The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip Breathing in COPD

Abstract

Introduction: Chronic Obstructive pulmonary disease (COPD) is characterized by airflow obstruction with breathing-related symptoms such as chronic cough, exertion dyspnoea, expectoration, and wheeze [1]. The Buteyko concept is a system of breathing exercises originally devised in the 1950s by Professor Konstantin Buteyko, a Russian physician and academic personality [2].

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Physiotherapy and Occupational Therapy Journal
Volume 12 Number 2, April - June 2019
DOI: http://dx.doi.org/10.21088/potj.0974.5777.12219.5
Original Article
The Study to Compare the Effect of Buteyko Breathing Technique and
Pursed Lip Breathing in COPD.
Rakhi Sharma
1
, Niraj Kumar
2
, Nishu Sharma
3
, Shama Praveen
4
, Anirban Patra
5
Author Affiliation: 1Lectrur 2Associate Professor
3,4,5Assistant Professor, Shri Guru Ram Rai Institute of Medical
& Health Sciences, Patel Nagar, Dehradun, Uttrakhand
248001, India.
Corresponding Author: Rakhi Sharma, Lectrur, Shri Guru
Ram Rai Institute of Medical & Health Sciences, Patel Nagar,
Dehradun, Uttrakhand 248001, India.
E-mail: rakhisharma.rs01@gmail.com
Received on: 17.04.2019, Accepted on 04.05.2019
Abstract
Introduction: Chronic Obstructive pulmonary disease (COPD) is characterized by airflow obstruction with
breathing-related symptoms such as chronic cough, exertion dyspnoea, expectoration, and wheeze [1]. The Buteyko
concept is a system of breathing exercises originally devised in the 1950s by Professor Konstantin Buteyko, a Russian
physician and academic personality [2].
Aim of The Study: To compare the better Effectiveness of Buteyko Breathing Technique and Pursed Lip Breathing
in Chronic Obstructive Pulmonary Disease.
Methodology: Fifty (50) subjects clinically diagnosed of chronic obstructive pulmonary disease (COPD). The
subjects divided randomly into two groups; Group A (25) and Group B (25). Group A receivedButeyko Berthing
Technique (BBT) and Group B received Pursed Lip Breathing (PLB) and done for 4 weeks.
Discussion: The Buteyko method is a purported method of "retraining" the body's breathing pattern to correct
for the presumed chronic hyperventilation and hypocapnea, and thereby treat or cure the body of these medical
problems. Buteyko has been found to be effective in management of Asthma [10]. In our study daily Buteyko
breathing exercise session of 30 to 35 minutes was given to patients. Progression of the exercise was made as per the
exercise manual of Buteyko Institute of Breathing & Health.
Conclusion: In the present study both of the techniques are effective but the Buteyko breathing technique found
more effective than pursed lip breathingfor 4 weeks. There was significant improvement in Pulmonary Function
Test in patients with COPD.
Keywords: Buteyko breathing technique, Pursed lip breathing, FEV1, FVC, Spiro meter (koko peak pro 6), Stop
watch and Tissue paper.
How to cite this article:
Rakhi Sharma, Niraj Kumar, Nishu Sharma et al. The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip
Breathing in COPD. Physiotherapy and Occupational Therapy Journal. 2019;12(2):103-113
Introduction
Chronic Obstructive pulmonary disease (COPD)
is characterized by air ow obstruction with
breathing-related symptoms such as chronic cough,
exertion dyspnoea, expectoration, and wheeze.
These symptoms may occur in conjunction with
airway hyper responsiveness and may be partially
reversible. Although COPD is a nonspeci c
term referring to a set of conditions that develop
progressively as a result of a number of different
disease processes, it most commonly refers to
chronic bronchitis and emphysema and a subset
of patients with asthma. These conditions can
be present with or without signi cant physical
impairment [1].
