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International Journal of Health Sciences & Research (www.ijhsr.org) 80
Vol.3; Issue: 11; November 2013
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article
Effectiveness of Breathing Exercises on Pulmonary Function Parameters and
Quality of Life of Patients with Chronic Obstructive Pulmonary Disease
Helen Shaji John Cecily1*, Amal A. Alotaibi1
1Asst. Professor, Majmaah University.
*Correspondence Email: h.cecily@mu.edu.sa
Received: 04/09//2013 Revised: 03/10/2013 Accepted: 11/10/2013
ABSTRACT
Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive irreversible
airway disease characterized by emphysema and chronic bronchitis, resulting in breathlessness,
cough and sputum. Though medications are used to control the symptoms of COPD, but it will
not give permanent cure. Performing breathing exercises reduces the frequent dyspnea and
improves relaxation and pulmonary function. Limited empirical documentation exists to support
the effectiveness of a nurse managed rehabilitation programme for older patients with COPD.
Aims & Objectives: To assess the effectiveness of breathing exercises among COPD patients in
reduction of dyspnea, improvement of pulmonary functional parameters and Quality of life.
Materials & Methods: Pretest post test control group design was used in this study. The study
includes 100 COPD patients in experimental group and 100 patients in control group.
Results: After undergoing breathing exercises, in the experimental group the level of dyspnea
was significantly reduced (P< 0.001) and there was significant improvement in the Quality Of
Life (QOL) and pulmonary functional parameters such as FEV1 ( Forced Expiratory Volume),
FVC ( Forced Vital Capacity), FEV1/ FVC ratio, and PEFR (Peak Expiratory Flow Rate)
(P<0.001). However in the control group there were no significant changes in dyspnea, QOL and
pulmonary function.
Conclusion: There was a significant reduction in dyspnea, improvement in pulmonary function,
and QOL of COPD patients after pulmonary rehabilitation exercises. So deep breathing exercises
is an effective and economical method for improving the physical capacity and general wellbeing
of patients with COPD.
Key words: Breathing exercises, Pulmonary function parameters, Quality of life, COPD
INTRODUCTION
Chronic Obstructive Pulmonary
Disease (COPD) is a progressive irreversible
airway disease characterized by emphysema
and chronic bronchitis, resulting in
breathlessness, cough and sputum.[1] As the
International Journal of Health Sciences & Research (www.ijhsr.org) 81
Vol.3; Issue: 11; November 2013
disease progresses, subjects with COPD
experience increasing deterioration of their
health-related quality of life (HRQOL), with
greater impairment in their ability to work
and declining participation in social and
physical activities.[2]
The global burden of Diseases
(GBD) study showed that approximately 2.7
million deaths from COPD occurred in
2000, half of them in the Western Pacific
Region. About 400000 deaths occur each
year from COPD in industrialized countries
and this can be expected to rise unless
urgent action is taken to control leading risk
factors, particularly tobacco. (Laura
Cinobanu, et al., 2007).[3] In India, smoking
association with COPD was reported in 82.3
percent of male patients on an average in an
analysis of several population studies.[4]
Exertional dyspnea often causes
patients with chronic obstructive pulmonary
disease (COPD) to unconsciously reduce
their activities of daily living (ADLs) to
reduce the intensity of their distress. The
reduction in ADLs leads to decon-ditioning
which, in turn, further increases dyspnea.
Both dyspnea and fatigue are important
factors affecting health-related quality of life
(HRQOL).[5] Though medications are used
to control the symptoms of COPD, but it
will not give permanent cure. Performing
breathing exercises reduces the frequent
dyspnea and improves relaxation and
pulmonary function. Limited empirical
documentation exists to support the
effectiveness of a nurse managed
rehabilitation programme for older patients
with COPD. Pulmonary rehabilitation
programs help to reduce shortness of breath,
increasing exercise tolerance, decrease the
frequency and duration of hospital
admissions, socio economic gains from
reduced hospitali-zations, a reduction in
anxiety, depression and somatic concern, the
return of patients to employment and the
establishment of a better quality of life.[3,6,7]
Objectives
1. To assess the perceived severity of
dyspnea, pulmonary function, and
QOL of COPD patients.
2. To assess the effectiveness of
breathing exercises among COPD
patients in reduction of dyspnea.
3. To assess the influence of breathing
exercises on QOL of COPD patients
4. To assess the effectiveness of
breathing exercises among the
COPD patients on pulmonary
functional parameters such as FEV1,
FVC, FEV1/ FVC ratio, and PEFR.
5. To associate the QOL of the COPD
clients with their selected
demographic variables.
Research Hypothesis
1. The mean post-test scores of dyspnea
level of the experimental group will
be significantly lower than their
mean pre-test measurement.
2. The mean post-test scores of
pulmonary function of the
experimental group will be
significantly higher than their mean
pre-test measurement values in terms
of FEV1, FEC, FEVI/FVC ratio, and
PEFR.
3. The mean post-test scores of QOL of
the experimental group will be
significantly higher than their mean
pre-test measurement.
