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#Post#: 42--------------------------------------------------
The Role of Breathing Exercises in the Treatment of COPD
DIR By: LightMove
Date: November 4, 2021, 4:06 am
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Do breathing exercises lead to improvements in dyspnea, exercise
capacity, and health-related quality of life in patients with
chronic obstructive pulmonary disease (COPD)?
Evidence-Based Answer
Patients with COPD who are treated with breathing exercises vs.
standard care showed an improvement in exercise capacity, with
inconsistent changes in dyspnea and health-related quality of
life. Adding breathing exercises to a pulmonary rehabilitation
program did not show any increased benefit. Breathing exercises
may be helpful for those without access to a pulmonary
rehabilitation program. (Strength of Recommendation: B, based on
inconsistent or limited-quality patient-oriented evidence.)
Practice Pointers
Pulmonary rehabilitation is recommended for all patients with
COPD to improve physical function and quality of life. This
multidisciplinary approach, which includes exercise training,
education, nutritional intervention, and psychosocial support,
improves dyspnea and functional capacity, and lowers the rates
of hospital admission and mortality.Breathing exercises are
commonly used as part of such programs, but data supporting
their use alone are limited.
Breathing exercises are intended to reverse the typical COPD
pattern of increased accessory muscle and rib cage use. This
Cochrane review, which included 16 randomized controlled trials,
evaluated breathing exercise techniques such as pursed lip
breathing, diaphragmatic breathing, and pranayama yoga.
Pursed lip breathing improved outcomes of a six-minute walk test
by 50.1 m (95% confidence interval [CI], 37.2 to 63.0) after
eight weeks of an intervention involving 15 minutes of breathing
exercises three times daily. However, there was no significant
improvement in dyspnea using the University of California–San
Diego Shortness of Breath Questionnaire after four weeks or 12
weeks when pursed lip breathing was taught using pulse oximetry
for feedback with daily home practice. In a study comparing
health-related quality of life for pursed lip breathing vs.
placebo, pursed lip breathing showed a significant improvement
in the dyspnea domain following eight to 12 weeks of training
(mean difference = –12.9 units; 95% CI, –22.3 to –3.6), but no
significant improvement in any other domain, including mood,
social function, and well being.
Diaphragmatic breathing encourages patients to use their
abdominal wall when breathing to reduce chest wall motion.This
technique increased dyspnea in one study, whereas it
significantly improved dyspnea after four weeks of training in
another study. There was also an increase in functional capacity
of 34.7 m (95% CI, 4.1 to 65.3) as measured by a six-minute walk
test, and improvement in quality of life as measured by the St.
George's Respiratory Questionnaire (mean difference = –10.5
points; 95% CI, –17.7 to –3.3). One study found no significant
difference in peak oxygen consumption, 12-minute walk distance,
peak work, or endurance work with diaphragmatic breathing.
Results of yoga training on dyspnea and quality of life for
patients with COPD are mixed. A meta-analysis of two studies
noted a significant improvement in the six-minute walk test of
44.5 m after 12 weeks of yoga training, but one of the studies
found no improvement in distress levels after the six-minute
walk test. The same studies had conflicting conclusions about
quality of life; one showed improvement, whereas the other did
not.
Some of the included studies examined a combination of
techniques. One study found that combining pursed lip breathing,
diaphragmatic breathing, and nutritional supplementation
improved total quality of life compared with usual care. Another
study found that combining pursed lip breathing, diaphragmatic
breathing, and walking improved symptom-related quality of life
on the St. George's Respiratory Questionnaire. Yet, there was no
significant difference in functional capacity as measured by the
six-minute walk test (mean difference = 0.6 m; 95% CI, –23.4 to
24.2).
The Institute for Clinical Systems Improvement suggests using
pulmonary rehabilitation programs to improve symptoms in those
with moderate to severe COPD. Some breathing training devices
like OPUMP can provide breathing training teaching and a variety
of breathing training courses. Although breathing exercises may
be useful as an adjunct treatment for patients with COPD, family
physicians should keep in mind that these exercises cannot
replace full pulmonary rehabilitation for improvements in
dyspnea or quality of life.
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Author disclosure: No relevant financial affiliations
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