 4.35 3.21 ± 3.40 .102 .129
  LCADL domestic score 8.20 ± 6.07 6.69 ± 5.13 .086 8.44 ± 7.83 9.43 ± 8.02 .139 .034
  LCADL physical activity score 4.05 ± 2.44 3.13 ± 2.16 .045 4.83 ± 2.57 5.00 ± 2.25 .813 .108
  LCADL leisure score 2.80 ± 2.38 2.00 ± 1.79 <.001 2.33 ± 2.61 3.57 ± 2.47 .051 .014

Abbreviations: FEV1, forced expiratory volume in the first second of expiration; FSS, Fatigue Severity Scale; FVC, forced vital capacity; IMT, inspiratory muscle training; LCADL, London
Chest Activity of Daily Living scale; MEP, maximal expiratory pressure; MIP, maximal inspiratory pressure; mMRC: modified Medical Research Council Dyspnea Scale; SGRQ, Saint George’s
Respiratory Questionnaire; 6MWD, 6-min walk test distance.
a
Data reported as mean ± standard deviation.
b
Within group differences comparing baseline vs 6-wk values.
c
Between group differences for change from baseline using Wilcoxon test or Mann-Whitney U test.

in either group. However, the SGRQ symptom score was sig-
nificantly lower (P = .034) for the IMT group than that for
the control group following the intervention (Table 2).
The London Chest Activity of Daily Living scale physical
activity score significantly decreased in the IMT group (P =
.045), but no significant differences were observed between
the 2 groups. When changes between the baseline and 6-wk
values were compared, significant differences were found in
the London Chest Activity of Daily Living domestic (P =
.034) and leisure scores (P = .014) (Table 2).
DISCUSSION
Inspiratory muscle training has been shown to positively in-
fluence inspiratory muscle strength and dyspnea, but the ex-
act mechanisms remain unclear in individuals with asthma.
This study investigated the effects of an IMT program on
inspiratory muscle strength, exercise capacity, dyspnea, fa-
tigue, daily living activities, and health status in those with
asthma. The main finding of this randomized controlled
study was that an MT program, using an external resistive
device combined with traditional respiratory exercises, was
more effective than programs employing traditional respi-
ratory exercises in improving inspiratory muscle function,
exercise capacity, daily living activities, quality of life, and
in reducing dyspnea and fatigue in patients with asthma.
A 2013 Cochrane review,2 which reviewed 5 studies,
found substantial differences between the different stud-
ies in terms of the training protocol, duration of training
sessions (10-30 min), and duration of the intervention
(3-25 wk). However, the risk of bias in the reviewed studies
was difficult to accurately ascertain because of poor report-
ing of methods. Despite this, most studies indicated a sig-
nificant increase in inspiratory muscle strength due to IMT,
except for 1 trial2 that indicated no significant difference be-
tween the IMT group and the control group for MEP, peak
expiratory flow rate, FEV1, FVC, and sensation of dyspnea.
Nonetheless, authors of the review article concluded that
there was no conclusive evidence to either promote or not
use IMT for asthma.2
Results from previous studies, which measured lung
function in persons with asthma following an IMT pro-
gram, have been variable regarding the benefits of using
IMT. Some studies have demonstrated an increase in FEV1

www.jcrpjournal.com Effect of IMT in Patients With Asthma     201

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
and FVC,9,29,30 whereas others have shown no changes in
these parameters.11,12,18,31 Also, in our study, lung function
did not significantly change after IMT for 6 wk. This might
have been due to the short duration of IMT or may have
been related to the specific characteristics of the asthmatic
patients in our study.
Based on previous reports, the effect of administering
IMT in patients with asthma, as determined primarily by in-
spiratory and expiratory strength measurements, consistent-
ly demonstrated significant improvement in inspiratory mus-
cle strength.9-13,18,31-33 For example, Shei et al13 observed that
improvement in inspiratory muscle strength may partly de-
fuse the increased effort of respiration leading to a decrease
in dyspnea and asthma symptoms. Similar to previous re-
ports11,18,31 the current study found significant improvements
in parameters such as MIP and a reduction in dyspnea per-
ception. In addition, our study found that IMT program par-
ticipants also demonstrated less fatigue and had improved
expiratory muscle strength. The inclusion of breathing train-
ing in the study program may have contributed to this effect.
It is thought that increased work of breathing can con-
tribute to dyspnea or fatigue and reduce exercise tolerance in
patients with asthma, but thus far, only 1 study34 has deter-
mined the impact of IMT on the exercise capacity of asthmat-
ic patients. The authors of that study found that asthmatic
individuals, who performed 6 wk of IMT, had improved in-
spiratory muscle strength, reduced oxygen consumption, and
perception of dyspnea during exercise. Similarly, the current
study found a significant improvement in 6MWT walking
distance attributed to IMT. It has been previously established
from pulmonary rehabilitation studies that an improvement
in 6MWT walking distance between 25 and 35 m is clinical-
ly relevant.35 In the current study, the walking distance was
improved 57.8 ± 37.5 m (from 445.7 m to 503.5 m) in the
IMT group compared with the improvement of 10.8 ± 18.1 m
(from 426 m to 436.8 m) in the control group.
New concepts in the treatment and management of
asthma focus on “control” and improvement in “quali-
ty-of-life” measures. Based on patient-reported outcome
measures, practical ways to design asthma control can be
used.19 Generally, patients with asthma have a lower level
of physical fitness, have fewer activities of daily living com-
pared with their peers, and have decreased health-related
quality of life.36 Increasing independence in daily activities
remains an important goal in pulmonary rehabilitation.
Although reduced perception of breathlessness during dai-
ly activities and improvement in overall health status is a
well-accepted outcome of IMT in COPD patients,37 such
outcomes in patients with asthma have not been reported.
However, 1 clinical trial found that children who engaged
in IMT had no difficulty with activities of daily living in
follow-up studies, compared with children who were not
administered IMT.33 Similarly, another study demonstrated
an average decline of 1.7 d of missed work in patients who
received IMT.9 To the best of our knowledge, the current
study is the first study showing positive effects from IMT
on activities of daily living and health-related quality of life
(symptom score) in patients with asthma.
Two important findings in this study were reduced hos-
pital admissions and exacerbation rates attributed to IMT.
Compared with the control group that had 2 patients with
disease exacerbations, and 1 patient needing to be admitted
to a hospital, no such cases occurred in the IMT group.
Furthermore, the exercise program appeared to be safe and
there were no adverse effects reported by the participants
after any exercise sessions.
This study had some limitations. The exercise program
was administered only for a short period of 6 wk. A longer
202    Journal of Cardiopulmonary Rehabilitation and Prevention 2018;38:198-203
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
intervention period, the inclusion of placebo-controlled
group, and a greater number of patients may have better
substantiated the overall effectiveness of an IMT program.
CONCLUSION
In conclusion, inspiratory muscle strength training in pa-
tients with asthma can lead to improvements in respiratory
muscle performance, exercise capacity, activities of daily liv-
ing, health-related quality of life, and a further decline in
dyspnea and fatigue. Therefore, in addition to existing phar-
macological and nonpharmacological treatment modalities,
our study demonstrated that IMT can be an additional ther-
apeutic modality offering tangible benefits to asthmatic pa-
tients. The current studies clearly demonstrated the need to
carry out more randomized controlled trials, particularly in
children and in patients with more severe asthma.
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