Imposed Pursed Lip Breathing at Rest and During Exercise In COPD
Imposed Pursed Lip Breathing at Rest and During Exercise In COPD
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.
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.
Inclusion Criteria:

 -  COPD stage 2 and 3 patients [based on "Global Initiative for Chronic Obstructive Lung
 Disease (GOLD) criteria]

 Exclusion Criteria:

 -  neurological disorder and

 -  cardiovascular disorder

 -  Impaired lower limbs mobility