The Buteyko concept is a system of breathing
exercises originally devised in the 1950s by
Professor Konstantin Buteyko, a Russian physician
and academic personality. Following its popularity
in Russia, the concept has gradually spread to
western countries over the last 20 years, notably
Australia and New Zealand and other parts of
Europe. The technique offers a complementary
method of reliving respiratory symptoms based

POTJ / Volume 12 Number 2 / April - June 2019
104 Physiotherapy and Occupational Therapy Journal
on the voluntary control of breathing, as well
as considering the effects of environmental and
dietary triggers [2].
Although this technique had been described and
recommended in the mid-1950s and beginning of
the 1960s, the  rst studies designed to establish
the bene ts and physiological effects of PLB were
not published until the mid-1960s. Even now-
-forty years later-there are few studies on PLB in
the literature and the factors underlying its ef cacy
are not well understood. While most studies have
focused on patients with COPD, some have found
that PLB may be bene cial in certain neuromuscular
diseases and exercise-induced asthma [3].
End expiratory lung volume (EELV) represents
the point of equilibrium between the forces of
elastic recoil of the lungs and the chest wall. A
decrease in EELV represents an increase in the
elastic recoil of the chest and potentially more
energy for inspiration, which may occur passively
as a result of the potential energy of the chest wall
at the end of expiration [4].
Mueller et al. evaluated the effect of PLB on
PaO
2
, PaCO
2
and oxygen saturation (SaO
2
) in COPD
patients at rest and during exercise. At rest, they
found a signi cant increase in PaO
2
and SaO
2
and a
signi cant decrease in PaCO
2
; the results were the
same for all patients, whether or not they perceived
bene ts from the PLB [5-7].
Need of The Study
Buteyko Breathing and Pursed Lip Breathing
has been de ned as a potent method to improve
exercise capacity hence and quality of life.
Aim of the Study
To comparethe better Effectiveness of Buteyko
Breathing Technique and Pursed Lip Breathing in
Chronic Obstructive Pulmonary Disease.
Hypothesis
Null Hypothesis
There will be no signi cant effect of Buteyko
Breathing Technique and Pursed Lip Breathing in
Chronic Obstructive Pulmonary Disease.
Alternative Hypothesis
There would be signi cant effect of the Buteyko
Breathing Technique or Pursed Lip Breathing in
Chronic Obstructive Pulmonary Disease.
Review of Literature
Tang C, Taylor N et al. conducted a study to
examine the effectiveness of chestphysiotherapy
for patients admitted to hospital with an acute
exacerbation of chronic obstructive pulmonary
disease (COPD). Chest physiotherapy techniques
such as intermittent positive pressure ventilation
and positive expiratory pressure may bene t
patients with COPD requiring assistance with
sputum clearance, while walking programmes
may have wider bene ts for patients admitted with
an exacerbation of COPD. Chest physiotherapy
techniques other than percussion are safe for
administration to this patient population [12].
Hogg JC, Chu F, Utokaparch S, et al. This studied
evolution of the pathological effects ofairway
obstruction in patients with COPD. The small
airways were assessed in surgically resected lung
tissue from 159 patients— 39 with stage 0 (at risk),
39 with stage 1, 22 with stage 2, 16 with stage 3, and
43 with stage 4 (very severe) COPD, according to
the classi cation of the Global Initiative for Chronic
Obstructive Lung Disease (GOLD). Progression
of COPD is associated with the accumulation of
in ammatory mucous exudates in the lumen and
in ltration of the wall by innate and adaptive
in ammatory immune cells that form lymphoid
follicles. These changes are coupled to a repair or
remodeling process that thickens the walls of this
airways [17].
CM Parker, N. Voduc, SD Aaron, KA Webb
et al. This study is conduct on "Physiological
changesduring symptom recovery from moderate
exacerbations of COPD" and concluded that
moderate acute exacerbation of chronic obstructive
pulmonary disease is characterized by worsening
air ow obstruction and lung hyperin ation.
Improvement of dyspnea was associated with
reduction in lung hyperin ation and consequent
increase in expiratory  ow rates [18].
