Is Incentive Spirometry Helpful?
Incentive spirometry (IS) is not helpful as a standalone intervention but should be used only as part of multimodal postoperative respiratory care in high-risk surgical patients—it has no proven role in stable COPD management or as an isolated therapy.
Context-Specific Recommendations
Postoperative Care (Where IS Has Limited Utility)
The evidence clearly shows that adding IS to comprehensive physiotherapy does not improve outcomes compared to multimodal care alone. 1
- In a randomized trial of 180 patients after thoracic surgery, adding IS to standard care (thoracic expansion exercises, supported coughing, early mobilization) showed no difference in complication rates or hospital length of stay 1
- Multiple studies in mixed thoracic surgery populations confirmed that IS added to multimodal management provides no additional benefit 1
- IS should never be used as the sole intervention—it must be part of comprehensive care including early mobilization, deep breathing exercises, supported coughing, and adequate pain control 2
When IS May Be Considered (As Part of Multimodal Care Only)
High-risk surgical patients may use IS as one component of comprehensive respiratory care, not as a replacement for physiotherapy: 2
- Patients undergoing abdominal, thoracic, head, or neck operations 2
- Those with COPD, musculoskeletal chest abnormalities, abnormal pulmonary function tests, or age >60-75 years 2
- Technique: 10 maximal inspiratory maneuvers hourly while awake, sitting upright, holding breath 3-5 seconds, continuing for 2-4 weeks postoperatively 2
Chest Trauma and Rib Fractures
For patients with multiple (≥3) displaced rib fractures or flail chest, IS should be combined with regional anesthesia for pain control and multimodal pulmonary hygiene: 3
- Splinting techniques during coughing are essential 3
- Adequate pain management is critical—without it, IS is ineffective 3
- Deep breathing exercises 10 times every hour while awake should accompany IS use 3
COPD Management (Where IS Has NO Role)
IS has no established role in stable COPD management—pharmacologic bronchodilators are first-line therapy: 4
- Long-acting inhaled anticholinergics (LAMA) or long-acting β-agonists (LABA) for symptomatic patients with FEV1 <60% predicted 4
- Standard pulmonary rehabilitation programs do NOT incorporate IS 4
- For COPD patients with bullae, IS is potentially dangerous due to pneumothorax risk 4
Perioperative Use in COPD Patients
In COPD patients undergoing surgery, IS may help reduce postoperative complications when combined with other interventions: 1
- Smoking cessation 4-8 weeks preoperatively 1
- Early mobilization 1
- Deep breathing exercises 1
- Effective analgesia 1
Critical Evidence Limitations
The evidence base for IS is weak and contradictory:
- A 2008 systematic review concluded that IS provides no benefit beyond standard physiotherapy and cannot replace or significantly augment physiotherapist-directed care 5
- IS may serve as a monitoring tool for lung function recovery (correlates with vital capacity and inspiratory reserve volume) but does not improve outcomes 6
- Preoperative IS training shows no benefit—a randomized trial in bariatric surgery found no difference in postoperative lung function between intensive preoperative IS use versus minimal use 7
Common Pitfalls to Avoid
- Never prescribe IS as monotherapy—it is ineffective without comprehensive respiratory care 1, 2
- Do not use IS in low-risk surgical patients—no evidence supports benefit in this population 2
- Ensure adequate pain control first—patients cannot perform IS effectively with uncontrolled pain 2, 3
- Do not delay early mobilization—walking and movement are more important than IS 1, 2
- Avoid IS in COPD patients with bullae—risk of pneumothorax 4
The Bottom Line Algorithm
Is this a high-risk surgical patient? (thoracic/abdominal surgery, COPD, age >60-75, abnormal PFTs)
Is this for stable COPD management?
- Do not use IS—prescribe bronchodilators instead 4
Is the patient using IS alone without physiotherapy?