PN MEDICAL BR2 The Breather Breathing Trainer User Guide

: June 5, 2024
: PN MEDICAL

PN MEDICAL BR2 The Breather Breathing Trainer

PROTOCOL BY USE CASE

This guide was created to give you the general Breather protocol along with patient-specific use cases for personalized treatment plans. If you are unsure about the optimal use case to choose, watch the therapist-only in-service video (pnmedical.com/go) or reach out to us by phone or email: 877-414-4449 or [email protected]. Section I of this guide contains links for you and your patients to watch our easy-to-follow, best-in-industry, video protocol training series. It demonstrates proper use and cleaning and explains the general treatment protocol in detail. It also includes how-to’s on proper breathing, posture, and more to help motivate Breather users to adhere to the plan you design for them.

INTRODUCTION, GENERAL PROTOCOL & VIDEO VERSION

DESCRIPTION

The Breather is a drug-free respiratory device that promotes respiratory muscle training (RMT) by breathing through different-sized apertures, thereby increasing respiratory muscle strength. As resistance is applied during both phases of the breath cycle, The Breather increases inspiratory as well as expiratory muscle strength by causing hypertrophy of the respiratory muscle fibers, and thickening and increased velocity of the diaphragm. RMT also improves laryngeal function, supporting speech quality, intensity, and swallow efficiency [1-3].

PATIENT IDENTIFICATION

Patients experiencing abnormal respiratory function impacting activities of daily living including dyspnea and/or activity intolerance as well as decreased breath support for phonation and safe swallowing should be considered for RMT.

Target Patient Groups [4]

Respiratory (COPD, asthma, chronic lung disease)
Cardiac (congestive heart failure, coronary artery disease, hypertension)
Neuromuscular (Parkinson’s, multiple sclerosis, myasthenia gravis, Pompe’s)
Pre-and post-operative (major thoracic and abdominal surgery, neurosurgery)
Healthy aging

Note: Successful application does require patient cooperation and motivation. In patients who have experienced an acute exacerbation, or chest infection, clinical judgment should be applied regarding the risk of provoking excessive fatigue of the inspiratory muscles. In this situation, reducing the intensity and/or frequency of RMT may be prudent.
RMT has proven successful in pediatric use and can be applied with due clinical judgement [5-7]. Caution: The Breather is not a toy and small parts may pose a choking hazard to children.

CLINICAL EVIDENCE

The effectiveness of RMT is supported by a growing body of scientific and medical evidence across a steadily increasing range of diseases and disorders. For a collection of clinical evidence, including frequent updates and discussions of emerging data, please see references attached to this document or visit pnmedical.com/clinical-evidence.

COMMON PATIENT CHALLENGES

Potential adverse events include transient lightheadedness or dizziness at training onset, mild fatigue, and issues with finger fatigue.

CONTRAINDICATIONS

During initial training, we recommend careful monitoring for episodes of acute exacerbation or excessive fatigue.

Caution is advised before initiation of therapy for: active hemoptysis, untreated pneumothorax, recent esophageal surgery, acute upper airway stenosis (true vocal fold mass, vocal fold paralysis in adducted position, subglottic stenosis), recent oral, facial or skull trauma/surgery, acute sinusitis, epistaxis, hemodynamic instability, tympanic membrane rupture or acute middle ear pathology (otitis, labyrinthitis).

GETTING STARTED USING THE BREATHER

Patient & Clinician Training Videos

Three short videos you or your patients can view at any time. Below are direct links to a few of the videos in the series.

Lesson 01: Who Takes This Course & Why
Lesson 02: Using & Cleaning The Breather
Lesson 03: Foundational Protocol for Your Breather

All videos can are available on pnmedical.com/training. For bonus material, newsletter, offers, and updates, users of The Breather or other RMT devices can freely join The Breather Club (TheBreather.com/Join).

Equipment

One Breather per patient (single patient use – permanent marker to label with patient’s name)
Pulse Oximeter and/or manometer is optional.
Watch with a second hand to monitor respiratory rate.
Soapy water to clean The Breather per manufacturer’s instructions on package insert.
Nose clips (single patient use) as indicated to limit air flowing through nose during RMT.

