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EFFECT OF DIAPHRAGM BREATHING EXERCISE AND
ELECTRIC FAN TO DYSPNEA, AND PULMONARY FUNCTION
IN CLIENTS COPD; A Systematic Review
Shelfi Dwi Putri Retnani S1, Pudji Lestari2, Ilya Krisnana2, Farida Hayati3
1MASTER STUDENT FACULTY OF NURSING, AIRLANGGA UNIVERSITY SURABAYA
2LECTURER OF NURSING DEPARTMEN, AIRLANGGA UNIVERSITY, SURABAYA
3LECTURER OF NURSING DEPARTMENT, STIKES KARYA HUSADA, KEDIRI
{(SHELFI.DR.PUTRI@GMAIL.COM) (PULES30YAHOO.COM) (ILYA-K@FKP.UNAIR.AC.ID)}
Keywords: Keywords: chronic obstructive pulmonary disease, diaphragm breathing exercise, electric fan, dyspnea,
pulmonary function
Abstract: Introduction: Dyspnea and decrease of lung function in COPD are a major problem. These things need
intervention that aims to relieve these problems. This systematic review has the purpose to know some
interventions included diaphragm breathing exercise and electric fan to improve of dyspnea and pulmonary
function. Methodology: Information related to this research was found on some journal databases such as
MEDLINE, PubMed, Ebsco, CINAHL, Elsevier, Science Direct, which is a respiratory journals and a
collection of abstract research that was identified from 2010 until 2017. Results: diaphragm breathing
exercise and electric fan was an effective therapy against a decrease in dyspnea and improvement of lung
function. Conclusion: diaphragm breathing exercise and electric fan that in which will be applied in daily
life activities of patients of COPD to resolve dyspnea and lung function.
1 INTRODUCTION Dyspnea, or breathlessness is a subjective
sensation of difficulty breathing and it can change
COPD became the 3rd leading cause of death in the quality life of patients (Wong et al. 2016).
2020, about 3 million deaths assigned by to COPD Dyspnea is overcame in daily simple task such as
in 2012, an estimated 6% of all deaths worldwide in walking in the road home, so paralyzing activity in
the year (GOLD 2017). Chronic obstructive COPD patients. Various non-pharmacological
pulmonary disease (COPD) is a respiratory disorder strategies can be used to treat shortness of breath,
characterized by airflow limitation is progressive such as breathing exercises and the use of an electric
due to blockage of the airways, due to the blockage fan (Luckett et al. 2017).
in the peripheral, then the volume of air can be There are a number of published studies
trapped in the lungs called hyperinflation (Borge et describing the use of diaphragmatic breathing
al. 2014). This case is usually caused by client with exercises, including research Morrow et al. 2012
COPD, including dyspnea and pulmonary function describes diaphragmatic breathing exercises can
decline illustrated by a decrease in vital force improve respiratory muscle activity but is not
expiration 1 (FEV1)..Worsening COPD is a major associated with dyspnea, while research Yamaguti et
cause of morbidity and mortality globally (Morrow al. 2012 describes diaphragmatic breathing exercises
et al. 2012). can increase abdominal movement and improve
54 The 9th International Nursing Conference 2018
“Nurses at The Forefront in Transforming Care, Science, and research”
functional capacity. In addition to diaphragmatic terminal cancer with breathlessness, emphysema,
breathing exercises, the authors propose is a non- chronic bronchitis. There were no age restrictions.
pharmacological exercise that can be used patients Intervention-the study population received from
of COPD to reduce shortness of breath by cold of therapy non-pharmacology included diaphragm
stimulation using an electric fan. The use of the breathing exercise, fan electric to improve of
electric fan to the patient with breathlessness dyspnea and pulmonary function.
supported by research Wong et al. 2016, describes Comparison-where there was a comparator, the
an eclectic fan effective in reducing dyspnea. These diaphragm breathing exercise and fan electric
findings are not replicated in a population of patients intervention was compared against a control period,
with COPD, although it seems reasonable to a sham technique or alternative interventions.
consider treatment of shortness of breath and Outcome-measures e studies were included if
reduced lung function of patients with COPD. they measured any lung function parameter,
Diaphragm breathing exercise is one breathing however the primary outcomes sought were
technique, which aims to reduce dypsnea with performance based measures such as FEV1, FVC,
increasing excursion diaphragm regulator process and FEV1/FVC. Patient reported measures, such as
and it can improve muscle strength of the diaphragm breathlessness were also recorded. Short and long
that is the main muscle of breathing (Cahalin et al term follow up periods were considered in light of
2002 in Morrow et al., 2012). Electric fan can the scoping search.
