The eff ect of a respiratory physiotherapy program on extraoesophageal reflux disease symptoms

Introduction: Respiratory physiotherapy methods can reduce the incidence and intensity of oesophageal symptoms in patients with gastroesophageal refl ux dis ease. Whether this therapy has the same eff ect on the extraoesophageal symptoms of gastroesophageal refl ux dis ease has not been investigated yet. Therefore, the aim of this study was to investigate the eff ect of a respiratory physiotherapy program aimed at activating and strengthening the diaphragm by inspiratory muscle training performed in postural positions on the intensity of extraoesophageal refl ux dis ease (EERD) symptoms and to assess whether the eff ect of this program diff ers in patients with normal and decreased inspiratory muscle strength. Methods: Patients with EERD were included in the study. Patients with decompensated cardiovascular dis ease, pulmonary dis ease, soft tissue dis ease, post-fundoplication patients, smokers and pregnant women were excluded from the study. Patients were assessed for inspiratory muscle strength (PImax) and the severity of EERD symptoms before and after completing an 8-week respiratory physiotherapy program using the Hull Airway Refl ux Questionnaire (HARQ) and the Refl ux Symptom Index. Based on the initial PImax value, patients were divided into two groups: Group 1 – patients with PImax ≥ 90% of the normative value (NV) (15 patients, mean age 45.6 ± 10.4 years); Group 2 – patients with PImax < 90% NV (21 patients, mean age 46.9 ± 10.9 years). The respiratory physiotherapy program included diaphragmatic breathing training and inspiratory muscle training, which was performed in three postural positions with the Threshold inspiratory muscle trainer resistance device. Results: A total of 36 patients (8 males) with EERD, mean age 46.4 ± 10.4 years and body mass index 25.6 ± 4.5 kg/m2 were included in the study. Signifi cantly higher symptom severity according to the HARQ before treatment was found in group 2. Both groups showed a statistically signifi cant increase in inspiratory muscle strength and a decrease in symptom intensity according to both questionnaires after treatment. Patients who were found to have reduced inspiratory muscle strength below 90% NV at baseline achieved greater improvement in inspiratory muscle strength and a greater reduction in symptom intensity after treatment. Conclusion: The respiratory physiotherapy program led to an increase in inspiratory muscle strength and a reduction in symptom intensity regardless of initial inspiratory muscle strength.