Before you begin

If you or your patient has access to the Internet, we recommend watching our easy-to-follow free video training course:http://www.pnmedical.com/courses/the-breather/.
Also or if no access to the Internet, read the manufacturer’s instructions on package insert.
NOTE : The online training is more in-depth than the manufacturer’s instructions included.
If the patient is on continuous oxygen, ensure that it is on during RMT. If oxygen is ordered PRN, use it if the patient becomes short of breath as RMT is exercise.
Introduce The Breather to the patient with an explanation of RMT. Demo with your own Breather.
Position patient to maximize diaphragmatic breathing.
Begin with the easiest settings by rotating both inhale and exhale dials so the #1 aligns with the arrow at the top of The Breather. NOTE – inhale and exhale dials function independently.

FIRST SESSION

NOTE: This information below is also in the training course in Lessons 1 and 2.

Instruct the patient to hold the mouthpiece with lips, not teeth as this may cause undue jaw pressure and inadequate lip seal.
Ask the patient to breathe in and out through the mouthpiece (not the nose). Instruct to inhale deeply and forcefully for 2-3 seconds, slight pause (under a second), then exhale forcefully for 2-3 seconds.
Cue the patient to listen for a strong ‘wind’ sound for audio biofeedback as a strong, audible airflow should be heard for inhaling and exhale. It’s most helpful for the therapist to demonstrate with their own Breather.
The patient should slightly remove The Breather from the mouth to swallow normally to prevent saliva buildup in The Breather.
If the patient has difficulty NOT breathing through their nose, it may be helpful to pinch the nose with fingers during initial instruction.
If necessary or preferred, a nose clip may be used.
Monitor vital signs as needed including oxygen saturation (using a pulse oximeter) as well as overt signs of hypoxemia.
If extreme respiratory distress during or after RMT occurs, avoid re-initiation of RMT until medical clearance can be obtained.
Obtain baseline for tolerated breaths per set and number of sets.

You should ask your patient frequently for feedback including:

How do you feel? Do you feel out of breath or lightheaded?

You should also observe:

Each inhale / exhale should be able to be forcefully maintained for 2-3 seconds.
Inspiratory resistance should cause an outward movement of the stomach on all inhalations. If inward movement of the stomach occurs on a few, but not all inhalations, this could be a sign of fatigue; the patient should rest more between breaths or sets, or decrease the setting temporarily.
Expiratory resistance should not cause puffing of the cheeks. If patient cannot eliminate this, the patient may need to rest more between breaths or decrease setting temporarily.
The therapist may also hold patient’s cheeks or have patient hold his cheeks. (A demo may be necessary.)

NOTE: Transient light headedness may occur at training onset

This is a normal response to a forced inspiratory/expiratory maneuver. It is short lived and self limited.
If experienced, the subject may resume the session after such symptoms have resolved.
In order tooptimize patient comfort,performance and safety we recommend he or she uses The Breather while sitting comfortably on a chair.

USING THE BREATHER FOR RESPIRATORY DISEASE

Respiratory muscle weakness is a major contributor to the development of dyspnea and exercise intolerance. It is also associated with respiratory muscle disorders prevalent in COPD and asthma, contributing to clinical decline and reduced health-related quality of life [5]. RMT using The Breather alleviates the symptoms of diverse respiratory diseases, and improves exercise capacity, dealing with activities of daily living, and quality of life [2,6].