stimulate the trigeminal nerve for reducing the Study designs-the ideal study design would have
perception of dyspnea (Luh et al. 2017). been the randomised controlled trial (RCT), but a
The aim of this paper is to systematically review scoping review of the literature suggested limited
the current empirical evidence for the use of the data available therefore we also included quasi
diaphragm breathing exercise and electric fan as experimental studies; non-randomised controlled
management approach for COPD Patients. trials, study qualitative, and before-and-after studies.
2 METHODS 3 RESULT
3.1 EFFECT OF DIAPHRAGM
2.1 RESOURCES BREATHING ON DYSPNEA OR
BREATHLESSNESS
Rresearch-related information is found on some
journal databases such as MEDLINE, PubMed, DIAPHRAGM BREATHING CAN REDUCE
Ebsco, CINAHL, Elsevier, Science Direct, which is DYSPNEA AFTER 4 WEEKS WAS OBSERVED
a respiratory journals and a collection of abstract BY A 10-POINT REDUCTION IN TOTAL ST.
research that identified from 2010 until 2017. All GEORGE'S RESPIRATORY QUESTIONNAIRE
reference list consists of original articles which also SCORE (F = 9.7; P<0.001) AND TOTAL MMRC
conducted a review to identify other relevant studies. DYSPNEA SCALE (F = 5.1; P<0.03)
All publications and abstracts of the english (YAMAGUTI ET AL. 2012). HOWEVER, NO
language which is also taken into consideration. SIGNIFICANT CHANGES TO THE
PARAMETER IN THE BORG DYSPNEA SCALE
OF PERCEIVED DYSPNEA (P= 0.1) (MORROW
ET AL. 2012). THIS DIFFERENCE SHOWED,
MAYBE BECAUSE OF THE SUBJECTIVE OF
2.2 DATA EXTRACTION DYSPNEA PARAMETERS, POTENTIAL
PROBLEMS IN UNDERSTANDING THE SCALE
OF THE ELEMENTS, DIFFERENCES IN
The inclusion criteria were used as standard samples IMPLEMENTATION AND TRAINING OF
are: DIAPHRAGMATIC BREATHING (CAHALIN ET
Participants - study population included healthy AL 2002; MORROW ET AL. 2012).
adults, adults with known history of chronic
obstructive airways disease or breathlessness, 3.2 EFFECT OF DIAPHRAGM
including patients described as having COPD, BREATHING ON PULMONARY
FUNCTION
The 9th International Nursing Conference 2018 55
“Nurses at The Forefront in Transforming Care, Science, and research”
SENSATION OF BREATHLESSNESS AFTER
DIAPHRAGMATIC BREATHING WAS AN FAN THERAPY (WONG ET AL. 2016).
EFFECTIVE THERAPY TO IMPROVE ANOTHER STUDY CONDUCTED IN CHRONIC
PULMONARY FUNCTION, THERE ARE SOME REFRACTORY BREATHLESSNESS PATIENTS
STUDIES THAT SUPPORT THESE RESULTS, USE ELECTRIC FAN COULD REDUCTION IN
AMONG OTHER RESEARCH THAT WAS BREATHLESSNESS RELATIVE TO THE MEAN
DONE IN COPD PATIENTS THERE ARE A BASELINE SCORES FOR THE SAMPLE WAS
DIFFERENCE IN VALUE BETWEEN THE 27% FOR THE VISUAL ANALOG SCALE (VAS)
INTERVENTION GROUP THAN THE CONTROL AND 19% FOR THE NUMERICAL RATING
GROUP (FEV1 WITH F= 0:28; P= 0.60, FVC SCALE (NRS) (BOOTH ET AL. 2016). THE
WITH F= 0:21; P= 0.65, AND FEV1/ FVC WITH STUDY SUPPORTS THE HYPOTHESIS THAT A
