Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessness levels; one RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB, those with moderate to severe COPD being most likely to benefit. Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit The use of Pursed Lips Breathing in stable COPD: a systematic review of the evidence Abstract Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessnes...

This study found 9 of 13 of patients taught PLB continued with long-term use and 8 of 13 reporting definite benefit from PLB. The role of PLB in increasing patients' confidence in their ability to manage their breathlessness and, use at night, were novel findings.

Background: Pulmonary rehabilitation (PR) is effective in the management of chronic obstructive pulmonary disease (COPD) patients. 33% of patients referred for PR do not start the programme.Aim: To examine the relationship between participation in outpatient PR and baseline measures of disease severity and psychosocial variables in COPD patients. Methods:In an observational study and prior to their first outpatient PR appointment, COPD patients completed outcome measures of depression (Brief Assessment Depression Card), social support (Duke Social Support Index), multidimensional health locus of control (MHLC) and COPD severity (Medical Research Council dyspnea score). Data on attendance at the PR appointments were obtained from the PR register.Results: Fifty-one patients (mean age 77.2 year, male= 20), completed the study. Results indicate that in a patient, the presence of depression has a moderate, but statistically significant association (p=0.02) with the uptake of PR. There was no significant correlation between uptake status and any of the domains of MHLC, DSSI or MRC (p>0.005). Conclusion:Patients with COPD and depression are less likely to take up a referral to PR compared to those without depression. None of social support, HLC and COPD severity has a relationship with the uptake or completion of outpatient PR.

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