J Cross, F Elender, G Barton et al. Conducted
study to estimate the effect, if any, of Manual Chest
Physiotherapy (MCP) administered to patients
hospitalized with COPD exacerbation on both
disease-speci c and generic health-related quality
of life. To compare the health service costs for those
who either receive or do not receive MCP while in
hospitalimputed ITT and PP results were similar.
No signi cant differences were observed in any of
the outcome measures or subgroup analyses [19].
Elisabeth Ståhl, Anne Lindberg et al. This study
to evaluate the associationbetween health-related
quality of life (HRQL) and disease severity using

POTJ / Volume 12 Number 2 / April - June 2019
105
lung function measures. The results showed that
HRQL in COPD deteriorates with disease severity
and with age. These data show a relationship
between HRQL and disease severity obtained by
lung function [20].
Research Methedology
Sampling Technique
Fifty subjects clinically diagnosed of chronic
obstructive pulmonary disease (COPD). All the
subjects considered for the study was done in
SGRRIMHS/SMIH department of physiotherapy
at Patel Nagar Dehradun. These subjects were then
randomly assigned into two groups of  fty (50)
subjects each namely Group A (25) and Group B (25).
All the participants took part in the experiments on
a voluntary basis after signing a consent form and a
demographic data was collected from each subject.
The purpose of the study was explained to all the
subjects. The subjects were selected according to
inclusion and exclusion criteria.
Inclusion criteria: Informed consent, Age group
40-65 yrs, Clinical diagnosis of COPD con rmed
by smoking history, physical examination and PFT
showing irreversible air ow limitation, Patients
who are taking bronchodilators., Males and females
referral established COPD.
Exclusion criteria: Musculoskeletal problems
limiting mobility, Rapid intensifying or unstable
Angina, Intermittent Claudication, Neurological
problems limiting cognition/mobility, Resting
O
2
saturation <90% with room air breathing and
Patient with viral infection.
Instrumentation: Spiro meter (koko peak pro 6),
Stop watch and Tissue paper.
Procedure
Fifty (50) subjects clinically diagnosed of chronic
obstructive pulmonary disease (COPD) were
selected according to inclusion and exclusion criteria
and divided randomly into two groups; Group A
(25) and Group B (25). Group A received. Buteyko
Berthing Technique (BBT) and Group B received
Pursed Lip Breathing (PLB) and done for 4 weeks.
Buteyko Brething Technique
At the starting of the session the subject should
have an empty stomach and sit in a chair in
comfortable position. Pulmonary function test was
monitored after sitting and relaxing for about 5
minutes.
Patients were asked to nod head backwards
and forwards slowly and coordinate thenodding
movement with breathing. Breathe in smoothly,
gently and as quietly as possible as head goes back
and out as head comes forwards.
Pulse was measured with resting two  ngers
about one centimeter below the wrist-in line with
the thumb-side of the hand.Patient was asked to
take in a normal sized breath inand out through
nose. Nose is held gently.
Stopwatch was used to keep track of time until
patient felt the  rst onset of a feeling of lack of air.
Nose was released, breathing in gently through
nose and stopping the stopwatch. Time of Control
Pause was noted.
Control pause was followed by relaxed breathing
and this was continued for 3minsfollowed by short
rest duration of 30 sec [22].
Post exercise control pause ( nal control pause)
was measured. Post exercise pulse was measured.
The above mentioned protocol was followed for
3 times in a day for 4 weeks.
After the exercises the pulmonary function
test and dyspnoea scale and ADL readings are
measured. [Fig. 1]
Fig. 1: Patient performing buteyko breathing exercise
Pursed Lip Breathing
At the starting of the session the subject should
have an empty stomach and sit in a chair in
comfortable position. Pulmonary function test was
monitored after sitting and relaxing for about 5
minutes. Patients were asked to relax the neck and
shoulder muscles.
Breathe in (inhale) slowly through nose for two
counts, keeping your mouth closed. Don't take a
deep breath; a normal breath will do. It may help to
count to inhale, one and two.
