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In both patients, breathing frequency (fR) increased, but tidal volume and the inspiratory-expiratory ratio were not improved during exercise. Despite the high fR obtained after IMT, V'E at peak exercise did not increase and endurance time shortened in the non-responder. In underweight patients with advanced COPD, IMT might lead to tachypnea and ventilatory inefficiency, which in turn might decrease exercise performance. Therefore, underweight patients with advanced COPD might be unable to tolerate IMT and should avoid receiving the train

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