Efficacy of Deep Breathing Exercise on dyspnoea among chronic obstructive pulmonary disease patients

 

Heera Jayasheela

Associate Professor, College of Nursing, Pravara Institute of Medical) Sciences (DU), Loni (Bk) District Ahmednagar, Maharashtra, India

*Corresponding Author E-mail: heera.jayasheela00@gmail.com

 

ABSTRACT:

Dyspnoea is the common symptom experienced among COPD patients which leads to limitation of activities of daily living and patients seeks frequent hospitalization for care and rehabilitation. A quasi experimental study with control group design evaluative approach was undertaken to assess the Efficacy of Deep Breathing Exercise on dyspnoea among chronic obstructive pulmonary disease admitted at Pravara Rural Hospital, Loni (Bk) Objectives:1. Assess the pre test dyspnoea score in study and control group.2. Evaluate the effectiveness of deep breathing exercise among study group 3. Associate the post test scores with selected demographic variables of study group COPD patients. Method: A total of 60 patients (30 each for study and control group) were enrolled using non probability convenient sampling technique. The independent variable was deep breathing exercise and dependent variable was dyspnoea among COPD patients. Inclusion criteria of samples included COPD patients above 35 years, having mild to moderate dyspnoea. Data was collected by using structured socio-demographic profile and Modified Borgs Dyspnoea scale. Result: The findings of the present study shows that there was significant (p<0.05) reduction of dyspnoea in study group as compared with control group. Chi-Square test shows that there is a significant association between demographic characteristics namely; History of active smoking, Duration of exposure to pollutants, Duration of Illness in study group (p<0.05) and remaining characteristics are not significant (p>0.05).Conclusion: This study showed the deep breathing exercise had reduced dyspnoea among COPD patients.

 

KEYWORDS: Efficacy, Deep Breathing Exercise, Dyspnoea, chronic obstructive pulmonary disease (COPD).

 

 


INTRODUCTION:

American Thoracic Society define dyspnoea “Experience of dyspnoea derives from interactions among multiple physiological, psychological, social and environmental factors and may induce secondary physiological and behaviour response.”1

 

Therapies for relieving dyspnoea include pharmacological and non pharmacological management. Non pharmacological management includes ventilation support like BiPAP, relaxation techniques, counselling, sitting near well ventilated open window, music therapy and dyspnoea relieving positions. Deep breathing exercise like Diaphragmatic and Pursed lip breathing exercise is a very popular and excellent “Rescue “technique for acute dyspnoea management of COPD.2

 

A study was conducted at Brazil to evaluate the impact of deep breathing exercise on cardio respiratory parameters of heart rate among COPD patients. The findings of the study shows that deep breathing exercise produced significant changes on heart rate, respiratory rate and SPO2 and there was no changes in blood pressure.3

 

A study conducted to assess the effect of deep breathing exercise on respiratory rate shows that deep breathing exercise decreases the respiratory rate from 19 to 12 breaths per minute ventilation. Further it increases the PaO2, SaO2 in COPD patients at rest and during exercise.4

 

Diaphragmatic breathing exercise and Pursed Lip Breathing it is used to promote relaxation, to improve lung volumes and reduce dyspnoea in patients with COPD. Deep breathing exercise aims to improve expiration both by its active and prolonged expiration and by preventing airway collapse because it promotes prolonged expirations with a decrease in end expiratory lung volume (EELV) which leads to lower breathing frequency and higher tidal volume.

 

STATEMENT OF THE PROBLEM:

“Efficacy of Deep Breathing Exercise on dyspnoea among chronic obstructive pulmonary disease patients.”

 

OBJECTIVES OF THE STUDY:

1.     Assess the pre test dyspnoea score in study and control group.

2.     Evaluate the efficacy of Deep breathing exercise among study group

3.     Associate dyspnoea scores with selected demographic variables of study group.

 

HYPOTHESIS:

H1 There is a significant difference between the pre test and post test level of dyspnoea score in study group and control group.

 

H2: There will be a significant association between dyspnoea scores with selected of demographic variables of study group COPD patients.

 

METHOD AND MATERIAL:

Research design and approach: 

Quasi Experimental study with control group design with evaluative approach.

 

Group

Pre-test

Intervention

Post-test

Study group

O1

X

O2

Control group

O1

-

O2

 

Variables:

Independent Variable:

Deep Breathing Exercise (Diaphragmatic and Pursed Lip Breathing exercise).

 

Dependent Variable:

Dyspnoea.

Setting of the study:

Pravara Rural Hospital, Taluka Rahata, District Ahmednagar, Loni (Bk). Maharashtra,

 

Population:

Chronic Obstructive Pulmonary Disease patients admitted at Pravara Rural Hospital

 

Sampling technique:

Non-probability convenient sampling technique was used for the selection of Chronic Obstructive Pulmonary Disease patients for the present study.

 

Sample size:

60 Chronic Obstructive Pulmonary Disease patients

 

Inclusion criteria:

COPD Patients who are,

1)    Above age group of 35 years

2)    Admitted at Pravara Rural Hospital,

3)    Willing to provide written informed consent.

 

Exclusion criteria:

1) Patients who are critically ill.

 

Tool and technique:

Section A:

Socio Demographic Profile of COPD, Clinical Characteristics of COPD.

 

Section B:

Modified Borg’s Dyspnoea Scale.