F= 1.86; P =0.18) (YAMAGUTI ET AL. 2012). HANDHELD FAN DIRECTED TO THE FACE
ANOTHER STUDY CONDUCTED IN HEALTHY REDUCES THE SENSATION OF
ADULTS ALSO SHOWED INCREASES IN BREATHLESSNESS. THERE WAS A
PULMONARY FUNCTION THAT SIGNIFICANT DIFFERENCE IN THE VAS
DIAPHRAGMATIC STRETCHING SHOWED A SCORES BETWEEN BEFORE AND AFTER
SIGNIFICANT IMPROVEMENT IN FVC (P = THERAPY, WITH A REDUCTION IN
0.006) AND FEV (P= 0.042) (VALENZA ET AL. BREATHLESSNESS WHEN THE FAN WAS
2015). RESEARCH CONDUCTED ON SHOWED DIRECTED TO THE FACE (P= 0.003)
SIGNIFICANT STUDENT INCREASES IN BOTH (GALBRAITH ET AL. 2010). FINDINGS
FVC AND FEV1. IN THE COMPARISON OF SUGGEST THAT A HAND-HELD FAN IS A
FVC AND FEV1 BEFORE AND AFTER. PORTABLE INTERVENTION WITH FEW
DIFFERENCE BETWEEN PRE-TEST AND DISADVANTAGES FROM THE WHICH MOST
POST-TEST IN THE EXPERIMENTAL GROUP, PATIENTS WITH CHRONIC
THE MEAN FEV1= 0.15 AND THE MEAN FVC = BREATHLESSNESS WILL DERIVE BENEFIT
0.18. (KIM & LEE 2013). THE SAME THING, ALONGSIDE OTHER NON-
STUDIES IN NORMAL ADULTS SHOWED PHARMACOLOGICAL AND
SIGNIFICANT DIFFERENCE IN FEV1 AND FVC PHARMACOLOGICAL STRATEGIES
REVIEWS THOSE OF BEFORE AND AFTER (LUCKETT ET AL. 2017).
THE DIAPHRAGM BREATHING EXERCISE
(LEE ET AL. 2017). MEASURING INSTRUMENT 4 DISCUSSION
USED TO MEASURE PULMONARY FUNCTION
IN THESE STUDIES IS SPIROMETRY. THE DIAPHRAGM BREATHING EXERCISE CAN
CONCLUSION THAT THE DIAPHRAGM INCREASE ABDOMINAL MOVEMENT WHEN
BREATHING EXERCISE IN COPD PATIENTS, NATURAL BREATHING, SO AS TO IMPROVE
NORMAL HEALTHY ADULTS OR ADULTS THE FUNCTIONAL CAPACITY (YAMAGUTI
AND STUDENTS CAN IMPROVE PULMONARY ET AL., 2012). DIAPHRAGM BREATHING
FUNCTION. EXERCISE CAN INCREASE MUSCLE
STRENGTH OF THE DIAPHRAGM IS THE
3.3 EFFECT OF ELECTRIC FAN ON MAIN MUSCLE OF BREATHING AND
DYSPNEA OR BREATHLESSNESS THORACIC SERVES AS THE BOTTOM EDGE.
CONTRACTION OF THE DIAPHRAGM
ELECTRIC FAN OR HAND-HELD FAN COULD MUSCLE PULL DOWN, INCREASING THE
REDUCE DYSPNEA OR BREATHLESSNESS ON SPACE ON THORACIC AND ACTIVELY
RESPONDENTS. THERE ARE DIFFERENT DEVELOP LUNG (BLACK & HAWKS 2014).
CHARACTERISTICS OF RESPONDENTS, THE WHEN THE MUSCLE WORK DIAPHRAGM
RESEARCH IN CHINESE PATIENTS WITH CAN BE MAXIMIZED THEN THE CLIENT CAN
TERMINAL CANCER, THEY WERE USE OF TAKE DEEPER BREATHS AND MORE
ELECTRIC FAN COULD BE EFFECTIVE IN EFFECTIVE SO THAT IT CAN MAINTAIN
ALLEVIATING DYSPNEA. THIS RESEARCH LUNG EXPANSION (LUH ET AL. 2017).
SHOWED SIGNIFICANT DIFFERENCE IN THE OTHER THERAPIES THAT ARE EFFECTIVE
NRS SCORES OF THE EXPERIMENTAL AGAINST FOR DYSPNEA OR
GROUP (P <0.01), INDICATING A BREATHLESSNESS IS ELECTRIC FAN OR
SIGNIFICANT REDUCTION IN THE PATIENTS' HAND-HELD FAN. RESULTS RESEARCH IN
56 The 9th International Nursing Conference 2018
“Nurses at The Forefront in Transforming Care, Science, and research”
WONG ET AL., (2016) ABOUT THE EFFECT OF Medicine, 30(5), pp.504–509.
