Introduction
Several respiratory disorders can cause diaphragm dysfunction. Diaphragm dysfunction is one of the significant manifestations of respiratory diseases like COPD (chronic obstructive pulmonary disease). Diaphragm dysfunction affects respiratory efficiency and causes progressive exacerbations of COPD, resulting in respiratory failure. Respiratory rehabilitation is a comprehensive treatment plan globally followed to improve health outcomes in patients with respiratory disorders. Respiratory rehabilitation helps improve diaphragmatic strength and endurance, reduces airflow resistance, and enhances dyspnea (shortness of breath) in patients with respiratory diseases.
What Is Respiratory Rehabilitation?
Respiratory or pulmonary rehabilitation is a comprehensive medical program for managing and maintaining patients with chronic respiratory diseases. It refers to a series of therapies administered to improve the quality of life in patients with chronic respiratory diseases. It helps a person breathe better and improves the quality of life in patients with lung disorders such as asthma, COPD, pulmonary hypertension, and cystic fibrosis. It also enhances the quality of life in patients with scoliosis or other diseases that affect the functioning of the lungs. Respiratory rehabilitation is also recommended before and after surgery for a lung transplant or in cases of lung cancer. Respiratory rehabilitation offers strength, reduces anxiety or depression, and helps in managing routine activities. It involves a series of therapies for two or three weekly sessions that last for several weeks or months.
What Is a Diaphragm?
The diaphragm muscle is essential for respiration, which helps in inhalation and exhalation. It is a dome-shaped muscle situated below the lungs and heart, and it separates the chest from the abdomen. The diaphragm muscle is the most essential muscle during inspiration. It contracts to allow an increase in the vertical diameter of the thorax to draw air. It relaxes during expiration to allow the expulsion of air.
Various respiratory disorders restrict airflow and cause persistent respiratory symptoms. These disorders can cause multiple adverse effects, including diaphragm dysfunction resulting in dyspnea and respiratory failure. Diaphragm dysfunction in respiratory diseases may be due to oxidative stress, systemic inflammation, chronic hypoxia (a decrease in the oxygen supply), hyperinflation, and malnutrition. Respiratory rehabilitation is a comprehensive therapy that improves health outcomes in patients with diaphragm dysfunction.
What Are the Rehabilitation Therapies for Diaphragm Dysfunction?
Various clinical interventions like mechanical ventilation further aggravates diaphragm dysfunction. Rehabilitation techniques like inspiratory muscle training, exercise intervention, and nutritional support have been proven to improve diaphragmatic strength and endurance, exercise tolerance, symptoms such as dyspnea, and overall quality of life in patients with respiratory disorders.
Inspiratory Muscle Training:
Inspiratory muscle training is a technique that applies a load to the accessory inspiratory muscles and the diaphragm to increase the strength and endurance of these muscles. This technique improves exercise capacity, relieves dyspnea, and improves inspiratory muscle strength. The American Thoracic Society or European Respiratory Society guidelines for respiratory rehabilitation recommend inspiratory muscle training as an adjunct to respiratory rehabilitation. In addition, neuromuscular electrical stimulation and breathing techniques reinforce and complement the effects of diaphragmatic training. Inspiratory muscle training strengthens the intercostal muscles, and harmoniously improves the functioning of the diaphragm muscle, and also increases the functional reserve capacity of the inspiratory muscles.
Diaphragm Training:
Diaphragm training is performed using devices that create resistive or threshold loads. This also includes threshold pressure training and inspiratory resistive training. Inspiratory resistive training is a technique in which the patient performs continuous resistance breathing via a resistive load device at a regular breathing rate. The amount of inspiratory resistance depends on the volume of air the patient is breathing. It has been proven that inspiratory resistive training helps overcome diaphragm fatigue, improves diaphragmatic strength and endurance, and also relieves dyspnea. Likewise, threshold pressure training enhances the strength and endurance of the diaphragm, relieves dyspnea, and improves lung function. In this technique, a threshold inspiratory muscle trainer is used to set the domain pressure in such a way that the patient’s respiratory work reaches a certain threshold and opens the trainer’s channel, allowing airflow.
Diaphragmatic breathing and pursued-lips breathing techniques are utilized as compensatory therapies in patients who cannot exercise. The diaphragmatic breathing technique decreases respiratory demand and improves breathing patterns without causing dyspnea, thereby increasing diaphragmatic strength. Pursued-lips breathing prevents premature closure of small airways, relieves hypoxia, and improves gas exchange.
Neuromuscular electrical stimulation stimulates the diaphragm muscle with a controllable current. This promotes muscle protein synthesis and muscle mass and improves diaphragm strength and fatigue resistance in patients with limited exercise capacity.
Intercostal Muscle Training:
The intercostal muscle contraction moves the ribs outward and upward and assists the diaphragm. Intercostal muscle training increases the strength, endurance, and mobility of these muscles and improves the ability to resist high-load exercises, and reduces the load on the diaphragm.
Exercise Intervention:
Exercise is an essential component of respiratory rehabilitation. It effectively improves diaphragm dysfunction, local inflammation, systemic inflammation, and oxidative stress and increases the oxygen utilization of the body. Aerobic and resistance exercises are commonly used in respiratory rehabilitation. Exercise interventions have direct actions on the diaphragm, resulting in improvements in the structure and function of the diaphragm. These exercises train the supporting muscles of the back, abdomen, and limbs, which play a supportive role during respiration. Therefore, exercise interventions reduce the fatigue of the diaphragm and improve its function.
Nutritional Support:
Chronic malnutrition results in diaphragm dysfunction and respiratory failure. Proper nutritional support enhances inspiratory muscle function, reduces dyspnea, and improves exercise capacity. The primary forms of nutritional support include oral nutritional supplements and dietary strategies. In addition, adequate vitamins, minerals, and trace elements should also be included in the diet. In order to increase the nutritional intake, nutritional liquids, semi-solids, or powder preparations are added to foods and drinks for oral administration.
Conclusion
Diaphragm dysfunction is common in respiratory diseases. Diaphragm dysfunction is a complex process influenced by various pathological factors. Respiratory rehabilitation is a comprehensive medical program that is specific to each patient. Rehabilitation methods such as exercise intervention, inspiratory muscle training, and nutritional support eliminate the risk factors and improve the overall health condition of the patient. Respiratory rehabilitation may be carried out in various forms, depending on the requirements, and may or may not involve pharmacological intervention. It offers benefits to patients with COPD, sarcoidosis, cystic fibrosis, and idiopathic pulmonary fibrosis, and also reduces exacerbations of various respiratory diseases.
