The historical perspective on pursed lip breathing exercises and its role in pulmonary rehabilitation programs

Main Article Content

Weihua Zhang Ashish Mehta

Abstract

Background: Pursed lip breathing (PLB) is an important aspect of respiratory exercise training utilized by patients with chronic obstructive pulmonary disease (COPD) to alleviate symptoms of dyspnea. This modality became a part of the recommended treatment during pulmonary rehabilitation and was endorsed by ACCP/AACVPR (American College of Chest Physicians/ American Association of Cardiovascular and Pulmonary Rehabilitation) in 1997. 1 Theoretically, PLB promotes maximum exhalation by creating back-pressure inside the airways and thereby improving patency. These changes in respiratory mechanics counteract the pathophysiology leading to emphysema and optimize pulmonary function, thus decreasing dyspnea symptoms associated with dynamic hyperinflation. While there is no overwhelming evidence to support the efficacy of PLB, clinicians still encourage their patients to use PLB techniques during their pulmonary rehabilitation program.


Methods: A total of 26 research articles met criteria for inclusion in this review.


The purpose of this review is to better understand the historical perspectives and evidence surrounding the use of PLB.


Discussion: Most evidence suggested that PLB could be an effective self-care management that optimizes pulmonary function. The knowledge gained from this review may be used to explore implementation strategies utilizing pursed lip breathing exercises for developing a home-based pulmonary rehabilitation program in order to optimize pulmonary function and quality of life in COPD patients.

Article Details

How to Cite
ZHANG, Weihua; MEHTA, Ashish. The historical perspective on pursed lip breathing exercises and its role in pulmonary rehabilitation programs. Medical Research Archives, [S.l.], v. 6, n. 8, aug. 2018. ISSN 2375-1924. Available at: <https://journals.ke-i.org/index.php/mra/article/view/1825>. Date accessed: 14 nov. 2018.
Section
Research Articles

References

References:
1. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation. Chest. Nov 5 1997;112(5):1363-1396.
2. American Lung Association. Trends in COPD (emphysema and chronic bronchitis): morbidity and mortality. 2010; http://www.lungusa.org/finding-cures/our-research/trend-reports/copd-trend-report.pdf.
3. Ma J, Ward EM, Siegel RL, Jemal A. TEmporal trends in mortality in the united states, 1969-2013. JAMA. 2015;314(16):1731-1739.
4. Walsh J. COPD: What yuou don't know can kill you. 2007; http://www.vietnow.com/veterans-health-copd/. Accessed Nov. 18, 2015, 2015.
5. Brown DW, Croft JB, Greenlund KJ, Giles WH. Trends in hospitalization with chronic obstructive pulmonary disease-United States, 1990-2005. Copd. Feb 2010;7(1):59-62.
6. Centers for Disease Control and Prevention. Public Health Strategic Framework for COPD Prevention. Atlanta, Ga: Centers for Disease Control and Prevention; 2011.
7. Kaptein AA, Scharloo M, Fischer MJ, et al. 50 years of psychological research on patients with COPD--road to ruin or highway to heaven? Respiratory medicine. Jan 2009;103(1):3-11.
8. Barach AL. Physiologic advantages of grunting, groaning, and pursed-lip breathing: adaptive symptoms related to the development of continuous positive pressure breathing. Bulletin of the New York Academy of Medicine. Aug 1973;49(8):666-673.
9. Grippi MA. Fishman's pulmonary diseases and disorders. Fifth edition. ed.
10. Wikipedia. Pursed Lip Breathing. 2015; https://en.wikipedia.org/wiki/Pursed_lip_breathing. Accessed December 1, 2015, 2015.
11. Medical-Dictionary. Pursed-lip Breathing. 2015; http://medical-dictionary.thefreedictionary.com/pursed-lip+breathing. Accessed December 1, 2015.
12. Kasper DL. Harrison's manual of medicine. 19th edition. ed.
13. Ingram RH, Jr., Schilder DP. Effect of pursed lips expiration on the pulmonary pressure-flow relationship in obstructive lung disease. The American review of respiratory disease. Sep 1967;96(3):381-388.
14. Puente-Maestu L, Stringer WW. Hyperinflation and its management in COPD. International journal of chronic obstructive pulmonary disease. 2006;1(4):381-400.
15. Facchiano L, Hoffman Snyder C, Nunez DE. A literature review on breathing retraining as a self-management strategy operationalized through Rosswurm and Larrabee's evidence-based practice model. Journal of the American Academy of Nurse Practitioners. Aug 2011;23(8):421-426.
16. Barach AL, Bickerman HA, Rodgers J. Continuous positive pressure breathing in chronic obstructive lung disease: effect on minute ventilation and blood gases. Annals of allergy. Feb 1973;31(2):72-78.
17. Onodera A, Yazaki K. [Effects of a short-term pulmonary rehabilitation program on patients with chronic respiratory failure due to pulmonary emphysema]. Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society. Aug 1998;36(8):679-683.
18. Roberts SE, Schreuder FM, Watson T, Stern M. Do COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term? A mixed methodological study. Physiotherapy. May 27 2016.
19. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. Jul 7 1999;282(1):54-61.
20. Freeman CM, Martinez CH, Todt JC, et al. Acute exacerbations of chronic obstructive pulmonary disease are associated with decreased CD4+ & CD8+ T cells and increased growth & differentiation factor-15 (GDF-15) in peripheral blood. Respiratory research. 2015;16:94.
21. Kohli P, Pinto-Plata V, Divo M, et al. Functional capacity, health status, and inflammatory biomarker profile in a cohort of patients with chronic obstructive pulmonary disease. Journal of cardiopulmonary rehabilitation and prevention. Sep-Oct 2015;35(5):348-355.
22. Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. Journal of cardiopulmonary rehabilitation and prevention. Jul-Aug 2007;27(4):237-244.
23. Cabral LF, D'Elia Tda C, Marins Dde S, Zin WA, Guimaraes FS. Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. European journal of physical and rehabilitation medicine. Feb 2015;51(1):79-88.
24. Mueller RE, Petty TL, Filley GF. Ventilation and arterial blood gas changes induced by pursed lips breathing. Journal of applied physiology. Jun 1970;28(6):784-789.
25. Tiep BL, Burns M, Kao D, Madison R, Herrera J. Pursed lips breathing training using ear oximetry. Chest. Aug 1986;90(2):218-221.
26. Sassi-Dambron DE, Eakin EG, Ries AL, Kaplan RM. Treatment of dyspnea in COPD. A controlled clinical trial of dyspnea management strategies. Chest. Mar 1995;107(3):724-729.
27. de Araujo CL, Karloh M, Dos Reis CM, Palu M, Mayer AF. Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease: A randomized cross-over study. Journal of rehabilitation medicine. Nov 2015;47(10):957-962.
28. Optimizing chronic disease management in the community (outpatient) setting (OCDM): an evidentiary framework. Ontario health technology assessment series. 2013;13(3):1-78.
29. Pulmonary rehabilitation-1999. American Thoracic Society. American journal of respiratory and critical care medicine. May 1999;159(5 Pt 1):1666-1682.
30. Fischer MJ, Scharloo M, Abbink JJ, et al. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respiratory medicine. Oct 2009;103(10):1564-1571.
31. Hayton C, Clark A, Olive S, et al. Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence. Respiratory medicine. Mar 2013;107(3):401-407.
32. Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chronic respiratory disease. 2011;8(2):89-99.

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