 

Data collection procedure:

Formal permission was obtained from concerned authority Medical Superintendent, Head of Department of Medicine and Chest Physician of Pravara Rural Hospital, Loni (Bk), Maharashtra The study proposal was reviewed and approved by the Research Ethical Committee. Subjects was selected according to the selection criteria and assured the confidentiality of the sample. The instructions on the tool were made clear to facilitate the cooperation. The researcher helped the samples to understand the questions for obtaining the correct responses. Informed Written Consent was obtained after explaining the purpose of the study and assured the anonymity and confidentiality of information by the investigator.

 

Data analysis:

Descriptive statistics like mean, SD, mean percentage was used for description of demographic characteristics of Chronic obstructive pulmonary disease patient. Inferential statistics like chi-square test was used to find out the association of level of dyspnoea scores of COPD patients with demographic variables in study group.

 

RESULTS AND DISCUSSION:

Section: A Description of Demographic variables:

Majority (79%) and (71%) in study and control group were above 65 years. Maximum (81%) and (74%) were males in both the group. Highest percentage (88%) and (79%) belongs to Hindu religion. Most of the subjects (83%) and (71%) in study and control groups were farmers. Regarding income most (79%) and (65%) in study and control group had income below 3000/ month. Maximum (89%) and (91%) in study and control group resided in rural area.

 

Clinical Characteristics of COPD patients:

Maximum (75%) and (69%) were active smokers in study and control group. Highest percentage (61%) and (69%) had   history of smoking cigarette/bidi above one packet per day. Most (59%) and (49%) females in study and control group had exposure to biomass fuel. Majority (64%) and (55%) in study and control group had allergy due to pollens. In study group most (51%) and (56%) subjects had exposure to allergens above 5 years. Most of the subjects (64%) and (71%) had duration of illness above 5 years.

 

Section: B Assessment of pre test dyspnoea of COPD patients in study and control group:

Assessment of pre test mean and SD level of dyspnoea in study and control group:

In study group, the pre test scores in the level of dyspnoea by Modified Borg’s dyspnoea score depicts (7%) had moderate dyspnoea, (10%) had somewhat severe, (43%) had moderate very very severe dyspnoea, (17%) had almost maximum and (23%) had maximum dyspnoea.

 

In control group, the pre test scores in the level of dyspnoea revealed (13%) had very severe dyspnoea, (40%) had very very severe, (27%) had maximum and (20%) had almost maximum dyspnoea.

 

Section: C Effectiveness of Deep breathing exercise in study group COPD patients

 

Table No: 1 Comparison of Mean.SD and paired ‘t” test of pre and post test level of Modified Borg’s Dyspnoea Scale score in study and control group COPD patients. N=30+30

Group

Pre test

Post test

Mean difference

‘t’ value

Mean

SD

Mean

SD

Study

8.31

1.80

2.40

1.63

5.91

2.64*

Control

8.55

1.42

5.6

1.49

2.95

2.07*

 

The above table shows that, in study group the calculated “t” value was 2.64 which was statistically significant at P<0.05 level as compared to control group. Hence H1 is accepted. There is a significant difference between the pre test and post test level of dyspnoea score in study group and control group. It can be concluded that Deep breathing exercise was effective in reducing dyspnoea in COPD patients in study group.

 

Section: C Associate the dyspnoea score with selected demographic variables in study group COPD patients:

By applying Chi-Square test there is a significant association of level of dyspnoea between demographic characteristics namely; History of active smoking, Duration of exposure to pollutants, Duration of Illness in study group (p<0.05) and remaining characteristics are not significant (p>0.05).

 

DISCUSSION:

The above findings are consistent with finding F Judith A Paice et al that revealed deep breathing exercise was effective for COPD patients the calculated ‘t’ was significant at p<0.05 level. Similarly a study conducted by Elnar Wildard Smith revealed that practice of deep breathing exercise reduced dyspnoea among the COPD patients (6) 

 

CONCLUSION:

The findings of the results revealed, in the study group chronic obstructive pulmonary disease patients who practiced Deep breathing exercise 5 minute for three times a day had reduced dyspnoea which was significant improved at p<0.05 as compared with control group.

 

REFERENCES:

1.        B Mark et al; American Thoracic Society Statement: Update on the Mechanisms, Assessment and Management of Dyspnoea on behalf of the ATS Committee on Dyspnoea October 2011.

2.        G Faager, A Stahle, FF Larsen. Influence of spontaneous pursed lip breathingon walking endurance and oxygen saturation in patients with moderrteto severe COPD.J. clinical rehabilitation 2012, vol.22(1):675-678

3.        EMC Ramos et al;” Influence of pursed lip breathing on heart rater variability and cardio respiratory parameters in subjects with chronic obstructive pulmonary disease (COPD)”, Brazilian Journal of Physical Therapy, 2013.XII (4), pp.288-293,

4.        British Thoracic Society COPD Consortium, Guidelines to Spirometry. April 2014.

5.        Long term pulmonary rehabilitation on functional, capacity, perceived dyspnoea and quality of life. Chest 2015 128;673-83.

6.        F Judith, Elnar Wildard Smith et al. The effect of deep breathing exercise on pulmonary functions Int Respiratory Journal 2015 Dec’37(6):363-367.

 

 

 

 

 

 

 

Received on 08.09.2019          Modified on 10.10.2019

Accepted on 12.11.2019     © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2020; 8(1):32-34.

DOI: 10.5958/2454-2660.2020.00006.X