Pucker or "purse” lips as if a patients were going
The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip Breathing in COPD

POTJ / Volume 12 Number 2 / April - June 2019
106 Physiotherapy and Occupational Therapy Journal
to whistle or gently  icker the  ame of a candle.
Breathe out (exhale) slowly and gently through
your pursed lips while counting to four. It may
help to count and exhale, one, two, three, four [21].
The above mentioned protocol was followed for
3 times in a day for 4 weeks.
After the exercises the pulmonary function
test and dyspnoea scale and ADL readings are
measured.
Procedure
Phase I - Pre exercise Phase (5mins)
Patients were advised to have an empty stomach,
and sit in a chair in comfortable position with spine
erect.
Step 1: Patients were asked to nod head
backwards and forwards slowly and coordinate
thenodding movement with breathing. Breathe in
smoothly, gently and as quietly as possible as head
goes back and out as head comes forwards.
Step 2: Pulse was measured with resting two
ngers about one centimeter below the wrist-in line
with the thumb-side of the hand.
Phase II - Exercise Phase (20mins)
Step 1: To measure Control Pause - Patient was
asked to take in a normal sized breath inand out
through nose. Nose is held gently.
Stopwatch was used to keep track of time until
patient felt the  rst onset of a feeling of lack of air.
Nose was released, breathing in gently through
nose and stopping the stopwatch.
Time of Control Pause was noted.
Step 2: Control pause was followed by relaxed
breathing and this was continued for 3minsfollowed
by short rest duration of 30 sec.
Step 3: Same as above was repeated four times
followed by a long rest duration of 2mins.
Phase III Post exercise Phase (5mins)
Step 1: Post exercise control pause (nal control
pause) was measured.
Step 2: Post exercise pulse was measured. (Patient
was advised to practice sets before breakfast, before
lunch or dinner and before sleep and to note down
the readings in daily log.)
The above mentioned protocol was followed
in  rst week of the study. Second week was
conducted following the same steps with key aim
to become accustomed to a slight feeling of “air
hunger” lasting several minutes. One way to do
this was using the Extended Pause exercise - which
introduces the concept of increasing air hunger.
Patients were asked to hold breath a little longer
than is comfortable. The last weeks of practice
included learning how to  ne-tune breathing to
the point wherepatient were hardly breathing at
all when practicing the exercises. In weeks 3-4, a
further stage of Reduced Breathing was used called
“Very Reduced Breathing”. It included practicing
reduced Breathing with hands on upper and lower
chest and allowing patient to breath to reduce to
less than normal volume settle into this pattern.
Post exercise values were measured after
completion of 4 week [Fig. 2 & 3].
Fig. 2: Patient performing post exercise

POTJ / Volume 12 Number 2 / April - June 2019
107
Fig. 3: Patient performing Spirometer
Chart 1: Procedure Chart
Data Analysis
Statistics were performed by using SPSS 16.
Results were calculated by using 0.05 level of
signi cance. In the present study 50 mild stage
COPD patients were taken with homogeneous
demographic data consisting of age and ratio of
FEV1/FVC which shows no statistical difference.
They were divided into two groups by simple
random sampling. Group A performed Buteyko
Breathing Exercise and Group B performed
Pursed Lip Breathing Exercise. There pulmonary
function test and dyspnoea grade were recorded
before and after the exercises. The exercise
protocol followed every day for 4 weeks and
exercise done 3 times in a day. Data was analysed
and the results concluded that the exercise
Total COPD Screening (n=90)
A sample of 50 subjects were
extended And randomized
into 2 groups
Data Analysis
Result & discussion
Conclusion
Group A (n=25)
Buteyko Breathing Technique Group B (n=25)
Pursed Lip Breathing
Pre-test data collected
Buteyko Breathing Exercises
performed by the patient as
per the set protocol
Pursed Lip Breathing
Exercises performed by the
patient as per the set protocol
Post- test data collected
Pre-test data collected
Post- test data collected
assigned to both the groups was effective in
showing signi cant reduction in both FEV1 and
FVC and in the grade of dyspnoea. Reduction
in Group A and Group B. Which was obviously
but the mean difference values, but the exercises
given to Group A (Buteyko Breathing Technique
Exercise) showed much signi cant improvement
in FEV1 and FVC and in the dyspnoea grade
providing comparison study which state that
Buteyko breathing exercise is more effective than
Pursed lip breathing exercise.