4. There will be a significant mean
difference in dyspnea level between
the experimental group and control
group.
5. There will be a significant difference
between the gains in pulmonary
measurement values in experimental
group and control group in terms of
FEV1, FVC, FEV1/FVC ratio, and
PEFR.
6. There will be a significant mean
difference in QOL between the
International Journal of Health Sciences & Research (www.ijhsr.org) 82
Vol.3; Issue: 11; November 2013
experimental group and control
group.
7. There will be a significant
association between QOL of COPD
patients with their selected
demographic variables.
METHODOLOGY
Research Approach: Experimental
approach
Research design: Pretest post test control
group design
Setting of the study: The study was
conducted in a Government Medical college
Hospital in India
Population: All the patients with COPD
who attend the OPD and admitted in the
hospital
Sample: It consists of 200 patients with
COPD, 100 patients in experimental group
and 100 in control group.
Sampling technique: Subjects were
selected by using simple random sampling
technique with random assignment for each
group.
Criteria for the selection of sample:
Inclusion criteria:
1. Clinically diagnosed moderate to
severe COPD patients by the
pulmonologists
2. Only males with the habit of
smoking were included
3. Age group between 31 – 80 years.
4. Those who are able to understand
and speak Tamil.
Exclusion criteria:
1. Patients who had acute breathing
difficulty
2. Those who were performing regular
breathing exercises or yoga
3. Patients who had recent abdominal
surgeries
4. Patients who were not willing to
participate
Description of the tool
Part I: Demographic variables such as age,
education, occupation, marital status,
smoking habit, alchohol use and duration of
illness
Part II: Assessment of Dyspnoea
Borg Dyspnoea scale was used to assess the
level of dyspnea among COPD patients. It is
a standardized scale to assess the level of
dyspnea among patients with respiratory
problems. In this scale dyspnoea is assessed
by patient‟s verbal description as mild,
moderate or severe. It starts at score 0 – 10,
from minimum to maximum breathing
difficulty.
Part III: Questionnaire on Quality of Life
WHO Quality Of Life Questionnaire
was modified and translated into Tamil
language and used for quality of life
assessment. It consists of 40 questions under
4 sections. Physical domain consisted of 16
questions, psychological domain had 16
questions, social domain had 6 questions
and spiritual domain had 2 questions. A
score of „4‟ was assigned to no symptoms or
low severity of symptoms and a score of „1‟
was assigned to maximum severity of
symptoms. The total QOL score of all the
domains was = 160.
Measurement of Pulmonary Function
Pulmonary function was tested with
a spirometer. It measures lung function,
specifically the measurement of the volume
and/ or speed (flow) of air that can be
inhaled and exhaled.1 Results are given in
both raw data (liters per second) and percent
of the “predicted values” for the patients of
similar characteristics (height, age, sex and
sometimes race and weight).
Data collection procedure:
Permission was obtained from
concerned hospital authorities. The samples
were selected by simple random sampling.
After explaining the nature and objective of
the study, the samples were asked to give
necessary background information through
International Journal of Health Sciences & Research (www.ijhsr.org) 83
Vol.3; Issue: 11; November 2013
interview. After that the severity of dyspnea
and the QOL were assessed using Borg
dyspnea scale and WHO Quality Of Life
questionnaire.
Subjects in the study group were
asked to do breathing exercises daily, each
session consists of at least 10 minutes for 3
times a day. The instruction booklets
regarding the performance of the exercises
were given to each of the samples and they
were supervised by the investigator for 10
full minutes every day for 30 days. Patients
in the control group were allowed to
continue with their usual physical activity.
RESULTS AND DISCUSSION
Demographic data showed that most
of them were between 61 and 70 years
(41%) both in experimental and control
group and majority of them were smoking
21 to 30 times per day in experimental group
(53%) and control group (62%) respectively.
Majority of them were illiterate in both
experimental (81%) and control group and
39% of them were doing moderate work.
Moreover 86% of them were married and
had the habit of alchoholism in both groups.
Regarding the duration of illness, majority
of them (73%) of them had COPD from 3 to
5 years in experimental and control group
respectively. Statistically no significant
difference was found in the distribution of
demographic variables among the patients
with COPD in experimental and control
groups.
In both groups more than 60% of
them had Family H/O diabetes mellitus from
1st degree relatives and 86% and 84% of
them didn‟t have any other systemic illness
in experimental and control group
respectively. Only 3 to 4% of them were
doing exercises regularly and about 94% of
them didn‟t have the habit of either
alchoholism or smoking in both groups. In
experimental group 28% and in control
group 36% of them didn‟t follow any dietary
restrictions.
Perceived severity of dyspnea, pulmonary
function, and QOL of COPD patients
In the pretest (before breathing
exercises) QOL was assessed using WHO
Quality Of Life Questionnaire. The overall
mean score of QOL in experimental group
was 89.97 and its standard deviation was
11.9 whereas the mean score of control
group was 84.98 and the S.D was 13.9.
