Abstract

Background: Incentive spirometry (IS) is a widely utilized respiratory therapy aimed at preventing postoperative pulmonary complications (PPCs) and improving lung function. Despite its widespread adoption, the evidence supporting its standalone ef𿿿cacyacrossvariousclinicalsettingsremainsinconsistent. Objective: This narrative review evaluates the effectiveness of IS in clinical practice, focusing on its role in postoperative care, chronic obstructive pulmonary disease (COPD) management, and COVID-19 rehabilitation. Methods: A comprehensive search of PubMed, Scopus, and Cochrane Library databases identi𿿿ed13randomizedcontrolledtrials (RCTs)publishedbetween 2000 and 2024. Inclusion criteria were studies involving adult populations, written in English, and focused on IS as an intervention. Data on study design, patient characteristics, IS protocols, and outcomes were extracted and synthesized qualitatively. Results: The findings revealmixedoutcomes. ISas a standalone intervention showedlimitedefficacyinreducingPPCsincardiac,thoracic,andupperabdominal surgeries. However, when integrated into multimodal rehabilitation protocols, IS demonstratedpotential benefits, including improvedpulmonary functionand faster recovery in patients with COPD and post-COVID-19 conditions. Variability in protocols and adherence across studies limited generalizability. Conclusion: WhileISalonemaynotsignificantlypreventPPCs,itsintegrationinto comprehensive care protocols can enhance patient outcomes. Tailored approaches that combine IS with other respiratory therapies may optimize its effectiveness. Future research should focus on standardizing protocols, long-term outcomes, and patient-centered measure.

