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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. 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