Effects of a Diaphragmatic Breathing Training Program in Chronic Obstructive Pulmonary Disease (COPD) Patients
Effects of a Diaphragmatic Breathing Training Program in Chronic Obstructive Pulmonary Disease (COPD) Patients
Diaphragmatic dysfunction and alterations of thoracoabdominal motions are common in patients
 with chronic obstructive pulmonary disease (COPD). Several studies have described an
 impairment in diaphragmatic mobility of COPD patients compared to age matched control
 subjects and it has been associated with increase in dyspnea, exercise intolerance and
 mortality. COPD patients also experiment a higher activity of the accessory breathing
 muscles, which greatly increases the work of breathing and dyspnea sensation.

 Breathing strategies have been considered an important component of pulmonary rehabilitation
 and refer to a range of techniques, including/which includes the diaphragmatic breathing
 (DB). The principal aim of DB is to improve the participation of the abdominal motion while
 reducing the accessory muscles activity. The role of DB as an adjunctive treatment modality
 in the rehabilitation of COPD patients remains controversial. Despite the conflicting
 results, improvement of the abdominal motion and a reduction of thoracic excursion, during
 voluntarily DB, has been described as a common finding of several studies. The investigators
 hypothesized that a 4-week DBTP could induce higher participation of the diaphragm and this
 modification would relieve respiratory symptoms and improve exercise tolerance and the HRQoL.
 Therefore, in this randomized controlled trial the investigators aimed to test the effects of
 a short-term DBTP on thoracoabdominal motion, pulmonary function, diaphragmatic mobility,
 dyspnea, HRQoL and exercise tolerance in patients with mild to severe COPD.
Inclusion Criteria: (1) age between 50 and 80 years; (2) a post-bronchodilator forced
 expiratory volume in one second (FEV1) < 80% of the predicted value and a FEV1/ forced
 vital capacity (CVF) ratio < 0,7; (3) stable respiratory/clinical condition without changes
 in medication and symptoms (dyspnea, volume or color of sputum) for at least 4 weeks before
 admission to the study; and (4) receiving regular treatment with inhaled bronchodilators
 and steroids.

 Exclusion Criteria: (1) presence of other pulmonary, cardiovascular or musculoskeletal
 diseases; (2) previously participation in any exercise-training program in the last 2 years
 before participating in this study; and (3) current smokers.