Results
Demographic Data
The general characteristics like age and height
showed homogeneity and there was no signi cant
difference statistically.
Age
Comparison of age of Group A and Group B
showed a Mean ± SD of 62.68 + 0 and 62.48 ± 2.12
respectively [Table 1 & Graph 1].
Table 1: Mean and SD of age between Group A Group B
Age N Mean SD
Group A 25 62.68 0
Group B 25 62.48 2.12
Graph 1: Mean of age between Group A Group B
Height
Comparison of height of Group A and Group B
showed a Mean ± SD of 169.8 ± 19.09 and 169.88 ±
3.54 respectively [Table 2 & Graph 2].
Table 2: Mean and SD of height between Group A and Group B
Height N Mean SD
Group A 25 169.8 19.09
Group B 25 169.88 3.54
The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip Breathing in COPD

POTJ / Volume 12 Number 2 / April - June 2019
108 Physiotherapy and Occupational Therapy Journal
Graph 2: Mean of height between Group A and Group B
Within Group Analysis
Data of Group A (Buteyko Breathing Technique)
When data was compared within group, analysis
for Group A showed following result.
FEV1
Comparison of pre and post FEV1 values within
Group A showed a Mean ± SD of pre FEV1 is 1.59
± 1.11 and Mean ± SD of post FEV1 is 2.90 ± 1.27
respectively. With t-value and p-value of which is
signi cant. [Table 3 & Graph 3]
Table 3: Comparison of mean and SD values of pre and post
FEV1 within Group A
FEV1 N Mean SD t-value p-value
Pre
FEV1 25 1.59 1.11 4.0 0.01
Post
FEV1 25 2.90 1.27
Graph 3: Comparison of mean values of pre and post FEV1
within Group A
FVC
Comparison of pre and post FVC values within
Group A showed a Mean ± SD of pre FVC is 2.95
± 1.75 and Mean ± SD of post FVC is 3.78 ± 1.34
respectively. With t-value and p-value of which is
signi cant. [Table 4 & Graph 4]
Table 4: Comparison of mean and SD values of pre and post
FVC within Group A
FVC N Mean SD t-value p-value
Pre FVC 25 2.95 1.75 1.53 0.01
Post FVC 25 3.78 1.34
Graph 4: Comparison of mean values of pre and post FVC
within Group A
FEV
1
/FVC
Comparison of pre and post FEV1/ FVC
values within Group A showed a Mean ± SD of
pre FEV1/FVC is 53.94 ± 5.50 and Mean ± SD
of post FEV1/FVC is 76.83 ± 6.44 respectively.
With t-value and p-value of which is signi cant.
[Table 5 & Graph 5].
Table 5: Comparison of mean and SD values of pre and post
FEV1/FVC within Group A
FEV1/FVC N Mean SD t-value p-value
Pre FEV1/
FVC 25 53.94 5.50 13.54 0.01
Post FEV1/
FVC 25 76.83 6.44
Graph 5: Comparison of mean values of pre and post FEV1/
FVC within Group A
Borg Scale
Comparison of pre and post dyspnoea grades
within Group A showed a Mean ± SD of dyspnoea
grade is 6.04 ± 0.71 and Mean ± SD of post
dyspnoea grade is 4.05 ± 0.60 respectively. With
t-value and p-value of which is signi cant [Table
6 & Graph 6].
