The effect of a respiratory physiotherapy program on extraoesophageal reflux disease symptoms

Abstract

Introduction: Using methods of respiratory physiotherapy, diaphragmatic breathing and inspiratory muscle training, it is possible to reduce the incidence and intensity of esophageal symptoms in patients with gastroesophageal reflux. Whether this therapy has the same impact on extraoesophageal symptoms of reflux disease has not been investigated yet. Therefore, the aim of this study was to assess the effect of a respiratory physiotherapy program on the intensity of symptoms of extraoesophageal reflux disease. The respiratory physiotherapy program included activating and strengthening the diaphragm using inspiratory muscle training performed in different postural positions. A secondary aim was to determine whether the effectiveness of a respiratory physiotherapy program differs in patients with decreased inspiratory muscle strength compared to those with normal inspiratory muscle strength.

Methods: A total of 36 patients (8 men) with a diagnosis of extraoesophageal reflux disease were included in the study (an average age was 46.4±10.4 years and a BMI was 25.6±4.5 kg.m^-2). Patients' inspiratory muscle strength (PImax) and intensity of extraoesophageal reflux symptoms using the Hull Reflux and Airways Questionnaire were assessed before and after completion of an 8-week respiratory physiotherapy program. Based on initial PImax values, patients were divided into two groups: “Group 1” – patients with PImax ≥ 90% predicted values (15 patients, mean age 45.6±10.4 years); "Group 2" - patients with PImax < 90% predicted values (21 patients, mean age 46.9±10.9 years). The respiratory physiotherapy program included diaphragmatic breathing and inspiratory muscle training with a resistance inspiratory device the Threshold inspiratory muscle trainer performed in three postural positions.

Results: A statistically significant difference was found in the intensity of symptoms between the groups at baseline. In both groups, after completing the respiratory physiotherapy program, there was a statistically significant increase in inspiratory muscle strength and a decrease in the intensity of symptoms of extraoesophageal reflux disease.

Conclusion: The results of the study suggest that the respiratory physiotherapy program including diaphragmatic breathing and inspiratory muscle training leads to an increase in inspiratory muscle strength and a reduction in symptom intensity, regardless of initial inspiratory muscle strength.