Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD)

Abstract

Abstract-Controlled breathing is included in the rehabilitation program of patients with chronic obstructive pulmonary disease (COPD). This article discusses the efficacy of controlled breathing aimed at improving dyspnea. In patients with COPD, controlled breathing works to relieve dyspnea by (1) reducing dynamic hyperinflation of the rib cage and improving gas exchange, (2) increasing strength and endurance of the respiratory muscles, and (3) optimizing the pattern of thoracoabdominal motion. Evidence of the effectiveness of controlled breathing on dyspnea is given for pursed-lips breathing, forward leaning position, and inspiratory muscle training. All interventions require careful patient selection, proper and repeated instruction, and control of the techniques and assessment of its effects. Despite the proven effectiveness of controlled breathing, several problems still need to be solved. The limited evidence of the successful transfer of controlled breathing from resting conditions to exercise conditions raises several questions: Should patients practice controlled breathing more in their daily activities? Does controlled breathing really complement the functional adaptations that patients with COPD must make? These questions need to be addressed in further research.

Breathing pattern and thoracoabdominal motion during exercise in chronic obstructive pulmonary disease

“…Pulmonary rehabilitation programs have been focusing on strategies to improve alveolar ventilation such as diaphragmatic breathing that seems to be related to modifications of breathing pattern (6). Studies have reported a decrease in rib cage motion and an increase in abdominal motion during diaphragmatic breathing (7,8).…”

Efficacy of Pursed Lips Breathing with Forced Expiration Techniques and Active Cycle of Breathing Technique on Pulmonary Mucus Clearance in Healthy Subjects

“…This finding confirms that enhanced mucus clearance can be achieved in healthy subjects by PLB & FETs. In particular, most previous studies found that successful PLB markedly reduced respiratory rate and dyspnoea, improved tidal volume and increased the vital capacity and oxygen saturation of patients with emphysema 10,11,20,21) . Furthermore, healthy individuals performing volitional PLB have also previously been found to exhibit significant increases in tidal volume during resting breathing and exercise as reported by Spahija et al in 1996 22) .…”

“…Our study is original research designed to evaluate the effects of PLB combined with FETs on mucus clearance. The increased clearance achieved by PLB & FETs could have resulted from the mechanical effect of PLB [1][2][3]14,15,23,24) , stimulation of mucociliary clearance resulting from forced expiration techniques 1,[5][6][7]9) or the mechanism of two-phase Due to the mechanical effect of PLB, active expiration through the half-opened lips induces expiratory mouth pressure of about 5 cmH 2 O 10,11,15) . The positive back pressure may splint the airway open, preventing compression or premature closure.…”

“…Pursed lips breathing (PLB) is considered to be the cornerstone of breathing retraining in pulmonary rehabilitation. It works to improve expiration, both by requiring active and prolonged expiration and by preventing airway collapse [10][11][12][13] . Indeed, PLB represents a functional predecessor to many modern strategies of applying positive expiratory pressure to the airway.…”

“…It is believed that the resistance at the mouth during a pursed-lips exhalation transmits back pressure that splints the airways open, preventing compression and premature closure, which is the same principle of operation as the fixed-orifice resistor of positive airway pressure techniques 14,15) . The subject performs a moderately active expiration through the half-opened lips, inducing expiratory mouth pressures of about 5 cmH 2 O 10,11,15) . Thus, the positive expiratory pressure of PLB may be an important additional effect for airway clearance.…”