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Title: Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial.
Austin Authors: Katz, Sherri L;Mah, Jean K;McMillan, Hugh J;Campbell, Craig;Bijelić, Vid;Barrowman, Nick;Momoli, Franco;Blinder, Henrietta;Aaron, Shawn D;McAdam, Laura C;Nguyen, The Thanh Diem;Tarnopolsky, Mark;Wensley, David F;Zielinski, David;Rose, Louise;Sheers, Nicole ;Berlowitz, David J ;Wolfe, Lisa;McKim, Doug
Affiliation: Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia..
Department of Medicine and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA..
Department of Respiratory Care, Shirley Ryan AbilityLab, Chicago, Illinois, USA..
Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia..
Respiratory and Sleep Medicine
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada..
Department of Pediatric and Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada..
Institute for Breathing and Sleep
Division of Pediatric Neurology, Alberta Children's Hospital, Calgary, Alberta, Canada..
Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, Ontario, Canada..
Department of Pediatrics, Epidemiology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada..
CHEO Research Institute, Ottawa, Ontario, Canada..
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada..
Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada..
Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada..
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada..
Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada..
Department of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada..
Division of Neuromuscular and Neurometabolic Disease, McMaster University, Hamilton, Ontario, Canada..
Division of Pediatric Respirology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada..
Division of Pediatric Respirology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada..
Department of Midwifery and Palliative Care, King's College London Florence Nightingale School of Nursing and Midwifery, London, London, UK..
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada..
Critical Care Directorate and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, London, UK..
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada..
Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada..
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada..
CANVent Respiratory Rehabilitation Services, Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada..
Issue Date: 2-Mar-2022
Date: 2022
Publication information: Thorax 2022-08; 77(8): 805-811
Abstract: Impaired cough results in airway secretion retention, atelectasis and pneumonia in individuals with Duchenne muscular dystrophy (DMD). Lung volume recruitment (LVR) stacks breaths to inflate the lungs to greater volumes than spontaneous effort. LVR is recommended in DMD clinical care guidelines but is not well studied. We aimed to determine whether twice-daily LVR, compared with standard of care alone, attenuates the decline in FVC at 2 years in boys with DMD. In this multicentre, assessor-blinded, randomised controlled trial, boys with DMD, aged 6-16 years with FVC >30% predicted, were randomised to receive conventional treatment or conventional treatment plus manual LVR twice daily for 2 years. The primary outcome was FVC % predicted at 2 years, adjusted for baseline FVC % predicted, age and ambulatory status. Secondary outcomes included change in chest wall distensibility (maximal insufflation capacity minus FVC) and peak cough flow. Sixty-six boys (36 in LVR group, 30 in control) were evaluated (median age (IQR): 11.5 years (9.5-13.5), median baseline FVC (IQR): 85% predicted (73-96)). Adjusted mean difference in FVC between groups at 2 years was 1.9% predicted (95% CI -6.9% to 10.7%; p=0.68) in the direction of treatment benefit. We found no differences in secondary outcomes. There was no difference in decline in FVC % predicted with use of twice-daily LVR for boys with DMD and relatively normal lung function. The burden associated with routine LVR may outweigh the benefit. Benefits of LVR to maintain lung health in boys with worse baseline lung function still need to be clarified. NCT01999075.
DOI: 10.1136/thoraxjnl-2021-218196
Journal: Thorax
PubMed URL: 35236763
PubMed URL:
Type: Journal Article
Subjects: Duchenne muscular dystrophy
lung volume recruitment
randomized controlled trial
respiratory therapy
Appears in Collections:Journal articles

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