PURPOSE FOR USE

Strengthens inspiratory muscles (diaphragm, external intercostals, accessory muscles of neck) and expiratory muscles (internal intercostals, abdominals)
Promotes diaphragmatic breathing
Decreases shortness of breath
Reduces hyperinflation
Reduces bronchodilator use

SPECIFIC CLINICAL BENEFITS

Increased maximal inspiratory and expiratory pressure (PImax, PEmax) [7]
Reduction of dyspnea (BORG scale) [8]
Increased exercise tolerance (6MWT) [8]
Reduced hyperinflation and improved inspiratory fraction and capacity (IC, IF) [8,9]
Increased peak inspiratory and expiratory flow (PIF, PEF) [10,11]
Improved oxygen saturation [12]
Improved diaphragmatic function [1]
Improved delivery and distribution of inhaled medication [10]
Reduced frequency of exacerbations [13]
Reduced hospitalization rate [6,13]

ADDITIONAL BENEFITS

Improved quality of life (QOL) [8]
Reduced hospitalization and healthcare requirements [13]
Reduced risk of death [9]

RECOMMENDED PROTOCOL:

Please carefully read and follow the general guidelines for GETTING STARTED and FIRST SESSION, or watch the free online training lessons (http://www.pnmedical.com/courses/the-breather/).

RMT target

6 days a week. 2 sessions per day (mornings and evening). 2 sets of 10 breaths per session.

Intensity

At least 60% of maximum effort. The correct setting should allow you to tolerate a set of 10 breaths, but it should feel challenging without causing fatigue. Note that the settings for inhalation and exhalation need to be determined and set independently. For more information, see Lesson 02: Using & Cleaning The Breather.

If using a manometer, the correct setting is around 60% to 80% of maximum inspiratory/expiratory pressure (MIP/ MEP).

Ongoing therapy

After maintaining training at baseline for approximately 1 week, increase resistances. When resistance is increased, repetitions may decrease initially then gradually increase again throughout the week.

Documenting progress

Keep an RMT diary to note number of reps and sessions, settings, and other comments.
See Section 7: Maintaining Respiratory Muscle Strength, for further details.

USING THE BREATHER FOR CARDIAC DISEASE

Cardinal manifestations of heart failure include dyspnea, fatigue and exercise intolerance. Respiratory muscle weakness is a major contributor to these symptoms [8,14]. RMT using The Breather improves dyspnea and exercise intolerance by improving respiratory muscle strength] and oxygen supply, as well as cardiac autonomy and blood flow to the limbs to further support regained activity. RMT can further reduce the risk of cardiovascular disease by reducing your blood pressure [8,15-17].

PURPOSE FOR USE

Strengthens inspiratory muscles (diaphragm, external intercostals, accessory muscles of neck) and expiratory muscles (internal intercostals, abdominals)
Promotes diaphragmatic breathing
Decreases shortness of breath
Improves blood flow to resting and exercising limbs
Delays metaboreflex activation

CLINICAL BENEFITS

Increased maximal inspiratory and expiratory pressure (PImax, PEmax) [7]
Reduction of dyspnea (BORG scale) [8]
Increased exercise tolerance (6MWT) [8]
Reduced hyperinflation and improved inspiratory fraction and capacity (IC, IF) [8,9]
Increased peak inspiratory and expiratory flow (PIF, PEF) [10,11]
Improved oxygen saturation [12]
Improved cardiac autonomy and sympathetic nerve activity [8,15]
Reduced systolic and diastolic blood pressure [17]

ADDITIONAL BENEFITS

Improved quality of life (QOL) [8]
Reduced hospitalization and healthcare requirements [13]
Reduced risk of death [9]

RECOMMENDED PROTOCOL

Please carefully read and follow the general guidelines for GETTING STARTED and FIRST SESSION, or watch the free online training lessons (http://www.pnmedical.com/courses/the-breather/).

RMT target

6 days a week. 2 sessions per day (mornings and evening). 2 sets of 10 breaths per session.

Intensity

Approximately 30% of maximum effort. The correct setting should allow you to comfortably tolerate a set of 10 breaths without causing dyspnea.
Note that the settings for inhalation and exhalation need to be determined and set independently. For more information, see Lesson 2.
If using a manometer, the correct setting is around 30% of maximum inspiratory/expiratory pressure (MIP/MEP).

Ongoing therapy

Increase settings according to increased respiratory muscle strength, but do not increase intensity.

Documenting progress

Keep an RMT diary to note number of reps and sessions, settings, and other comments.
See Section 7: Maintaining Respiratory Muscle Strength, for further details.

