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Annals of International Medical and Dental Research
E-ISSN: 2395-2822 | P-ISSN: 2395-2814
Vol-7, Issue-3 | May-June, 2021
Page no- 573-577 | Section- Research Article (Pulmonary Medicine)
Effectiveness of Breathing Exercises in Patients with COPD
1 2
Sunita Grover , Bindu Goyal
¹
Assistant Professor, Department Abstract
TB and Chest Diseases, Al Falah
school of Medical Sciences and Background: Chronic obstructive pulmonary disease (COPD) is one of the
Research Center, Dhauj, most common life-threatening diseases affecting populations globally. The
Faridabad, Haryana, India. Email: present study conducted to assess effectiveness of breathing exercises in
drgroversunita@gmail.com, patients with COPD. Methods: 60 COPD patients of both genders (Group I)
*Corresponding author and equal number of healthy control were also recruited (Group II) Patients
were prescribed PLB, VF training, VF plus exercise, singing, DBE, and
2 combined BEs training. Parameters such as ventilation, dyspnea, exercise
Consultant, Departmentof capacity, and QoL and ventilation-related outcomes included respiratory rate
Pulmonology, Vardhman (RR), tidal volume (VT) etc. were recorded. Result: The mean respiratory rate
Mahaveer Health Care, (RR) in group I was 20.4 and in group II was 23.8, tidal volume was 628.2 in
Patiala,Punjab, India. group I and 480.4 in group II, inspiratory time was 1.52 in group I and 1.30 in
group II, total respiratory time was 4.40 in group I and 3.42 in group II and
oxygen consumption was 1024 in group I and 1124.6 in group II. The
difference was significant (P< 0.05). Conclusion: There was improvement in
Received: January 2021 all parameters in COPD as well as in control group, hence can be concluded
Accepted: February 2021 that exercises have great impact on respiratory functions.
Keywords: Chronic Obstructive Pulmonary Disease, Dyspnea, Quality of Life.
INTRODUCTION Breathing technique is an all embracing
term for a range of techniques such as
Chronic obstructive pulmonary disease active expiration, slow and deep
(COPD) is one of the most common breathing, pursed lips breathing,
life-threatening diseases affecting relaxation therapy, body positions such
populations globally. as forward leaning, inspiratory and
Pathophysiological changes in airway, expiratory muscle training and
tissue, and vascular supply to lungs [3]
diaphragmatic breathing. The aims of
increase airway resistance and air these techniques vary considerably and
trapping, and decrease lung include the improvement of (regional)
compliance resulting in increased work ventilation and gas exchange, reduction
of breath, and dyspnea in COPD of dynamic hyperinflation,
patients. To avoid dyspnea, COPD improvement of respiratory muscle
patients commonly avoid or limit function, reduction in dyspnea and
physical activities which, in turn, lead improvement of exercise tolerance and
to decrease in exercise tolerance, and an [4]
quality of life. In patients with COPD,
increase in anxiety, disability, and poor breathing techniques aim at relieving
[1,2]
quality of life (QoL). dyspnea by: 1) increasing strength and
endurance of the respiratory muscles;
573
Copyright: ©The author(s), published in Annals of International Medical and Dental Research, Vol-7, Issue-3. This is an open access article under
the Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0) license. (https://creativecommons.org/licenses/by-nc/2.0/)
Annals of International Medical and Dental Research
E-ISSN: 2395-2822 | P-ISSN: 2395-2814
Vol-7, Issue-3 | May-June, 2021
Page no- 573-577 | Section- Research Article (Pulmonary Medicine)
2) optimizing the pattern of saturation (SpO2) were recorded.
thoracoabdominal motion; and 3) Results thus obtained were subjected to
reducing dynamic hyperinflation of the statistical analysis. P value less than
[5]
rib cage and improving gas exchange. 0.05 was considered significant.
