The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis

BACKGROUND

Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are physical therapy interventions frequently adopted by patients with chronic obstructive pulmonary disease (COPD). This systematic review aimed to investigate the effects of PLB combined with DB on pulmonary function and exercise capacity in patients with COPD.

METHODS

Six databases were searched to collect relevant studies published before August 30, 2019 in English and Chinese. Randomized controlled trials (RCTs) with PLB combined with DB training as the exclusive intervention for COPD were identified. Mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI) was calculated. Heterogeneity was assessed by Cochran's Q test and I² statistics.

RESULTS

A total of 15 RCTs were included, involving 1098 patients with COPD (570 in treatment groups and 528 in control groups). Significant improvements were found in forced expiratory volume in 1 s (FEV₁) (SMD = 0.47, 95% CI = 0.27-0.67, P < .001), forced vital capacity (FVC) (SMD = 0.87, 95% CI = 0.59-1.15, P < .001), FEV₁ as a proportion of FVC (FEV₁/FVC) (MD = 8.30, 95% CI = 1.17-15.43, P = .02), and 6-min walk test (6MWT) distance (MD = 29.09, 95% CI = 19.35-38.83, P < .001).

CONCLUSIONS

The intervention of PLB combined with DB effectively promotes pulmonary function and exercise capacity in patients with COPD. The combined application of PLB and DB is an easy and low-cost physical therapy intervention, which should be promoted as a daily essential practice of COPD.

The Effects of Modified Pursed Lips Breathing on Oxygenation Status in Children

Respiratory disease in children can contribute to damaged alveoli, frailty of respiratory muscles, reduced lung function, impaired gas exchange, and gas retention in the airway. Such condition may lead to disruption of oxygen status. This study aimed to examine the effects of modified pursed lips breathing (PLB) by blowing into a water-filled bottle through a straw and a party whistle on the oxygenation status in children with oxygenation problems. This study used a quasi-experiment method with a pretest-posttest without a control group design approach. The sample consisted of 32 school-aged children and adolescents who were divided into two intervention groups. Group 1 underwent modified PLB by blowing into a water-filled bottle through a straw and Group 2 was provided with modified PLB by blowing a party whistle. The intervention was conducted one time in a day, in a rest time, for 10 min. The results showed that modified PLB by blowing into a water-filled bottle through a straw was more effective in reducing respiratory rate (RR) and improving oxygen saturation (SpO₂) than modified PLB by blowing a party whistle. Modified PLB intervention by blowing into a water-filled bottle through a straw improved the oxygenation status of children affected by oxygenation problems. This intervention can be implemented as an independent nursing intervention to improve children's oxygenation status.

Initial Treatment of High-Altitude Pulmonary Edema: Comparison of Oxygen and Auto-PEEP

BACKGROUND

Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, against the application of bottled oxygen (O₂-Pat) in two patients suffering from HAPE.

METHODS

We compare the effect of these two different therapies on oxygen saturation measured by pulse oximetry (SpO₂) over time.

RESULT

In both patients SpO₂ increased significantly from 65-70% to 95%. Above 80% this increase was slower in AP-Pat compared with O₂-Pat. Therapy started immediately in AP-Pat but was delayed in O₂-Pat because of organizational and logistic reasons.

CONCLUSIONS

The well-established therapies of HAPE are always the option of choice, if available, and should be started as soon as possible. The advantage of Auto-PEEP is its all-time availability. It improves SpO₂ nearly as well as 3 L/min oxygen and furthermore has a positive effect on oxygenation lasting for approximately 120 min after stopping. Auto-PEEP treatment does not appear inferior to oxygen treatment, at least in this cross-case comparison. Its immediate application after diagnosis probably plays an important role here.

Visualizing pursed lips breathing of patients with chronic obstructive pulmonary disease through evaluation of global and regional ventilation using electrical impedance tomography

Objective. This study aims to explore the possibility of using electrical impedance tomography (EIT) to assess pursed lips breathing (PLB) performance of patients with chronic obstructive pulmonary disease (COPD).Methods. 32 patients with COPD were assigned equally to either the conventional group or the EIT guided group. All patients were taught to perform PLB by a physiotherapist without EIT in the conventional group or with EIT in the EIT guided group for 10 min. The ventilation of all patients in the final test were continuously monitored using EIT and the PLB performances were rated by another physiotherapist before and after reviewing EIT. The global and regional ventilation between two groups as well as between quite breathing (QB) and PLB were compared and rating scores with and without EIT were also compared.Results.For global ventilation, the inspiratory depth and the ratio of expiratory-to-inspiratory time during PLB was significantly larger than those during QB for both group (P< 0.001). The inspiratory depth and the ratio of expiratory-to-inspiratory time during PLB in the EIT guided group were higher compared to those in the conventional group (P< 0.001), as well as expiratory flow expiratory uniformity and respiratory stability were better (P< 0.001). For regional ventilation, center of ventilation significantly decreased during PLB (P< 0.05). The expiratory time constant during PLB in the EIT guided group was greater than that in the conventional group (P< 0.001). Additionally, Bland-Altman plots analysis suggested a high concordance between subjective rating and rating with the help of EIT, but the score rated after EIT observation significantly lower than that rated subjectively in both groups (score drop of -2.68 ± 1.1 in the conventional group and -1.19 ± 0.72 in the EIT guided group,P< 0.01).Conclusion.EIT could capture the details of PLB maneuver, which might be a potential tool to quantitatively evaluate PLB performance and thus assist physiotherapists to teach PLB maneuver to patients.