The role of lung volume recruitment therapy in neuromuscular disease: a narrative review.
Nicole L Sheers, Rachel O'Sullivan, Mark E Howard and 1 others
PMID 37565183WHAT IT FOUND
Lung volume recruitment reliably increases cough strength and lung inflation during the manoeuvre, but recent randomised trials show no long-term benefit on lung function or quality of life.
It is not proven to prevent infections or slow disease decline.
Key findings
01Lung volume recruitment consistently increases lung inflation capacity and peak cough flow during the manoeuvre, but these effects do not carry over to sustained improvements in lung function after the session.
02Recent randomised controlled trials in children with Duchenne muscular dystrophy and adults with neuromuscular disease found no significant difference in lung function decline or quality of life between those using regular lung volume recruitment and controls.
03The evidence base for lung volume recruitment is limited by small sample sizes, poor adherence, and a lack of prospective validation for clinical thresholds used to start therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review is a narrative synthesis, not a systematic review, so it may not capture all relevant evidence. Many included studies are small, retrospective, or lack control groups, limiting the strength of conclusions. There is significant heterogeneity in LVR protocols, equipment, and patient populations, making direct comparison difficult. Adherence to therapy in long-term studies was often low and measured by self-report. The clinical significance of increased peak cough flow during LVR is not well established, as it does not clearly correlate with improved secretion clearance or reduced infection rates.
Declared interests
One author received PhD funding from the National Health and Medical Research Council and the Motor Neurone Disease Research Institute of Australia. No other conflicts of interest are declared.
The easy way to misread this
Do not assume that the immediate increase in cough strength during a lung volume recruitment session translates to long-term health benefits. Recent high-quality trials show no improvement in lung function decline or quality of life with regular use, so it should not be prescribed with the expectation of slowing disease progression.