USING THE BREATHER FOR NEUROMUSCULAR DISEASE

Neuromuscular diseases such as Parkinson’s, Myasthenia Gravis or muscular dystrophies are often associated with peripheral and respiratory muscle weakness, which may progress during the course of the disease. Depending on the disease, respiratory muscle weakness leads to speech and swallow problems, reduced speech intensity, as well as respiratory impairment [18,19].RMT using The Breather improves speech, swallow and cough function, reduces penetration and aspiration, and strengthens respiratory muscles. Please note that in muscular dystrophies, RMT should only be applied under medical supervision to avoid overtraining.

PURPOSE FOR USE

Strengthens inspiratory muscles (diaphragm, external intercostals, accessory muscles of neck) and expiratory muscles (internal intercostals, abdominals)
Improves movement of the hyolaryngeal complex
Generates improved airflow through vocal folds
Improves respiratory support for safe swallow function
Improves protective cough and assists in airway clearance
Promotes diaphragmatic breathing
Decreases shortness of breath
May slow progression of respiratory myopathy

CLINICAL BENEFITS

Increased maximal inspiratory and expiratory pressure (PImax, PEmax) [7]
Reduction of dyspnea (BORG scale) [8]
Increased exercise tolerance (6MWT) and improved posture control [8,20]
Reduced hyperinflation and improved inspiratory fraction and capacity (IC, IF) [8,9]
Increased peak inspiratory and expiratory flow (PIF, PEF) [10,11]
Improved oxygen saturation [12]
Improved laryngeal function for speech and swallow [18,21]
Improved reflex cough for better pulmonary hygiene [21]
Improved diaphragmatic function, supporting breathing andspeech [1]

ADDITIONAL BENEFITS

Improved quality of life (QOL) [8]
Reduced hospitalization and healthcare requirements [13]
Reduced risk of death [9]

RECOMMENDED PROTOCOL

NOTE: these are protocol recommendations based on clinical evidence for RMT. These should not replace clinicaljudgement by the therapist and still need to be tailored to each patient’s case, status, and preferences. Please carefully read and follow the general guidelines for GETTING STARTED and FIRST SESSION, or watch the free online training lessons (http://www.pnmedical.com/courses/the-breather/).

RMT target

Work up to 5 sets of 5 breaths per session, twice a day, 6 days per week, or as tolerated.

Intensity

Approximately 60% of maximum effort. The correct setting should allow you to tolerate a set of 10 breaths, but it should feel challenging without causing fatigue.
Note that the settings for inhalation and exhalation need to be determined and set independently. For more information, see Lesson 02: Using & Cleaning The Breather.
If using a manometer, the correct setting is around 60% of maximum inspiratory/expiratory pressure (MIP/MEP).

Ongoing therapy

Increase settings according to increased respiratory muscle strength, but do not increase intensity (ie keep intensity at 60% of MIP/MEP).

Documenting progress

Keep an RMT diary to note number of reps and sessions, settings, and other comments.

USING THE BREATHER BEFORE & AFTER SURGERY

Postoperative pulmonary complications (PPC) such as pneumonia and atelectasis are the leading cause of morbidity and mortality after major cardiac or abdominal surgery. PPC increase the duration of hospitalization and healthcare costs. Perioperative RMT using The Breather can reduce the risk of PPC, morbidity and mortality and decrease the length of stay [22,22]. In addition, RMT can support liberation from mechanical ventilation. RMT reduces time to liberation, and increases liberation success [24,25].

