Imposed Pursed Lip Breathing at Rest and During Exercise In COPD
Condition: COPD
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      A randomized control trial was conducted at physiotherapy department of Pakistan Railway
      General Hospital from July 2017 to Dec 2017. 30 patients with stable COPD were enrolled in
      the study on the basis of inclusion and exclusion criteria. The participants were randomly
      assigned into two groups, Group A= interventional group, Group B = control group through toss
      and coin method using non-probability convenient sampling technique and written consent was
      obtained from each patient participated in the study. From 30 patients 15 patients were
      randomly allocated to each group, Group A: Interventional (n= 15), Group B: Control (n=15). 1
      patient in control group B was dropout because he didn't come for follow up. Overall 29
      patients were evaluated for study as in Group A, interventional (n=15) and Group B control
      (n=14).Patients in group A were performed breathing control at the start of session and then
      Purse lips breathing technique during aerobic bicycling for 8 min while in group B patients
      first perform breathing control and then aerobic bicycling for 8 min. Subjects in both
      experimental and control group underwent spirometry and baseline vitals, such as Respiratory
      rate, blood pressure, and oxygen saturation, at rest and at the completion of session was
      noted. Borg scale of dyspnea also used to rate the level of dyspnea at rest and at the end of
      session. Clinical COPD Questionnaire (CCQ) was used at 1st and final week of evaluation. It
      was 6 weeks training protocol, with three days per week session was given to the patient.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD) is a main and growing worldwide prevailing
      disease that has lacking consideration from medical practitioners. COPD is self-imposed by
      cigarette smoking and underlying pathology is commonly irreparable. This is main reason of
      morbidity and mortality in under developing countries, so quick response is necessary to be
      aware of disease signs and symptoms to provide valuable impediment and management programs.

      In U.S public survey the way prevalence of COPD has figure out by questioning adult
      population in case they had one of seventeen pulmonary diseases in previous months. Asthma,
      bronchitis and emphysema listed in these 17 diseases to approximate the cases for prevalence
      of disease. In era of 2000, approx. 10 million people diagnosed with COPD by doctor. Along
      this calculation large ratio of COPD-ers left over under diagnosed. In different countries
      the occurrence rate varies from 3.5% in Hong Kong and Singapore to 6.7% in Vietnam. Taken as
      a whole the prevalence rate is higher in Asian Pacific countries about 6.3% as compared to
      World Health Organisation (WHO) report data that hypothesized the figure of 3.8%.

      Dyspnea is a main cause for seek medical advice or referral to pharmacotherapy and pulmonary
      rehabilitation regimes to lessen the inflammation and spasm of airways in addition to self
      management approach for example breathing retraining techniques. COPD patients have
      inadequate exhalation time because of increased resistance in the airways with increase
      chance of collapse. While doing exercise airflow limitation exacerbates that leads to air
      trapping with shortened exhalation phase. This is noticeable by increase in expiratory lung
      volumes which causes reduction in exercise capacity that might be restricted by fatigue of
      their lower limb muscles other than the ventilatory causes. The disease severity can be
      decided through the intenseness of breathlessness therefore the primary aim of COPD
      management is dyspnea reduction.

      Commonly used strategy for ventilatory pattern training is purse lips breathing technique
      (PLB). PLB is supposed to alter the ventilatory pattern as a result of that breathlessness is
      decreased. The action of PLB technique is to improve exhalation and prevent airway
      obstruction. The patient performs expiration actively by means of partly opened mouth by
      applying pressure of 5cm of water (H2O).

      PLB reduces rapid and prolong breathing and causes increased level of Carbon dioxide (CO2) in
      alveoli. These improved levels may dilate the airway smooth muscles and V/Q ratio and O2 in
      circulation. PLB is worked by generating back pressure in airways in a way to open up the
      narrowed airways. It is also create positive pressure during expiratory phase to prolong the
      exhalation time in order to decrease expiratory lung volumes and increase in tidal volume.

      Patients with emphysema and bronchial atelectasis tried to perform PLB the expired air volume
      increased as compared to forced exhalation. This proposed that patient expires in a relaxed
      manner with PLB which causes less air trapping and also reduced dynamic hyperinflation.

      In 2012 a randomized control study conducted on 14 stable COPD patients to rule out the
      effects of imposed purse lips breathing on exercise tolerance. In this study it has been
      shown that at rest PLB improves gaseous exchange, breathing pattern and lessen the
      respiratory rate near to normal.As in COPD patients' diaphragm hyperinflate due to air
      trapping by performing this breathing technique, diaphragm brings to a vantage point.

      In COPD metabolic disruption in skeletal muscles is a main factor for exercise intolerance.
      Previous Investigators compared the upper and lower limb activities in COPD patients
      presented with obvious dyspnea and limited active daily living (ADLs). In COPD-ers due to
      decreased strength and endurance are correlated with early sarcopenia, reduced capacity of
      aerobic exercises and rapid collection of lactic acid while doing exercise these factors
      possible culprits for muscle fatigue. Aerobic training is well known and consistent in the
      improvement of disease symptoms, exercise tolerance and quality of life in patients with
      COPD. According to data of various studies cycle ergometer (CET) is commonly used training to
      increase strength and endurance in lower limb musculature. In one study results CET can cause
      physiological effects on COPD patients thought to improve O2 uptake & minute tidal volume
      with reduction in pulse rate, sensation of breathlessness and muscle fatigue.

      In Pakistan about 6-7 million people have suffering due to COPD and death rate is 71 for each
      10000 population. Although the demand for such strategies is considerable but at the same
      time the facility to grant these services is deprived. When talk about data on application of
      purse lips breathing technique in COPD patients, very few researches are found in Pakistan.
      Currently in Peshawar work on chest physiotherapy for worsening symptoms of COPD is reported.
      If the implication of these techniques in symptoms free period of disease this might be cause
      improvement in health related quality of life. The present study is to determine the effects
      of imposed purse lips breathing technique on dyspnea, breathing pattern and pulmonary
      function testing during rest and exercise in patients with COPD.
    

Intervention name(s): PLB+Aerobic Bicycling; Aerobic Bicycling
Intervention type(s): Other; Other
Intervention description(s): Combination of Breathing control and Purse lips breathing technique for 5 minutes at the start of session.
Purse lips breathing with aerobic bicycling for 8 minutes; Breathing control for 5 minutes at the start of session.
Aerobic bicycling for 8 minutes
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: COPD; Pursed Lips Breathing; Dyspnea; Pulmonary Function Test (PFT); Aerobic Training