Many types of BE such as slow and
deep breathing, active expiration, RESULTS
pursed-lip breathing (PLB), relaxation
breathing, diaphragmatic breathing Table 1: Distribution of patients
(DBE), and ventilatory feedback (VF) Total- 60
training, have been prescribed to Gender Males Females
decrease lung hyperventilation, Number 35 25
enhance respiratory muscle function,
exercise tolerance, and QoL in COPD [Table 1] shows that out of 60 patients,
patients. These BEs have been used males were 35 and females were 25.
individually, or in combination of
[6] Table 2: Comparison of parameters
different types of BE. The present Parameters Group Group P
study conducted to assess effectiveness I II value
of breathing exercises in patients with Respiratory 20.4 23.8 0.91
COPD. rate
Tidal volume 628.2 480.4 0.04
MATERIALS AND METHODS Inspiratory 1.52 1.30 0.09
time
The present study was conducted Total 4.40 3.42 0.05
among 60 COPD patients of both respiratory
genders (Group I). Enrolment of time
patients was done after obtaining their Oxygen 1024 1124.6 0.12
written consent. consumption
Demographic data of all patients was
recorded. Equal number of healthy [Table 2, Figure 1] shows that mean
control were also recruited (Group II) respiratory rate (RR) in group I was 20.4
Patients were prescribed PLB, VF and in group II was 23.8, tidal volume was
training, VF plus exercise, singing, 628.2 in group I and 480.4 in group II,
DBE, and combined BEs (combination inspiratory time was 1.52 in group I and
1.30 in group II, total respiratory time was
of DBE with other BEs). Duration of BE 4.40in group I and 3.42 in group II and
training was one session to 4 weeks. oxygen consumption was 1024 in group I
Parameters such as ventilation, and 1124.6 in group II. The difference was
dyspnea, exercise capacity, and QoL significant (P< 0.05).
and ventilation-related outcomes
included respiratory rate (RR), tidal
volume (VT), inspiratory time (Ti),
expiratory time (Te), minute ventilation
(Ve), total respiratory time (Ttot), mean
inspiratory flow (VT/Ti), oxygen
574
Copyright: ©The author(s), published in Annals of International Medical and Dental Research, Vol-7, Issue-3. This is an open
access article under the Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0) license.
(https://creativecommons.org/licenses/by-nc/2.0/)
Annals of International Medical and Dental Research
E-ISSN: 2395-2822 | P-ISSN: 2395-2814
Vol-7, Issue-3 | May-June, 2021
Page no- 573-577 | Section- Research Article (Pulmonary Medicine)
the aim is to reduce the relative load on
the muscles (PI/PImax) and hence
dyspnea and to increase maximal
sustained ventilatory capacity. This
might also imply an improvement of
exercise capacity in patients with
ventilatory limitation during
[10]
exercise. The present study
Figure 1: Comparison of parameters conducted to assess effectiveness of
breathing exercises in patients with
DISCUSSION COPD.
Dyspnea is an important and In present study, out of 60 patients,
debilitating symptom in patients with males were 35 and females were 25.
[11]
chronic obstructive pulmonary disease Ubolnour et al, conducted a
[7] randomized controlled trials
(COPD). Several pathophysiological
factors known to contribute to dyspnea investigating the effects of BEs in
include: 1) increased intrinsic COPD patients. Risk of bias and quality
mechanical loading of the inspiratory of evidence were assessed, using
muscles; 2) increased mechanical Cochrane Collaboration’s tool, and the
restriction of the chest wall; 3) Grading of Recommendation
functional inspiratory muscle Assessment, Development, and
weakness; 4) increased ventilatory Evaluation (GRADE) approach,
demand related to capacity; 5) gas respectively. Nineteen studies (n=745),
exchange abnormalities; 6) dynamic were included. Quality of evidence,
airway compression; or 7) was low to moderate. When compared
cardiovascular effects. The relief of to the control groups, respiratory rate
dyspnea is an important aim of the significantly (p≤0.001) improved in the
treatment of COPD, an only partially pursed-lip breathing (PLB), ventilatory
[8] feedback (VF) plus exercise,
reversible disease. Among treatment
modalities commonly applied such as diaphragmatic breathing exercise
bronchodilator therapy, exercise (DBE), and combined BEs.
training and oxygen therapy, breathing Additionally, PLB significantly
techniques are also applied to alleviate improved tidal volume (p<0.001),
symptoms and improve respiratory inspiratory time (p=0.007), and total
[9] respiratory time (p<0.001). VF plus
physiology. It is believed that when
respiratory muscle effort (ratio of the exercise significantly improved
actual inspiratory pressure over the inspiratory capacity (p<0.001), and
maximal inspiratory pressure, singing significantly improved the
PI/Pimax) exceeds a critical level, physical component of QoL, than did
breathing is perceived as unpleasant. the control groups (p<0.001). All BEs
By improving respiratory muscle did not significantly improve dyspnea,
function or reducing inspiratory load compared to the controls (p>0.05).