Table 6: Comparison of mean and SD values of pre and post
dyspnoea grades within Group A
BORG SCALE N Mean SD t-value p-value
Pre Grade 25 6. 04 0.71 11.75 0.01
Post Grade 25 4.05 0.60

POTJ / Volume 12 Number 2 / April - June 2019
109
Graph 6: Comparison of mean values of pre and post dyspnoea
grades within Group A
ADL Scale
Comparison of pre and post grades within Group
A showed a Mean ± SD of grade is 5 ± 1.48 and
Mean ± SD of post grade is 7.08 ± 2.25 respectively.
With t-value and p-value of which is signi cant.
[Table 7 & Graph 7].
Table 7: Comparison of mean and SD values of pre and post
ADL Scale within Group A
ADL SCALE N Mean SD t-value p-value
Pre Grade 25 5 1.48 3.85 0.01
Post Grade 25 7.08 2.25
Graph 7: Comparison of mean values of pre and post ADL Scale
within Group A
Data of Group B (Pursed Lip Breathing Exercise)
When data was compared within group, analysis
for Group B showed following result.
FEV
1
Comparison of pre and post FEV1 values within
Group B showed a Mean ± SD of pre FEV1 is 1.49
± 0.22 and Mean ± SD of post FEV1 is 2.52 ± 0.32
respectively. With t-value and p-value of which is
signi cant. [Table 8 & Graph 8].
Table 8: Comparison of mean and SD values of pre and post
FEV1 within Group B
FEV1 N Mean SD t-value p-value
Pre FEV1 25 1.49 0.22 0.2 0.01
Post FEV1 25 2.52 0.32
Graph 8: Comparison of mean values of pre and post FEV1
within Group B
FVC
Comparison of pre and post FVC values within
Group B showed a Mean ± SD of pre FVC is 3.03
± 0.07 and Mean ± SD of post FVC is 3.46 ± 0.42
respectively. With t-value and p-value of which is
signi cant. [Table 9 & Graph 9]
Table 9: Comparison of mean and SD values of pre and post
FVC within Group B
FVC N Mean SD t-value p-value
Pre FVC 25 3.03 0.07 0 0.01
Post FVC 25 3.46 0.42
Graph 9: Comparison of mean values of pre and post FVC
within Group B
FEV
1
/FVC
Comparison of pre and post FEV1/ FVC values
within Group B showed a Mean ± SD of pre FEV1/
FVC is 49.37 ± 7.50 and Mean ± SD of post FEV1/FVC
is 65.26 ± 1.02 respectively. With t-value and p-value
of which is signi cant. [Table 10 & Graph 10].
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POTJ / Volume 12 Number 2 / April - June 2019
110 Physiotherapy and Occupational Therapy Journal
Table 10: Comparison of mean and SD values of pre and post
FEV1/FVC within Group B
FEV1/FVC N Mean SD t-value p-value
Pre FEV1/ FVC 25 49.37 7.50 10.5 0.01
Post FEV1/FVC 25 65.26 1.02
Graph 10: Comparison of mean of pre and post FEV1/FVC
within Group B
Borg Scale
Comparison of pre and post grades within
Group B showed a Mean ± SD of dyspnoea grade is
5.68 ± 0.55 and Mean ± SD of post dyspnoea grade
is 5.02 ± 51 respectively. With t-value and p-value
of which is signi cant. [Table 11 & Graph 11]
Table 11: Comparison of mean and SD values of pre and post
dyspnoea grades within Group B
BORG SCALE N Mean SD t-value p-value
Pre Grade 25 5.68 0.55 4.7 0.01
Post Grade 25 5.02 0.51
Graph 11: Comparison of mean values of pre and post dyspnoea
grades within Group B
ADL Scale
Comparison of pre and post ADL scale within
Group B showed a Mean±SD of grade is 4.28±0.71
and Mean±SD of post ADL scale is 6.32±1.41
respectively. With t-value and p-value of which is
signi cant. [Table 12 & Graph 12]
Table 12: Comparison of mean and SD values of pre and post
ADL Scale within Group B
ADL SCALE N Mean SD t-value p-value
Pre Grade 25 4.28 0.71 5.51 0.01
Post Grade 25 6.32 1.41
Graph 12: Comparison of mean values of pre and post ADL
Scale within Group B
Between Group Comparison
FEV
1
Comparing Mean and SD of pre FEV1 and post
FEV1 between Group A and Group B. Mean ± SD
of pre FEV1 of Group A is 1.59 ± 1.11 and post FEV1
of Group A is 2.90 ± 1.27 with a t-value of 4.0. Mean
± SD of pre FEV1 of Group B is 1.49 ± 0.22 and post
FEV1 of Group B is 2.52 ± 0.32with a t-value of 0.2.
