OBJECTIVE: Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA. METHODS: This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12 to 18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for approximately 35 min, thrice/week over 12 weeks. The maximal inspiratory (IP max) and expiratory (EP max) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index), and asthma control test (ACT) were assessed before and after the intervention. RESULTS: The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (p = 0.031 and p = 0.009 respectively) or the In-MT (p = 0.029 and p = 0.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (p = 0.001, p = 0.004, and p = 0.0005 respectively) or In-MT (p = 0.038, p = 0.037, and p = 0.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (p < 0.001) or In-MT (p = 0.002) training. CONCLUSION: This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA.

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