Inspiratory muscle training devices for chronic lung disease management: current evidence and future directions.

INTRODUCTION: Inspiratory muscle training (IMT) is a potential adjunct therapy to improve inspiratory muscle strength and endurance, exercise capacity, health-related quality of life (HRQL) and symptoms in chronic lung diseases. A growing number of IMT devices are commercially available; however, their mechanisms, utilization, and supporting evidence vary. AREAS COVERED: This narrative review summarizes IMT devices used in chronic lung diseases, including threshold trainers, flow-resistive devices, and isocapnic hyperpnea devices. A PubMed search to February 2026 identified studies that tested commercially available IMT devices in chronic lung disease and described their mechanism, usability and their efficacy or effectiveness. Manufacturer websites also provided device-specific information. Factors that influence IMT outcomes are described including: training intensity, duration, frequency, patient selection, and practical considerations. EXPERT OPINION: IMT is a feasible intervention that improves inspiratory muscle strength and exercise capacity, commonly improving respiratory symptoms and HRQL. Device type (pressure-threshold versus flow-resistive) and practical factors, including cost, usability, supervision, and feedback capabilities may influence both training load and clinical response. Future directions include perioperative IMT as a prehabilitation strategy, the potential role of respiratory muscle memory, and the development of digital and artificial intelligence-enhanced IMT devices.