PURPOSE FOR USE

Strengthens inspiratory muscles (diaphragm, external intercostals, accessory muscles of neck) and expiratory muscles (internal intercostals, abdominals)
Promotes diaphragmatic breathing
Improves protective cough and assists in airway clearance
Improves respiratory support for safe swallow function
Improves movement of the hyolaryngeal complex

CLINICAL BENEFITS

Increased maximal inspiratory and expiratory pressure (PImax, PEmax) [7]
Improved diaphragmatic function and increased thickness [1,26]
Improved oxygen saturation [12]
Reduced systolic and diastolic blood pressure [17]
Improved laryngeal function for speech and swallow [18,21]
Improved reflex cough for better pulmonary hygiene [21]

INPATIENT SPECIFIC BENEFITS

Reduced duration of mechanical ventilation [25]
Increased success rate for liberation from mechanical ventilation [24]
Reduced risk of postoperative pneumonia and atelectasis [22]
Reduced hospital length of stay [13,23]

ADDITIONAL BENEFITS

Improved quality of life (QOL) [8]
Reduced hospitalization and healthcare requirements [13]
Reduced risk of death [9]

RECOMMENDED PROTOCOL

NOTE: these are protocol recommendations based on clinical evidence for RMT. These should not replace clinical judgement by the therapist and still need to be tailored to each patient’s case, status, and preferences. Please carefully read and follow the general guidelines for GETTING STARTED and FIRST SESSION, or watch the free online training lessons (http://www.pnmedical.com/courses/the-breather/).

Preoperative RMT

Start RMT using The Breather ≥ 2 weeks before surgery at highest tolerated setting, with incremental increase if BORG < 5, 2 x 10 breaths twice (or more) per day, in addition to standard care. Re-start RMT at tolerated setting after surgery upon extubation.

Postoperative RMT

Start RMT using The Breather as soon as cleared surgically and/or upon extubation at the highest tolerated setting. Work up to 2 sets of 10 breaths at least twice a day, 7 days per week.

Liberation from mechanical ventilation

For difficult to wean patients, work up to 2 sets of 10 breaths with 1-2min of rest between sets twice (or more) per day, at the highest comfortable setting, for 7 days per week. Evaluate weaning success with daily spontaneous breathing trials until successful weaning.

Intensity

As tolerated.

Ongoing therapy

Continue use during ICU and hospital stay, working up to the recommended protocol for respiratory or cardiac use, as indicated (see Section 2 or 3 of this Protocol). Encourage use after discharge for continued benefit.

USING THE BREATHER DURING HEALTHY AGEING

During the normal process of ageing, respiratory muscles decline in mass and function, reducing physical activity and functional independence, and contributing to sarcopenia and deterioration of gait, which can increase the risk of falling. Respiratory muscle weakness in the elderly also causes loss of the elastic lung recoil, reduced airway clearance capacity, and decreased responsiveness to hypercapnia and hypoxemia [26-28]. Respiratory muscle training (RMT) using The Breather can improve respiratory muscle strength, allowing for increased physical activity and exercise tolerance, and improved respiratory function.

PURPOSE FOR USE

Strengthens inspiratory muscles (diaphragm, external intercostals, accessory muscles of neck) and expiratory muscles (internal intercostals, abdominals).
Improves movement of the hyolaryngeal complex.
Generates improved airflow through vocal folds.
Improves respiratory support for safe swallow function.
Improves protective cough and assists in airway clearance.
Promotes diaphragmatic breathing.
Decreases shortness of breath.
Improves blood flow to resting and exercising limbs.

CLINICAL BENEFITS

Increased maximal inspiratory and expiratory pressure (PImax, PEmax) [7]
Reduction of dyspnea (BORG scale) [8]
Increased exercise tolerance (6MWT) and improved posture control, reducing back pain [20]
Increased peak inspiratory and expiratory flow (PIF, PEF) [10,11]
Reduced systolic and diastolic blood pressure [17]
Improved quantity and quality of sleep [17]
Improved laryngeal function for speech and swallow [18, 21]
Improved reflex for better pulmonary hygiene [21]
Improved diaphragmatic function, supporting breathing and speech [1, 26]

ADDITIONAL BENEFITS

Improved quality of life (QOL) [8]
Reduced hospitalization and healthcare requirements [13]
Reduced risk of death [9]

RECOMMENDED PROTOCOL

NOTE: these are protocol recommendations based on clinical evidence for RMT. These should not replace clinical judgement by the therapist and still need to be tailored to each patient’s case, status, and preferences. Please carefully read and follow the general guidelines for GETTING STARTED and FIRST SESSION, or watch the free online training lessons (http://www.pnmedical.com/courses/the-breather/).