[Table 13 & Graph 13]
Table 13: Mean and SD of pre FEV1 and post FEV1 for Group
A and Group B
FEV1 Group A Group B
Mean SD Mean SD
Pre FEV1 1.59 1.11 1.49 0.22
Post FEV1 2.90 1.27 2.52 0.32
Graph 13: Mean pre FEV1 and post FEV1 for Group A and
Group B
FVC
Comparing Mean and SD of pre FVC and post
FVC between Group A and Group B. Mean ± SD of
pre FVC of Group A is 2.95 ± 1.75 and post FVC of
Group A is 3.78 ± 1.34 with a t-value of 1.53. Mean
± SD of pre FVC of Group B is 3.03 ± 0.07 and post
FVC of Group B is 3.46 ± 0.42 with a t-value of 0.
[Table 14 & Graph 14]

POTJ / Volume 12 Number 2 / April - June 2019
111
Borg Scale
Comparing Mean and SD of pre dyspnoea grade
and post dyspnoea grade between Group A and
Group B. Mean ± SD of pre dyspnoea grade of
Group A is 6.04 ± 0.71 and post dyspnoea grade of
Group A is 4.05 ± 0.60 with a t-value of 11.75. Mean
± SD of pre dyspnoea grade of Group B is 5.6 ± 055
and post dyspnoea grade of Group B is 5.02 ± 0.51
with a t-value of 4.7. [Table 16 & Graph 16].
Table 16: Mean and SD of pre dyspnoea grade and post
dyspnoea grade for Group A and Group B
DYSPNOEA Group A Group B
Mean SD Mean SD
Pre Grades 6.04 0.71 5.68 0.55
Post Grades 4.05 0.60 5.02 0.51
Graph 16: Mean pre dyspnoea grade and post dyspnoea grade
for Group A and Group
ADL Scale
Comparing Mean and SD of pre ADL scale and
post ADL scale between Group A and Group B.
Mean ± SD of pre ADL scale of Group A is 5 ± 1.48
and post ADL scale of Group A is 7.08 ± 2.25 with
a t-value of 3.85. Mean ± SD of pre ADL scale of
Group B is 4.28 ± 0.71 and post ADL scale of Group
B is 6.32 ± 1.41 with a t-value of 5.51. [Table 17 &
Graph 17].
Table 17: Mean and SD of pre ADL scale and ADL scale for
Group A and Group B
ADL Scale Group A Group B
Mean SD Mean SD
Pre
Grades 5 1.48 4.28 0.71
Post
Grades 7.08 2.25 6.32 1.41
Graph 17: Mean and SD of pre ADL scale and ADL scale for
Group A and Group B
The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip Breathing in COPD
Table 14: Mean and SD of pre FVC and post FVC for Group A
and Group B
FVC Group A Group B
Mean SD Mean SD
Pre FVC 2.95 1.75 3.03 0.07
Post FVC 3.78 1.34 3.46 0.42
Graph 14: Mean of pre FVC and post FVC for Group A and
Group B
FEV
1
/FVC
Comparing Mean and SD of pre FEV1/FVC and
post FEV1/FVC between Group A and Group B.
