The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis

Yang, Ying; Wei, Liuyi; Wang, Shizhen; Li, Ke; Zhao, Huimin; Mao, Jing; Li, Jie; Mao, Zongfu

doi:10.1080/09593985.2020.1805834

Cited by 25 publications

(43 citation statements)

References 26 publications

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“…Except for one SR showed no significant difference, the other 5 19–21 , 23 , 24 SRs showed that breathing exercises could significantly improve the pulmonary function of COPD patients. Among them, 4 19–21 , 24 SRs used the outcome FEV1, 3 19 , 21 , 24 SRs had a low-quality level, and 1 20 SR had a very low-quality level; 3 19 , 21 , 24 SRs used the outcome FVC, 2 21 , 24 SRs had a low-quality level, and 1 19 SR had a very low-quality level; only 1 23 SR used the outcome FEV1%, and the quality level was very low; 6 19–21 , 23–25 SRs used the outcome FEV1/FVC. The quality grade of 3 21 , 23 , 25 SRs was low, and the other 3 19 , 20 , 24 SRs were very low.…”

Section: Resultsmentioning

confidence: 83%

“…The subjects were all patients with COPD, of which 4 19 , 20 , 22 , 23 were diagnosed as patients with stable COPD, and 5 19–21 , 23 , 25 described the diagnostic criteria. In terms of quality assessment tools, 1 19 SR used the Jadad scale, 4 20–22 , 24 SRs used the Cochrane risk of bias tool, 1 25 SR used both the Jadad scale and Cochrane risk of bias tool, and 1 23 SR used PEDro scale. The characteristics of included SRs are presented in Table S3 .…”

Section: Resultsmentioning

confidence: 99%

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Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews

Li¹,

Ji²,

Wang³

et al. 2022

COPD

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Background The effectiveness of breathing exercises in the treatment of chronic obstructive pulmonary disease (COPD) has been demonstrated in several systematic reviews (SRs), but a comprehensive review is still lacking. The aim of this study was to synthesize evidence from SRs, to summarise the effects of breathing exercises interventions for COPD patients. Methods We conducted an overview of the SRs of breathing exercises in the treatment of COPD. We include Systematic Reviews of randomized-controlled clinical trials. In the included COPD, control of breathing exercises alone was the only variable and no restriction was placed on relevant outcome measures. The SRs were screened by computer retrieval from the Chinese National Knowledge Infrastructure (CNKI), WanFang database, Chinese Science and Technology Journal Database (CSTJ), Chinese Biological Medicine (CBM), MEDLINE (PubMed), Embase, Cochrane library, and Web of Science. The Risk of Bias in Systematic reviews (ROBIS) tool, the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement, a Measure Tool to Assess Systematic Reviews (AMSTAR) 2, and the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) were used to evaluate the risk of bias, reporting quality, methodology quality, and evidence quality. Results Nine SRs met the inclusion criteria and were included in the overview, 4 SRs in Chinese, and 3 SRs in English. All the SRs were published between 2015–2021. According to the ROBIS tool, 4 SRs (57.14%) were rated as low risk of bias. The PRISMA scale showed that 5 SRs had some defects, and 2 SRs were relatively complete. Reporting deficiencies exist primarily in protocol and registration (28.6%), search (42.9%), risk of bias across studies (0%), additional analyses (42.9%), and funding (28.6%). Based on the AMSTAR-2 scale, 3 SRs were low quality, and the other 4 SRs were very low. The result of evidence quality assessment showed that among the 34 outcomes involved in the 7 studies, 19 were low-level outcomes, 15 were very low-level outcomes, and there were no moderate and high-level quality outcomes. Limitations and publication bias were two major factors that reduced the quality of evidence. Conclusion Breathing exercises in certain can improve pulmonary function, exercise endurance, dyspnea, quality of life, and respiratory muscle strength of COPD patients. However, there is an urgent need for high-quality studies to guide clinical practice due to certain deficiencies in reporting quality and the low quality of methodology and outcomes.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews

Li¹,

Ji²,

Wang³

et al. 2022

COPD

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“…As part of the pulmonary rehabilitation method (comprehensive intervention program), breathing exercises are a simple but highly targeted training that can be completed at home independently by patients with COPD, resulting in strengthening the respiratory muscle and ultimately improving long-term management of dyspnea [ 32 , 33 ]. DBT is a common physiotherapy technique used to relieve dyspnea, improve pulmonary function, and enhance the psychological condition of COPD patients [ 34 , 35 ]. Significant variations in readmission outcomes and provision of COPD care have been noted.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Diaphragmatic Breathing Training Combined with Discharge Care Bundles in Patients with Chronic Obstructive Pulmonary Disease

