Effectiveness of inspiratory plus expiratory neuromuscular electrical stimulation in the rehabilitation of patients with severe COPD

Introduction: Neuromuscular electrical stimulation (NMES) contributes to COPD rehabilitation, but the current NMES therapy only works on inspiratory phase. Objectives: The purpose of this study was to compare the intervention effectiveness of inspiratory plus expiratory NMES (IENMES) with inspiratory NMES (INMES) in COPD patients. Methods: 120 patients (receiving standard treatment) with severe and very severe stable COPD (GOLD3 and GOLD4) were randomly divided into the IENMES group (n=60) and the INMES group (n=60). The IENMES group patients were treated with Respiratory Neuromuscular Stimulator (Yaguo Technology Ltd, Beijing, China). Patients in both groups were given treatment once a day for 30 minutes, and totally for 4 weeks. The 6-min walking distance (6MWD), mMRC, FEV1, FEV1% pred, FEV1% FVC, MVV and PEF were observed before and after treatment. Results: After 4 weeks of treatment, 6MWD was more improved in IENMES group (65.53±39.45m) compared with INMES group (26.66±32.65m); mean between-group difference was 29.07m ([95% CI 16.098 to 42.035]; p<0.001). There was no significant difference in the other parameters between the two groups. For GOLD4 subjects, FEV1, FEV1%pred, FEV1%FVC were significantly improved in IENMES group (p<0.05). Conclusion: Compared with the INMES treatment, IENMES treatment is better in improving the exercise endurance of patients with severe and very severe COPD in stable phase and improving the lung ventilation of patients with very severe COPD, which indicates that IENMES has significant effectiveness in promoting the pulmonary rehabilitation of patients with severe COPD.