Mean ± SD of pre FEV1/FVC of Group A is 53.94 ±
5.50 and post FEV1/FVC of Group A is 76.83 ± 6.44
with a t-value of 13.54. Mean ± SD of pre FEV1/
FVC of Group A is 49.37 ± 7.50 and post FVC of
Group B is 65.26 ± 1.02 with a t-value of 10.5. [Table
15 & Graph 15]
Table 15: Mean and SD of pre FEV1/ FVC and post FEV1/FVC
for Group A and Group B
FEV1/
FVC Group A Group B
Mean SD Mean SD
Pre FEV1/
FVC 53.94 5.50 49.37 7.50
Post
FEV1/
FVC
76.83 6.44 65.26 1.02
Graph 15: Mean of pre FEV1/ FVC and post FEV1/FVC for
Group A and Group B

POTJ / Volume 12 Number 2 / April - June 2019
112 Physiotherapy and Occupational Therapy Journal
Disscusion
As per the previous studies both of the techniques
are used for COPD patients and both are effective
but in this study we  nd that Buteyko breathing
exercises are more effective and better than pursed
lip breathing exercise.All the subjects underwent
spirometric evaluation for FVC, FEV1. Subjects were
demonstrated the steps and technique of Buteyko
Breathing Exercise and Pursed Lip Breathing.
Advocates of this method believe that the effects
of chronic hyperventilation has effects which
include bronchospasm disturbance of cell energy
production via krebs cycle, as well disturbance of
numerous vital homeostatic chemical reactions in
the body [9].
The Buteyko method is a purported method of
"retraining" the body's breathing pattern to correct
for the presumed chronic hyperventilation and
hypocapnea, and thereby treat or cure the body of
these medical problems. Buteyko has been found to
be effective in management of Asthma [10].
The quality of evidence of the Buteyko Method
according to an Australian Department of Health
report is stronger than any other complementary
medicine treatment of asthma [11].
There are now new de nitions for both asthma
and COPD that acknowledge the overlap and
highlight the similarities and differences between
them. Asthma and COPD have important
similarities and differences [12] both are chronic
in ammatory diseases that involve the small
airways and cause air ow limitation [13,14,15,16]
both result from gene-environment interactions
and both are usually characterised by mucus and
bronchoconstriction.
Niraj Kumar, (2018). The present study
concluded that group A (Pneumatic Compression
Therapy and Lymphatic Drainage Exercises)
showed signi cant improvement as Group B
(Manual lymphatic drainage (MLD) and control
group (lymphatic drainage exercises) for upper
limb in lymphoedema [23].
Taniya Singh, (2019) et al. We have shown that
there is no signi cant result between active cycle of
breathing technique along with postural drainage
and autogenic drainage in clearance of secretions
and oxygenation in clinically diagnosed patients
with chronic bronchitis. In this study, Active cycle
of breathing technique with postural drainage and
autogenic drainage are effective individually but
comparatively there is no signi cant difference
between 2 groups [24].
Limitations of the Study
Sample size in this study was small.
Only mild stage of COPD was taken as lack
of instrumentation for proper screening of the
patients.
Future Study
There is a need of research to carry out by taking
large sample size.
The age group can be changed with more concern
to patients.
Further studies can be done using different
variables.
The follow up protocol can be taken more than
4 week.
Conclusion
In the present study both of the techniques are
effective but the Buteyko breathing technique
found more effective than pursed lip breathing.
There was signi cant improvement in Pulmonary
Function Test in COPD patients through Buteyko
breathing exercise than Pursed Lip Breathing for 4
weeks in patients with COPD. There was signi cant
improvement in Dyspnoea post Buteyko breathing
exercise than pursed lip breathing for 4 weeks in
patients with COPD.
There was also signi cant improvement in
FVC and FEV1 Buteyko breathing exercise for 4
weeks in patients with COPD. There is minimal
changes found in activity of daily living rather than
dyspnoea and pulmonary function test.
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dx.doi.org/10.21088/potj.0974.5777.12119.7
The Study to Compare the Effect of Buteyko Breathing Technique and Pursed Lip Breathing in COPD