Qin

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Both physical exercise and discharge care bundles can improve patient outcomes and reduce hospitalization rates among subjects with chronic obstructive pulmonary disease (COPD). The retrospective analysis aims to determine the advantages of care bundles combined with diaphragmatic breathing training (DBT) in COPD patients after discharge. Methods. Of the 110 COPD patients, 55 patients received DBT alone (DBT group) and 55 participants received the combined intervention (care bundle + DBT group). Three months after discharge, we assessed the outcomes of patients using Bristol COPD Knowledge Questionnaire (BCKQ), Hospital Anxiety and Depression Scale (HADS), COPD Assessment Test (CAT), and St. George’s Respiratory Questionnaire (SGRQ). Meanwhile, COPD-related hospital readmissions were also recorded. Results. The BCKQ score for assessing the disease knowledge level was increased in patients at 3 months after the combined interventions as compared to the baseline values, which was higher in the care bundle + DBT group than the DBT group at 3 months. Moreover, improvements in negative emotion and clinical symptoms from baseline to 3-month follow-up were seen in both the two groups. Besides, the care bundle + DBT group showed the mitigation of depression and anxiety and the alleviation of clinical symptoms in comparison with the DBT group at 3 months. Participants who received combined interventions had lower SGRQ scores than those who received DBT alone. The time to first COPD-related readmission was shorter for patients in the care bundle + DBT group compared with the DBT group. Conclusions. DBT combined with discharge care bundles for COPD patients resulted in improvements in disease-specific knowledge, negative emotions, and clinical symptoms with better HRQOL and lower readmission rate.

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“…Numerous studies have shown that pursed-lips and diaphragmatic breathing can improve lung function in patients. [35][36][37][38] Singing is mainly characterized by pursed-lips and diaphragmatic breathing. Pursed-lips breathing is widely used in pulmonary rehabilitation programmes in order to impose positive expiratory pressure, with the aim of creating resistance to expiratory flow and preventing early bronchial collapse, 39,40 and conscious use of the diaphragm during respiration increases lung capacity.…”

mentioning

confidence: 99%

Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis

Fang¹,

Qiao²,

Yu³

et al. 2022

COPD

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Background: Chronic obstructive pulmonary disease (COPD) is a chronic lung disease which feature is progressive airflow obstruction. Singing is a popular and convenient activity that requires people to manage their lung volumes and airflow actively. Despite the well-known benefits of singing to healthy people, the specific effect still remains unclear. Objective: To investigate the mental and psychological benefits of singing in patients with stable COPD. Search Methods: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) on randomized controlled trials (RCTs) including singing exercise as the main intervention in stable COPD. We searched 8 electronic databases, including Web of Science, PubMed, Embase, Cochrane Library, Clinical Trials.gov, and the Physical Therapy Evidence Database (PEDro), CNKI, and Wanfang Database from inception until May 2022. The searching languages was English or Chinese. Data extraction using standardized templates was performed by two independent reviewers. The quality of the studies was assessed using the PEDro scale. Data synthesis was performed with Revman 5.4. The pooled effect sizes are reported by MD and 95% CI. Results: Five RCTs involving 333 patients with stable COPD were included in this meta-analysis. Singing was regarded as the main intervention in the experimental group. Meta-analysis revealed that singing improves quality of life on Short Form 36 physical component summary (SF-36 PCS) (MD = 12.63, 95% CI: 5.52 to 19.73, P < 0.01) and respiratory muscle in maximal expiratory pressure (PE max ) (MD = 14.30, 95% CI: 0.87 to 27.73, P = 0.04) in patients with COPD. However, it has limited effects on Short Form 36 mental component summary (SF-36 MCS), lung function, exercise capability, and adverse mental state. Conclusion:Based on results of the meta-analysis, singing could be used to improve quality of life (SF-36 PCS) and respiratory muscles (PE max ) in patients with COPD.

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The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis

Cited by 25 publications

References 26 publications

Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews

Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews

A Retrospective Study of Diaphragmatic Breathing Training Combined with Discharge Care Bundles in Patients with Chronic Obstructive Pulmonary Disease

Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis

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