Feasibility of transcranial magnetic stimulation adjuvant therapy for chronic respiratory diseases: a narrative review.

Chronic respiratory disorders (CRDs) are the third most common cause of cancer- and cardiovascular disease-related mortalities. Non-pharmacological interventions for CRDs effectively slow disease progression, improve quality of life, ameliorate symptoms, and potentially extend survival. Pulmonary rehabilitation faces limitations in respiratory training efficacy owing to methodological constraints, poor patient adherence, and questions about long-term benefits. Transcranial magnetic stimulation (TMS) has been used to demonstrate the capacity of cortical excitability modulation to cause neuronal plasticity. For respiratory function, TMS exhibits dual diagnostic and therapeutic applications; it can identify neural origins of diaphragmatic dysfunction, directly stimulate pathways to activate the diaphragm, and address comorbid anxiety and depression through limbic cortical circuitry. This review outlines the physiological respiratory mechanisms and evaluates the current evidence for TMS interventions in respiratory dysfunction. Our objectives are to elucidate TMS mechanisms in CRDs, evaluate its feasibility as an adjunctive respiratory training approach, and propose novel conceptual frameworks for respiratory impairment management.