Objectives: In chronic obstructive pulmonary disease (COPD), quality of life and exercise capacity are altered in relationship to dyspnea. Benefits of inspiratory muscle training (IMT) on quality of life, dyspnea, and exercise capacity were demonstrated, but when it is associated to pulmonary rehabilitation (PR), its efficacy on dyspnea is not demonstrated. The aim of this systematic review with meta‐analysis was to verify the effect of IMT using threshold devices in COPD patients on dyspnea, quality of life, exercise capacity, and inspiratory muscles strength, and the added effect on dyspnea of IMT associated with PR (vs. PR alone).Study selection: This systematic review and meta‐analysis was conducted on the databases from PubMed, Science direct, Cochrane library, Web of science, and Pascal. Following key words were used: inspiratory, respiratory, ventilatory, muscle, and training. The searching period extended to December 2017. Two reviewers independently assessed studies quality.Results: Forty‐three studies were included in the systematic review and thirty‐seven studies in the meta‐analysis. Overall treatment group consisted of six hundred forty two patients. Dyspnea (Baseline Dyspnea Index) is decreased after IMT. Quality of life (Saint George's Respiratory Questionnaire), exercise capacity (6 min walk test) and Maximal inspiratory pressure were increased after IMT. During PR, no added effect of IMT on dyspnea was found.Conclusion: IMT using threshold devices improves inspiratory muscle strength, exercise capacity and quality of life, decreases dyspnea. However, there is no added effect of IMT on dyspnea during PR (compared with PR alone).

Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about ACTs in adults with bronchiectasis and makes recommendations to improve the future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature. The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on ACTs in clinical practice indicates that the most frequently used techniques are active cycle of breathing techniques, positive expiratory pressure devices and gravity-assisted drainage, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patients’ perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.