FLECTRIC FAN ON DYSPNEA IN CHINESE ON Borge, C.R. et al., 2014. Effects of controlled
THE CLIENT TERMINAL CANCER SHOWS breathing exercises and respiratory muscle
THAT THE COLD AIR FROM THE FAN CAN training in people with chronic obstructive
REDUCE DYSPNEA AND IT IS FOR THERAPY pulmonary disease: results from evaluating the
NON-PHARMACOLOGICAL. COLD STIMULUS quality of evidence in systematic reviews.
IS THEN RELAYED TO FOLLOW THE PATH BMC Pulmonary Medicine.
OF THE TRIGEMINAL NERVE TO THE Galbraith, S. et al., 2010. Does the Use of a
BRAINSTEM AND THALAMUS TO PROCEED Handheld Fan Improve Chronic Dyspnea? A
TO THE SOMATOSENSORY CORTEX. Randomized, Controlled, Crossover Trial.
SOMATOSENSORY CORTEX IS ONE PART OF Journal of Pain and Symptom Management,
THE CORTEX THAT FEEL THE SENSATION 39(5), pp.831–838. Available at:
OF DYSPNEA. THE STIMULATION IS http://dx.doi.org/10.1016/j.jpainsymman.2009.
CHANGING THE FEEDBACK FROM RE- 09.024.
AFFERENT IMPULSES TO THE GOLD, 2017. Global Initiative for Chronic
SOMATOSENSORY CORTEX AND MODIFY Obstructive Lung A Guide for Health Care
THE PERCEPTION OF DYSPNEA (LUH ET AL. Professionals 2017th ed. R. Hadfield, ed.,
2017). Kim, E. & Lee, H., 2013. The Effects of Deep
THE TECHNIQUE BREATHING EXERCISES IS Abdominal Muscle Strengthening Exercises
KNOWN THAT ARE MOST EFFECTIVE WHEN on Respiratory Function and Lumbar Stability.
IMPLEMENTED FOR 4 TO 12 WEEKS, 2 TO 5 J. Phys. Ther. Sci., 25, pp.663–665.
TIMES PER WEEK, WITH EACH SESSION Lee, H.-Y., Cheon, S.-H. & Yong, M.-S., 2017.
LASTING NO MORE THAN 20 TO 30 MINUTES. Effect of diaphragm breathing exercise applied
CONSIDERING THIS, THE SELECTED on the basis of overload principle. The Journal
DURATION TIME IS 30 MINUTES 3 TIMES A of Physical Therapy Science, 29, pp.1054–
WEEK FOR 4 WEEKS (SEO ET AL. 2015) 1056.
Luckett, T. et al., 2017. Contributions of a hand-held
5 CONCLUSION fan to self-management of chronic
breathlessness. European Respiratory Journal,
DIAPHRAGM BREATHING EXERCISE AND pp.1–10. Available at:
ELECTRIC FAN WAS AN EFFECTIVE http://dx.doi.org/10.1183/13993003.00262-
THERAPY AGAINST A DECREASE IN 2017.
DYSPNEA AND IMPROVEMENT OF LUNG Luh, N. et al., 2017. Hand‑held Fan Airflow
FUNCTION. DIAPHRAGM BREATHING Stimulation Relieves Dyspnea in Lung Cancer
EXERCISE AND ELECTRIC FAN THAT IN Patients. Asia‑Pacific Journal of Oncology
WHICH WILL BE APPLIED IN DAILY LIFE Nursing, 4(2), pp.162–167.
ACTIVITIES, THIS THERAPY IS Morrow, B. et al., 2012. The effect of positioning
RECOMMENDED AS THE PRIMARY NON- and diaphragmatic breathing exercises on
PHARMACOLOGICAL TREATMENT FOR respiratory muscle activity in people with
COPD PATIENTS WHO EXPERIENCE chronic obstructive pulmonary disease. South
DYSPNEA ON EXERTION. African Journal of Physiotherapy, pp.1–6.
Available at: http://www.sajp.co.za.
Valenza, M.C. et al., 2015. Effects of a diaphragm
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The 9th International Nursing Conference 2018 57
“Nurses at The Forefront in Transforming Care, Science, and research”
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