575
Copyright: ©The author(s), published in Annals of International Medical and Dental Research, Vol-7, Issue-3. This is an open
access article under the Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0) license.
(https://creativecommons.org/licenses/by-nc/2.0/)
Annals of International Medical and Dental Research
E-ISSN: 2395-2822 | P-ISSN: 2395-2814
Vol-7, Issue-3 | May-June, 2021
Page no- 573-577 | Section- Research Article (Pulmonary Medicine)
We found that mean respiratory rate have great impact on respiratory
(RR) in group I was 20.4 and in group II functions.
was 23.8, tidal volume was 628.2 in
group I and 480.4 in group II, REFERENCES
inspiratory time was 1.52 in group I
and 1.30 in group II, total respiratory 1. Bisschop A, Gayan-Ramirez G, Rollier H,
time was 4.40 in group I and 3.42 in Gosselink R, de Bock V, Decramer M.
group II and oxygen consumption was Intermittent inspiratory muscle training
1024 in group I and 1124.6 in group II. induces fiber hypertrophy in rat diaphragm.
Am J Respir Crit Care Med 1997; 155: 1583-89.
In the 19 included studies, the effects of 2. Rollier H, Bisschop A, Gayan-Ramirez G,
PLB, VF training alone, VF plus Gosselink R, Decramer M. Low load inspiratory
exercise, singing, DBE, and combined muscle training increases diaphragmatic fiber
BEs were examined. According to the dimensions in rats. Am J Respir Crit Care Med
GRADE approach, quality of evidence 1998; 157: 833-39.
3. Ramirez-Sarmiento A, Orozco-Levi M, Guell R
of PLB and VF plus exercise was et al. Inspiratory muscle training in patients
downgraded to low to moderate with chronic obstructive pulmonary disease:
because of a small sample size, structural adaptation and physiologic
heterogeneity among studies, and/or outcomes. Am J Respir Crit Care Med 2002; 166:
low methodological quality of included 1491-97.
4. Harver A, Mahler DA, Daubenspeck JA.
studies. For VF training alone singing Targeted inspiratory muscle training improves
and combined BEs, the quality of respiratory muscle function and reduces
evidence was moderate because of a dyspnea in patients with chronic obstructive
small sample size. For DBE, quality of pulmonary disease. Ann Intern Med. 1989; 111:
evidence was low because of a small 117-24.
5. Lotters F, van Tol B, Kwakkel G, Gosselink R.
sample size and heterogeneity among Effects of controlled inspiratory muscle training
studies. PLB significantly improved RR in patients with COPD: a meta-analysis. Eur
VT (p=0.0004) Ti (p=0.007) and Ttot Respir J 2002; 20: 570-76. 42.
(p=0.0004) than did the control group. 6. Smith K, Cook D, Guyatt GH, Madhavan J,
Quality of evidence of these outcomes Oxman AD. Respiratory muscle training in
chronic airflow limitation: a meta-analysis. Am
was moderate. There was no significant Rev Respir Dis 1992; 145: 533-39.
between-group difference in other 7. Belman MJ, Warren CB, Nathan SD, Chon KH.
ventilatory related outcomes (p=0.10– Ventilatory load characteristics during
0.85), dyspnea (p=0.15), and 6MWD ventilatory muscle training. Am J Respir Crit
[12] Care Med 1994; 149: 925 -29.
(p=0.85). The limitation of the study 8. Villafranca C, Borzone G, Leiva A, Lisboa C.
is small sample size. Effect of inspiratory muscle training with
intermediate load on inspiratory power output
CONCLUSION in COPD. Eur Respir J 1998; 11: 28-33.
9. Martinez FJ, Couser JI, Celli BR. Factors
Authors found that there was influencing ventilatory muscle recruitment in
improvement in all parameters in patients with chronic airflow obstruction. Am
Rev Respir Dis 1990; 142: 276-82.
COPD as well as in control group, 10. Sharp JT, Danon J, Druz WS, Goldberg NB,
hence can be concluded that exercises Fishman H, Machnach W. Respiratory muscle
function in patients with chronic obstructive
pulmonary disease: its relationship to disability
576
Copyright: ©The author(s), published in Annals of International Medical and Dental Research, Vol-7, Issue-3. This is an open
access article under the Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0) license.
(https://creativecommons.org/licenses/by-nc/2.0/)
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