UKC

I am unsure if this is the right place or not for this post.

Respiratory Physio has recommended using Powerbreathe to recover some of the capacity lost due to long COVID.

I remember these being a bit of a flash in the pan in the running world maybe 25 years ago then falling a bit flat due to poor evidential support of their claims. Their efficacy approaching that of homeopathy.

Anyone got any experience of using these and or data to support/deny the claims.

Physio uses one herself, so there may be some confirmation bias in the recommendation.

I used one when I was suffering from exercise induced asthma when I used to cycle a lot in cold weather. Definitely helped. It was recommended to me by a pro cyclist in our local club who reckoned it helped him a lot

You can get air warmers which you basically breath through a thin mesh of varying depth, there's a little resistance but not much, so you can wear them for hours. You can get thicker for training, thinner for racing. Elite skiers often use them when it's cold, ie -15 or 20c and beyond, because many hours, every day, of low temp low humidity air can be quite damaging. Airtrim is the brand I've come across.

There are more 'gimmicky' items with very high resistance, which will claim all sorts of generally unproven stuff about strengthening lungs etc.. if used for even very short periods.

Yes, I have heard a few n=1 reports, these could easily be placeboic. Pro athletes seem to be more susceptible to woo than the general population.

Anyway, a Powerbreathe has arrived today and I will try it out with as open a mind as I can muster.

If it works, it works, real or placeboic, if it improves things it is good.

Good luck, but I can't see how it'll help. Nobody has ever said my intercostal muscles are aching because I've been training hard breathing etc... if you want to train them then dumbell pullovers whilst lying at 90 degrees across a bench are the exercise for you.(start very easy).

There's various versions of inspiratory muscle training (IMT) devices out there, all working is essentially the same way (increasing the resistance to breathing). They are also varying degrees of not much fun and so tend to be used longer term only by people who are prepared to put in the effort for a reward - which means very athletic types and those with a real medical problem that they want to get on top of. So people's experiences differ and if the OP has long covid then that's a different scenario to an elite cyclist wanting a 0.5% gain. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297193/ is a reasonable start for dissecting evidence and it's noticeable that they found 969 studies in the literature of which 6 could be used for analysis. This isn't unusual and reflects the huge amount of not very good papers out there! However the studies do show evidence of improvement that's meaningful. I have a handful of patients who have used them and report good improvements in their symptoms, but not enough of a sample size to discern any improvements in their measured lung function tests. My suspicion is that their rate of decline is slower but they all have very serious lung disease. Everyone I have spoken to who (a) used a power breathe consistently and (b) told me about it seems to get improvements in symptoms but there's a lot of bias in that sample as humans tend to report helpful things they have tried more than unhelpful ones.

Also worth pointing out that relatively simple lung function testing with spirometry at your local hospital rarely finds long covid related abnormalities, although more complex tests (like DLCO and CPET) do. So using spirometry as a way to detect improvement in long covid lung function is unlikely to be helpful.

TLR go for it. It's not going to do harm and you will work out if it is worth it in terms of symptom benefit within weeks. Routine "medical" testing probably won't show a benefit because it can' but your "best time to the top of the hill" might well. 

God luck!

(Dr) b

Thanks, as said above, I am going in to it with as open a mind as possible, maybe clutching at straws. It can't do any harm. My problem is my evidence based mindset.

I'd put them in the same bracket as training supplements. Did the results come from the product, or because you'd just splashed x amount pounds so you mentally focused more, trained harder, proper rest and recovery etc.. it's impossible to separate. As you say there is no harm in trying. 

Imho it's consistency that brings results. The easy initial gains in fitness come quickly, but then you have to play the long game over a few years to gain more. I don't think people struggle because they can't draw air into the lungs, it's all the processes thereafter and covid really was a bugger, effectively a disease that impacts anywhere the blood goes and less so respiratory tracts like you think with snotty colds, so o2 uptake, organ function etc. Covid is already thought to damage the walls, lining and air sacs of the lungs. I don't know if they heal, but consistent exercise must help those not damaged to operate with more efficiency?