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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. This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 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 ∼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 (FEV 1 ), forced vital capacity (FVC), and FEV 1 /FVC index], and asthma control test (ACT) were assessed before and after the intervention. The In/Ex-SC yielded larger increases in IP max  and EP max  than either the Placebo training ( P =.031 and  P =.009 respectively) or the In-MT ( P =.029 and  P =.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV 1 , FVC, and FEV 1 /FVC compared to the Placebo training ( P =.001,  P =.004, and  P =.0005 respectively) or In-MT ( P =.038,  P =.037, and  P =.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo ( P &lt;.001) or In-MT ( P =.002) training. 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.

journal of asthma

The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: a placebo-controlled randomized clinical investigation