RMT target

6 days a week. 2 sessions per day (mornings and evening). 2 sets of 10 breaths per session.

Intensity

At least 50% of maximum effort. The correct setting should allow you to tolerate a set of 10 breaths with moderate effort. Note that the settings for inhalation and exhalation need to be determined and set independently.
For more information, see Lesson 02: Using & Cleaning The Breather. If using a manometer, the correct setting is around 50-60% of maximum inspiratory/expiratory pressure (MIP/ MEP).

Ongoing therapy

Documenting progress

Keep an RMT diary to note number of reps and sessions, settings, and other comments. RMT using the Breather should be built into your daily routine.
See Section 7: Maintaining Respiratory Muscle Strength, for further details.

MAINTAINING RESPIRATORY MUSCLE STRENGTH

As with peripheral muscle strength, respiratory muscles require exercise to maintain muscle strength. To maintain benefits achieved during initial training, RMT should be included into the daily routine. Scientific evidence has shown that respiratory parameters and exercise capacity continue to improve at least throughout the first year of RMT, but also that improvements are lost after discontinuation [6].

For the optimal benefit of RMT, the patient should work towards completing 2 sets of 10 repetitions twice a day, 6 days a week.
After maintaining training at baseline for approximately 1 week, increase resistances.
When resistance is increased, repetitions may decrease initially then gradually increase again throughoutthe week.
Choose the settings on the inspiratory and expiratory dials that allow the target number of reps per session without causing fatigue.
Encourage building a set routine for using The Breather, such as after getting up and before going to bed, to optimize adherence.
Begin training the patient (or caregiver) to monitor resistance & duration (reps) tolerance as soon as possible.
The patient can develop these self-monitoring skills under the guidance of the therapist, therefore, increasing the likelihood of continuance of RMT after therapy sessions are completed.
Include watching and feeling for correct technique as outlined above in the ‘First Session’ as well as monitoring for diaphragmatic breathing. In an effort to avoid RMT abandonment, educate patient to find their new (often lower) settings after illness, etc..
Document patient progress, e.g. levels of resistance, reps & sets, numbers of sessions, Maximum Phonation Time, Ventilatory Response Index, Dyspnea Scale.
If possible and useful, set patient targets, such as being able to walk up stairs without rest, etc.
If patient often experiences shortness of breath or a ‘panicking feeling’, instruct them to simply breathe easily through The Breather at the lowest setting (not forcefully as in training).
Expiratory resistance mimics purse lip breathing and slower breathing inhalation is calming. Often it only takes a moment for breathing to become under control.

EFFORT SCALE

This effort scale is for therapist and patient use. It provides a guideline to meet the correct RMT intensity for optimal training benefit.

NOTE: This effort scale should not replace clinical therapist judgement.

% of MIP or MEP| Perceived Effort| Sustainability Throughout Session
---|---|---
10 – 20| Hardly any effort| May consistently finish the set with ease