In the pretest (before breathing
exercises) severity of dyspnea was assessed
using Borg Dyspnea scale. The overall mean
dyspnea score was almost same for both
experimental and control group, ie 6.29 and
its standard deviation was 1.0.
In the pretest (before breathing
exercises) pulmonary function was assessed
using spirometer. The overall mean FEV1
value was almost same for both
experimental (1.28) and control group (1.23)
and its standard deviation was 0.49 and 0.52
respectively. In the pretest, the mean FVC
value was 1.60 and the standard deviation
was 0.49 in Experimental group and the
mean FVC was 1.67 with the standard
deviation of 0.61 for the control group.
However the PEFR mean was 156.49 with
the standard deviation of 63.4 for the
Experimental group whereas in the control
group the mean was 164.23 and the standard
deviation was 91.7.
In the pretest, there was no
statistically significant difference was found
in the mean and standard deviation of QOL,
dyspnea score, FEV1, FVC and PEFR score
among patients with COPD in experimental
and control groups.
International Journal of Health Sciences & Research (www.ijhsr.org) 84
Vol.3; Issue: 11; November 2013
1. Comparison of pre and posttest level of mean and standard deviation of QOL, Dyspnea,
FEV1, FVC and PEFR among patients with COPD in experimental and control groups.
Physiological
functions
Period
Experimental
Control
Mean
Difference
„t‟ value
P value
Mean
SD
mean
SD
Dyspnea
Before
6.29
1.0
6.32
1.0
0.03
0.212
0.0832
After
4.54
0.7
6.50
0.8
1.96
1.75
0.00
Quality Of Life
Before
86.97
11.9
84.98
13.1
2.0
1.124
0.262
After
94.95
11.2
80.9
10.9
14.05
8.987
0.00
FEV1
Before
1.28
0.49
1.23
0.52
0.05
0.770
0.442
After
1.42
0.46
1.18
0.51
0.24
3.524
0.001
FVC
Before
1.60
0.49
1.67
0.61
0.07
0.863
0.389
After
1.75
0.48
1.59
0.59
0.16
2.118
0.035
FEV1/FVC
Before
79.1
13.2
73.5
13.8
5.6
2.963
0.003
After
81.0
12.9
74.0
14.1
9.0
3.674
0.00
PEFR
Before
156.49
63.4
164.23
91.7
7.7
0.694
0.488
After
207.39
76.8
164.35
92.5
43.3
3.579
0.00
The results reveal that after
undergoing breathing exercises, in the
experimental group the dyspnea was
significantly reduced and there was
significant improvement in the QOL and
pulmonary functional parameters. However
in the control group there were no
significant changes in dyspnea, QOL and
pulmonary function.
2. Relationship between FEV1 and FVC
before and after intervention
Before intervention the correlation
coefficients of experimental and control
groups were 0.901 and 0.886 respectively.
After intervention the relationship of the
experimental and control group were 0.878
and 0.885 respectively. The above
correlation coefficients were statistically
significant (P < 0.01).
3. Association between QOL of patients
with COPD in experimental and control
group with their selected demographic
variables
Results revealed that there was a
significant relationship between the QOL
and occupation, smoking habit, marital
status and duration of illness at P < 0.05
level among the COPD patients in
experimental group. However there was
highly significant relationship between the
QOL and occupation, smoking habit and
duration illness at P < 0.001 level among the
patients with COPD in control group.
DISCUSSION
Findings of the study revealed that
after undergoing breathing exercises there
was a significant improvement (P< 0.001) in
the pulmonary functional parameters. This
finding is consistent with the studies
conducted by Holland AE (2012)[8] and
Gosselink R (2004)[9] on breathing exercises
for COPD patients. Moreover the current
study also revealed that there is a highly
significant reduction in the dyspnea level
and improvement in the QOL of COPD
patients after undergoing breathing
exercises. However the study conducted by
Holland AE (2012)[8] reported that there are
no consistent effects on dyspnea and Health
Related Quality Of Life after breathing
exercises which is not supporting to the
present study.
CONCLUSION
COPD is a common disease and a
common cause of mortality and morbidity.
Dyspnea is a characteristic and a troubling
manifestation of this disease. Loss of
physical capacity and the adverse
psychological effects of COPD contribute
greatly to morbidity. Medicines have limited
role in improving physical capacity of these
International Journal of Health Sciences & Research (www.ijhsr.org) 85
Vol.3; Issue: 11; November 2013
patients. People suffering from severe forms
of this disease, usually spend their
remaining years of life in bed and have
declining quality of life.
In the present study, there was a
significant reduction in dyspnea,
improvement in pulmonary function, and
QOL of COPD patients after pulmonary
rehabilitation exercises. It can be concluded
that deep breathing exercises is an effective
and economical method for improving the
physical capacity and general wellbeing of
patients with COPD
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How to cite this article: Cecily HSJ, Alotaibi AA. Effectiveness of breathing exercises on
pulmonary function parameters and quality of life of patients with chronic obstructive
pulmonary disease. Int J Health Sci Res. 2013;3(11):80-85.