Objective: This study systematically reviews randomized controlled trials (RCTs) and control trials of non-pharmacological interventions currently used to improve respiratory function/metrics for people with PD. (PROSPERO Registration Number: CRD42017072968)

Background: Respiratory dysfunction in Parkinson’s Disease (PD) is an under diagnosed and under treated impairment of the disease. In Ireland, a review of hospital admissions for individuals with known PD, found one third of admissions were as a result of respiratory system diseases1. Increased hospital mortality, length of stay and health care costs were associated with these respiratory system diseases. Clinically, a reactive approach to pneumonia or chest infection diagnosis in PD is taken, rather than preventative approaches.

Method: Electronic databases, PubMed, EMBASE, CINAHL, Web of Science, Pedro, MEDLINE, and Cochrane Library were searched from inception up to May 31st 2018 using a customised search strategy. No limitations were applied to the searches. Two researchers independently screened at title, abstract and manuscript stages to identify RCTs and control trials of non-pharmacological interventions to improve respiratory function in patients with PD for inclusion. Quality rating of included studies and key data extraction was conducted by two independent reviewers.  Results are reported using both a narrative and best evidence synthesis.

Results: Nine thousand and fourteen unique studies were identified across databases. Following review at title, abstract and manuscript stages, 5 studies (4 RCTs and 1 control trial) were included in the review. Interventions included: Aerobic Exercise, Qigong, Respiratory Muscle Strength Training, Breath Stacking, Incentive Spirometry and Yoga. Methodological quality of the studies varied; 2 RCTs demonstrated low risk of bias, 2 high risk of bias and the control trial demonstrated moderate risk of bias. Best evidence synthesis identified that currently no high-level evidence supports non-pharmacological interventions to improve respiratory morbidity, mortality or lung volume in patients with PD.  Level two evidence supports respiratory muscle training to improve inspiratory and expiratory respiratory muscle strength in patients with PD.

Conclusion: In conclusion, high quality RCTs are required to test non-pharmacological interventions for respiratory health in PD.

References: 1. Kelly, B., Blake, C. and Lennon, O. Acute Hospital Admissions of Individuals with a Known Parkinson’s Disease Diagnosis in Ireland 2009-2012: A Short Report. Journal of Parkinson’s Disease, 2016;6(4), pp. 709-716

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MDS Abstracts - https://www.mdsabstracts.org/abstract/systematic-review-of-non-pharmacological-interventions-for-respiratory-health-in-parkinsons-disease-pd/