30 – 40

REFERENCES

Darnley GM, Gray AC, McClure SJ, Neary P, Petrie M, McMurray JJ, et al. Effects of resistive breathing on exercise capacity and diaphragm function in patients with ischaemic heart disease. Eur J Heart Fail. 1999;1: 297–300.
Magadle R, McConnell AK, Beckerman M, Weiner P. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients. Respir Med. 2007;101: 1500–1505.
Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve. 2016;54: 48–53.
McConnell A. Respiratory Muscle Training: Theory and Practice. 1 edition. Churchill Livingstone; 2013.
Laghi F, Tobin MJ. Disorders of the respiratory muscles. Am J Respir Crit Care Med. 2003;168: 10–48.
Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005;128: 3177–3182.
Neves LF, Reis MH, Plentz RDM, Matte DL, Coronel CC, Sbruzzi G. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. Respir Care. 2014;59: 1381–1388.
Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, et al. Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther. 2013;11: 161–177.
Petrovic M, Reiter M, Zipko H, Pohl W, Wanke T. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2012;7: 797–805.
Weiner P, Weiner M. Inspiratory muscle training may increase peak inspiratory flow in chronic obstructive pulmonary disease. Respiration. 2006;73: 151–156.
Lima EVCL, Lima WL, Nobre A, dos Santos AM, Brito LMO, Costa M do R da SR. Inspiratory muscle training and respiratory exercises in children with asthma. J Bras Pneumol. 2008;34: 552–558.
Bernardi E, Pomidori L, Bassal F, Contoli M, Cogo A. Respiratory muscle training with normocapnic hyperpnea improves ventilatory pattern and thoracoabdominal coordination, and reduces oxygen desaturation during endurance exercise testing in COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;10: 1899– 1906.
Rubí M, Renom F, Ramis F, Medinas M, Centeno MJ, Górriz M, et al. Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91: 364–368.
Verissimo P, Casalaspo TJA, Gonçalves LHR, Yang ASY, Eid RC, Timenetsky KT. High prevalence of respiratory muscle weakness in hospitalized acute heart failure elderly patients. PLoS One. 2015;10: e0118218.
Ferreira JB, Plentz RDM, Stein C, Casali KR, Arena R, Lago PD. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial. Int J Cardiol. 2013;166: 61–67.
Chiappa GR, Roseguini BT, Vieira PJC, Alves CN, Tavares A, Winkelmann ER, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol. 2008;51: 1663–1671.
Vranish JR, Bailey EF. Inspiratory Muscle Training Improves Sleep and Mitigates Cardiovascular Dysfunction in Obstructive Sleep Apnea. Sleep. 2016;39: 1179–1185.
Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75: 1912– 1919.
Fregonezi G, Azevedo IG, Resqueti VR, De Andrade AD, Gualdi LP, Aliverti A, et al. Muscle impairment in neuromuscular disease using an expiratory/inspiratory pressure ratio. Respir Care. 2015;60: 533–539.
Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47: 12–19.
Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of Swallowing and Cough Functions Following Stroke: An Expiratory Muscle Strength Training Trial. Arch Phys Med Rehabil. 2016;97: 1345–1351.
Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscletraining in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clin Rehabil. 2015;29: 426–438.
Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015; CD010356.
Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15: R84.
Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015;61: 125–134.
Souza H, Rocha T, Pessoa M, Rattes C, Brandão D, Fregonezi G, et al. Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility. J Gerontol A Biol Sci Med Sci. 2014;69: 1545–1553.
Mills DE, Johnson MA, Barnett YA, Smith WHT, Sharpe GR. The effects of inspiratory muscle training in older adults. Med Sci Sports Exerc. 2015;47: 691–697.
Fonseca M de A, Cader SA, Dantas EHM, Bacelar SC, Silva EB da, Leal SM de O. Respiratory muscle training programs: impact on the functional autonomy of the elderly. Rev Assoc Med Bras. Associação Médica Brasileira; 2010;56: 642–648.

PN MEDICAL BR2 The Breather Breathing Trainer User Guide

PN MEDICAL BR2 The Breather Breathing Trainer

PROTOCOL BY USE CASE

INTRODUCTION, GENERAL PROTOCOL & VIDEO VERSION

GETTING STARTED USING THE BREATHER

FIRST SESSION

USING THE BREATHER FOR RESPIRATORY DISEASE

RECOMMENDED PROTOCOL:

USING THE BREATHER FOR CARDIAC DISEASE

RECOMMENDED PROTOCOL

USING THE BREATHER FOR NEUROMUSCULAR DISEASE

RECOMMENDED PROTOCOL

USING THE BREATHER BEFORE & AFTER SURGERY

RECOMMENDED PROTOCOL

USING THE BREATHER DURING HEALTHY AGEING

RECOMMENDED PROTOCOL

MAINTAINING RESPIRATORY MUSCLE STRENGTH

EFFORT SCALE

REFERENCES

CONTACTS

References

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Download This Manual (PDF format)

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