Non-pharmacological Interventions for Respiratory Health in Parkinson's Disease: A Systematic Review and Meta-analysis

Author: Laura McMahon1, Catherine Blake1, Olive Lennon1
1 UCD, School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland.
Conference/Journal: Eur J Neurol
Date published: 2020 Oct 24
Other: Special Notes: doi: 10.1111/ene.14605. , Word Count: 250

Respiratory dysfunction in Parkinson's Disease (PD) is often an under-diagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support non-pharmacological interventions to improve respiratory impairments in individuals with PD.

The relevant literature was searched using a customised and systematic strategy. Randomised and non-randomised control trials of non-pharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow and perception of dyspnoea.

Non-pharmacological interventions included: Functional Training, Generalised Strength Training, Respiratory Muscle Strength Training, Aerobic Exercise, Qigong, Yoga, Breath Stacking, Incentive Spirometry and Singing. Methodological quality of included studies varied. Meta-analyses of non-pharmacological interventions demonstrated significant effects for inspiratory muscle strength (MD 19.68; CI 8.49, 30.87; z=3.45; p=0.0006; I2 =2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z=3.33; p=0.0009; I2 =23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z=3.45; p=0.0006; I2 =0%). Best evidence synthesis identified level 1 evidence supporting non-pharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD.

Non-pharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.

Keywords: Meta-analysis; Parkinson’s Disease; Respiratory; Systematic Review.

PMID: 33098349 DOI: 10.1111/ene.14605