Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity

Abstract

Pursed lips breathing (PLB) is used by a proportion of patients with chronic obstructive pulmonary disease (COPD) to alleviate dyspnea. It is also commonly used in pulmonary rehabilitation. Data to support its use in patients who do not spontaneously adopt PLB are limited. We performed this study to assess the acute effects of PLB on exercise capacity in nonspontaneously PLB patients with stable COPD. We performed a randomized crossover study comparing 6-min walk test (6MWT) at baseline without PLB with 6WMT using volitional PLB. Spirometry, maximal inspiratory and expiratory mouth pressures, and diaphragmatic excursion during tidal and vital capacity breathing using B-mode ultrasonography were measured at baseline and after 10 min of PLB. A Visual Analog Scale (VAS) assessed subjective breathlessness at rest, after 6MWT and after 6MWT with PLB. p 0.01 was considered significant. Mean + SD age of patients was 53.1 + 7.4 years. Forced expiratory volume in 1second was 1.1 + 0.4 L/min (38.4 + 13.2% predicted). Compared with spontaneous breathing, all but one patient with PLB showed a significant increment in 6MW distance (þ34.9 + 26.4 m; p ¼ 0.002). There was a significant reduction in respiratory rate post 6MWT with PLB compared with spontaneous breathing (À4.4 + 2.8 per minute; p ¼ 0.003). There was no difference in VAS scores. There was a significant correlation between improvement in 6MWT distance and increase in diaphragmatic excursion during forced breathing. The improvement was greater in patients who had poorer baseline exercise performance. PLB has an acute benefit on exercise capacity. Sustained PLB or short bursts of PLB may improve exercise capacity in stable COPD.

Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

“…Randomisierte, kontrollierte Studien zum Stellenwert der physiotherapeutischen Atemtherapie oder zum Nutzen der einzelnen physiotherapeutischen Atemtechniken in der Behandlung der COPD sind in sehr geringem Maße verfügbar. Randomisierte Studien [269,270], eine systematische Übersicht [271], sowie eine Evaluation der Evidenz aus systematischen Übersichten [272] zeigen positive Effekte von Atemtechniken, insbesondere der dosierten Lippenbremse, aber auch von einem Training der Zwerchfellatmung, das in Übereinstimmung mit den BTS-Empfehlungen zur physiotherapeutischen Atemtherapie Patienten mit COPD von Atemtechniken profitieren. Weniger gut belegt sind atemerleichternde Körperpositionen wie das Sitzen mit nach vorne geneigtem Oberkörper, die Fixation des Schultergürtels oder Relaxationsübungen, die bei COPD-Patienten mit Angst und ausgeprägter Dyspnoe zur Reduktion von Dyspnoe und der Atemfrequenz führen können.…”

Effectiveness of pulmonary rehabilitation in elderly patients with COPD: A systematic review and meta‐analysis of randomized controlled trials

“…The subgroup analysis for the outcome of the 6WMT showed that the effect of walking for elderly people with COPD was inconsistent with findings fromBhatt, Luqman-Arafath, and Gupta (2013), which may be related to the clinical heterogeneity and the frequency, time, and intensity of walking. The evidence did not demonstrate that rehabilitation programs improve SaO 2 in elderly COPD patients, perhaps because of small sample sizes of the trials and the lack of detailed data.The innovation of this paper is that we conducted a systematic review and meta-analysis of data related to elderly patients with COPD who participated in pulmonary rehabilitation programs.…”

Is There an Optimal Level of Positive Expiratory Pressure (PEP) to Improve Walking Tolerance in Patients With Severe COPD?

“…Recently, Bhatt et al 15 reported good results regarding exercise tolerance improvement in patients with severe COPD. They conducted a crossover trial investigating the effects of PLB on 6MWD and found that patients walked 34.9 m more if they breathed with volitional PLB, compared to breathing normally (P=.002), with a concomitant reduction in RR after the test.…”

“…Patients may present increased residual volume at rest (static hyperinflation) and/or may develop hyperinflation under strain (dynamic hyperinflation), as the increase of the respiratory rate shortens the expiratory time. 15 In COPD patients, some studies investigated the effects of PEP on strength, endurance, lung volumes or walking exercise. The equal pressure point (EPP) is shifted peripherally, resulting in an earlier closure of the peripheral airways with consequent air trapping.…”