Incentive Spirometer and Inspiratory Muscle Training

Introduction

Postoperative pulmonary complications demand significant medical attention due to their potential for serious consequences. The incentive spirometer is a valuable tool in pulmonary rehabilitation, aiding in inspiratory muscle training to prevent such complications. Inspiratory muscle training and breathing exercises are cost-effective interventions for improving asthma control, positively impacting pulmonary function, muscle strength, functional capacity, and quality of life. Inspiratory muscle training, involving resistance exercises for inspiratory muscles, offers additional benefits, including reduced dyspnea, oxygen consumption during breathing, and improved emotional well-being.

What Is an Incentive Spirometer?

An incentive spirometer measures the air volume drawn into the lungs during inhalation. As the patient breathes in through it, a piston inside the device rises to measure the inspired air volume. Widely utilized in physical, speech, and respiratory therapy, the incentive spirometer promotes slow, deep breathing and aids in lung expansion and airway clearance, akin to the natural deep breaths observed during yawning or sighing.

The device provides visual feedback to evaluate a patient’s inspiratory effort by tracking inhalation volume. It is a cost-effective and easily manageable tool in rehabilitation, devoid of known side effects. Simple to learn and operate independently, it fosters patient compliance through visual reinforcement.

Research indicates that incorporating incentive spirometry into inspiratory muscle training helps maintain or enhance inhaled lung volume, reduces postoperative lung infections, and facilitates sputum clearance. However, findings on its efficacy for chronic conditions vary. Inspiratory muscle training remains pivotal in mitigating postoperative pulmonary complications. Utilizing an incentive spirometer post-surgery aids in preserving lung integrity, promoting airway clearance, and preventing lung collapse. Encouraging deep breathing facilitates secretion movement and lung expansion, which is crucial for recovery.

What Are the Indications for an Incentive Spirometer and Inspiratory Muscle Training?

Indications for inspiratory muscle training are:

1. General Surgery With Hospital Stays Exceeding One Day: Incentive spirometry alone is not sufficient for preventing postoperative pulmonary complications. It should be integrated into a comprehensive pulmonary rehabilitation plan, which includes deep breathing techniques, directed coughing, effective pain management, and early mobilization. The recommended incentive spirometer regimen involves ten sessions per day, each comprising correct inhalation of up to 500 ml ten times per session. Additional measures to prevent lung complications post-surgery include oral care, elevating the head of the bed by at least 30 degrees, engaging in multiple daily transfers upon surgeon approval, ambulation, and sitting upright during meals.

2. Prolonged Bed Rest: Extended immobility affects various organ systems, including the respiratory system, leading to decreased ventilation, atelectasis, and pneumonia. Atelectasis, characterized by lung or alveolar collapse, is a common post-surgical respiratory complication.

3. Patients With Neuromuscular Diseases or Spinal Cord Injuries: Individuals with cervical or upper thoracic spinal cord injuries experience impaired respiratory muscle function, resulting in pulmonary dysfunction and difficulty with deep breathing. Those with tetraplegia face more severe pulmonary challenges compared to those with paraplegia. Respiratory muscle training is crucial for all spinal cord injury patients, particularly those with tetraplegia or chronic spinal cord injuries.

4. In children with cerebral palsy, incentive spirometry has improved pulmonary function and speech production control.

5. Following rib fractures, patients are at risk of various complications such as hemothorax, pneumothorax, and atelectasis. Incentive spirometry has effectively reduced pulmonary complications and improved lung function in these cases.

6. For individuals with chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation is essential for managing exacerbations and improving overall health. While incentive spirometry and inspiratory muscle training offer short-term benefits for exercise capacity and dyspnea, they should be integrated into a comprehensive COPD management plan alongside lifestyle modifications and physical exercise.

7. In patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer, the use of incentive spirometry and inspiratory muscle training has been shown to lower hospitalization costs and reduce the incidence of postoperative pneumonia.

8. Acute chest syndrome is a complication in children with sickle cell disease, necessitating prompt management with interventions including incentive spirometry to optimize lung function and support respiratory health.

9. Patients with ankylosing spondylitis may benefit from incentive spirometry to improve pulmonary function and arterial blood gasses.

10. In Parkinson’s disease, respiratory dysfunction, though not widely recognized, may manifest with early inspiratory muscle weakness and progress to limited chest mobility and compromised lung expansion, increasing the risk of aspiration pneumonia, particularly in advanced stages. Inspiratory muscle training can be beneficial for managing respiratory issues in Parkinson’s disease patients.

11. Breathing exercises offer potential for adults with mild to moderate asthma, improving quality of life, hyperventilation symptoms, and lung function.

12. In cases of COVID-19, pulmonary rehabilitation, including inspiratory muscle training, is recommended for patients experiencing mild to severe symptoms, such as pneumonia and secretion clearance difficulties. It also proves beneficial for those recovering from mechanical ventilation. However, breathing techniques are not indicated for patients with dry, nonproductive coughs or unchanged thorax radiography findings.

What Is an Incentive Spirometer Device?

The incentive spirometer is a handheld breathing device that instructs patients to take slow, deep breaths through a mouthpiece, providing visual feedback on inhalation volume. Two main types exist: volume-oriented and flow-oriented devices.

Flow-oriented spirometers typically feature three chambers with balls that rise with increasing airflow, indirectly indicating the inhaled volume. In contrast, volume-oriented spirometers use a one-way valve to prevent exhalation into the device. They include a slider to set a target breath volume, with an indicator showing the volume displaced as the patient inhales.

The patient aims to achieve maximal inspiratory volume and hold for five to ten seconds before exhaling and returning the device’s piston to its starting position.

Research suggests that volume-oriented spirometers require less effort and promote diaphragmatic exercise, while flow-oriented devices increase upper chest muscle activity. Volume-oriented spirometry had demonstrated greater effectiveness in improving pulmonary function, functional capacity, and difficulty questionnaire scores compared to flow-oriented spirometry and diaphragmatic breathing exercises.

What Are the Contraindications of an Incentive Spirometer?

While no absolute contraindications exist for using an incentive spirometer, certain precautions should be observed during inspiratory muscle training. Caution is warranted in individuals with respiratory tract infections, unexplained hemoptysis, pneumothorax, uncontrolled hypertension, aneurysm, recent thoracic, abdominal, or eye surgery, as well as in cases of nausea, vomiting, confusion, or dementia.

Patients with bullous emphysema should use the incentive spirometer cautiously, especially in high-intensity settings. Aggressive use of the device may potentially lead to partial lung collapse, as observed in a reported case. This risk is attributed to the repeated forceful inspirations under resistance, which can cause significant swings in intrathoracic pressure and increase stress on lung tissue, particularly in individuals with emphysema and lung hyperinflation.

Conclusion

Incentive spirometers and inspiratory muscle training are valuable pulmonary rehabilitation and respiratory care interventions. They offer effective means to improve lung function, enhance respiratory muscle strength, and reduce the risk of pulmonary complications in various clinical settings. With proper implementation and adherence, these techniques contribute significantly to managing and preventing respiratory issues, ultimately improving patients’ overall quality of life and health outcomes.