• 1.   Freitas E.R.F.S., Soares B., Cardoso J., Atallah Á. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev. 2007; (3): CD004466.
• 2.   do Nascimento Junior P., Módolo N.S.P., Andrade S., Guimarães M.M.F., Braz L.G., El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2014; (2): CD006058.
• 3.   Agostini P., Singh S.J. Incentive spirometry following thoracic surgery: what should we be doing? Physiotherapy. 2009; 95(2): 76-82.
• 4.   Rupp M., Miley H., Russell-Babin K. Incentive spirometry in postoperative abdominal/ thoracic surgery patients. Crit Care Nurs Q. 2013; 36(1): 89-99.
• 5.   Sullivan K., Churchill I., Hylton D., Hanna W. Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration. 2021; 100(11):1114-1126.
• 6.   Restrepo R.D., Wettstein R., Wittnebel L.D., Tracy M.S. Incentive Spirometry: 2011. Respir Care. 2011; 56(10): 1600-1604.
• 7.   Santos E.C., Pinto A.C.P.N., Macedo J., Lunardi A. Effect of incentive spirometry after cardiac surgery: protocol for a systematic review. BMJ Open. 2020; 10(8): e036271.
• 8.   Dhruva R.D. The Effect of Inspiratory Muscle Training, Incentive Spirometer and Deep Breathing Exercise in Asthmatic Patient: A Narrative Review. Int J Sci Res. 2024; 13(1): 231-235.
• 9.   Overend T., Anderson C.M., Lucy S., Bhatia C., Jonsson B.I., Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001; 120(3): 971-978.
• 10.   Van Tuijn C.F.J., Gaartman A.E., Nur E., Rijneveld A.W., Biemond B.J. Incentive spirometry to prevent acute chest syndrome in adults with sickle cell disease: a randomized controlled trial. Am J Hematol. 2020; 95(7): E160-E163. doi:10.1002/ajh.25805.
• 11.   Dos Santos E.D.C., da Silva J.S., de Assis Filho M.T.T., Vidal M.B., Monte M.C., Lunardi A.C. Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial. J Physiother. 2020; 66(1): 19-26. doi:10.1016/j. jphys.2019.11.006.
• 12.   Rodriguez-Alvarez M.D.M., Roca-Antonio J., Martínez-González S., Vilà-Palau V., Chacón C., Ortega-Roca A., Borrell-Thiò E., Erazo S., Almirall-Pujol J., Torán-Monserrat P. Spirometry and Smoking Cessation in Primary Care: The ESPIROTAB STUDY, A Randomized Clinical Trial. Int J Environ Res Public Health. 2022; 19(21): 14557. doi:10.3390/ ijerph192114557.
• 13.   Andrea Ban Y.L., Siti Istiana A.S., Nik Nuratiqah N.A., Ng B.H., Rose Azzlinda O., Hasni J., SyedZulki i S.Z. The bene𿿿ts of early pulmonary rehabilitation with incentive spirometer among chronic obstructive pulmonary disease patients with exacerbation of chronic obstructive pulmonary disease. Med J Malaysia. 2024; 79(5): 561-568.
• 14.   Martin-Lujan F., Basora-Gallisa J., Villalobos F., Martin-Vergara N., Aparicio-Llopis E., Pascual-Palacios I., Santigosa-Ayala A., Catalin R.E., Rey-Reñones C., Solà R.; ESPITAP Study Group Investigators. Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study. J Epidemiol Community Health. 2021; 75(10): 1001-1009. doi:10.1136/jech-2020-216219.
• 15.   Abo Elyazed T.I., Abd El-Hakim A.A.E., Saleh O.I., Sonbol M.M.F., Eid H.A., Moazen E., Alhassoon M.H., Elfeky SEF. Diaphragmatic strengthening exercises for patients with post-COVID-19 condition after mild-to moderate acute COVID-19 infection: a randomized controlled study. J Rehabil Med. 2024;56:jrm25491. doi:10.2340/jrm.v56.25491.
• 16.   Ragavendran S., Raghu C., Prasad S.R., Arasu T., Nagaraja P.S., Singh N.G., Manjunath N., Muralikrishna N., Yogananth N. Comparison of epidural analgesia with ultrasound-guided bilateral erector spinae plane block in aorto femoral arterial bypass surgery. Ann Card Anaesth. 2022; 25(1): 26-33. doi:10.4103/aca. ACA_23_20.
• 17.   Kharel P., Zadro J.R., Ferreira G., Howell M., Howard K., Wortley S., McLennan C., Maher C.G. Can language enhance physical therapists’ willingness to follow Choosing Wisely recommendations? A best-worst scaling study. Braz J Phys Ther. 2023; 27(4): 100534. doi:10.1016/j.bjpt.2023.100534.
• 18.   Swaminathan N., Kundra P., Ravi R., Kate V. ERAS protocol with respiratory prehabilitation versus conventional perioperative protocol in elective gastrectomy: a randomized controlled trial. Int J Surg. 2020; 81: 149-157. doi:10.1016/j. ijsu.2020.07.027.
• 19.   Amin R., Alaparthi G.K., Samuel S.R., Bairapareddy KC, Raghavan H, Vaishali K. Effects of three pulmonary ventilation regimes in patients undergoing coronary artery bypass graft surgery: a randomized clinical trial. Sci Rep. 2021;11(1):6730. doi:10.1038/s41598-021 86281-4.
• 20.   Zhang L., Liu W., You H., Chen Z., Xu L., He H. Assessing the analgesic ef𿿿cacy of oral epigallocatechin-3-gallate on epidural catheter analgesia in patients after surgical stabilisation of multiple rib fractures: a prospective double blind, placebo-controlled clinical trial. Pharm Biol. 2020; 58(1): 741-744. doi:10.1080/1388020 9.2020.1797123.
• 21.   Dahne J., Player M.S., Strange C., Carpenter M.J., Ford D.W., King K., Miller S., Kruis R., Hawes E., Hidalgo J.E., Diaz V.A. Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Ef𿿿cacy. J Med Internet Res. 2022;24(8):e38663. doi:10.2196/38663.
• 22.   Salamanca-González P., Valls-Zamora R.M., Pedret-Figuerola A., Sorlí-Aguilar M., Santigosa-Ayala A., Catalin R.E., Pallejà Millán M., Solà-Alberich R., Martin-Lujan F., The Cenit Research Group Investigators. Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care. Nutrients. 2021;13(10):3597. doi:10.3390/ nu13103597.
• 23.   Parthkumar Devmurari, Priyanshu Rathod. Breathing Retraining Adjuncts - A Systematic Review . JRTDD [Internet]. 2023 May 22 [cited 2024 Dec. 19]; 6(5s): 312-25. Available from: https://jrtdd.com/index.php/journal/ article/view/522
• 24.   Devmurari P., Dinesh S., Parmar L. To Assess the Cardio Respiratory Endurance in College Going Students-An Observational Study. Cardiometry. 2021 Aug 1(19): 90-2.
• 25.   Devmurari P., Shah J., Satani K., Parmar L. Correlation of 6-minute walk test and body mass index in primary school children. Turkish Journal of Physiotherapy and Rehabilitation. 2021; 32(3).

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