Effects of Balloon Blowing Therapy and Bubble PEP on Oxygen Saturation, Dyspnea, and Enjoyment in Pediatric Pneumonia

Comparative Effects of Balloon Blowing Therapy and Bubble PEP on Oxygen Saturation, Dyspnea, and Perceived Enjoyment in Children With Pneumonia

Pneumonia is a major cause of illness and death in children, leading to breathing difficulties and reduced oxygen levels due to impaired gas exchange. Non-pharmacological techniques like balloon blowing and Bubble PEP are simple, engaging methods used to improve respiratory function.

This randomized clinical trial will compare the effects of Balloon Blowing Therapy and Bubble PEP on oxygen saturation, dyspnea, and enjoyment in 40 children with pediatric pneumonia over one week.

Study Overview

• Status: Recruiting
• Conditions: Pneumonia in Children
• Intervention / Treatment: Device: Balloon Blowing Therapy; Device: Bubble PEP

Detailed Description

Pneumonia is one of the main causes of morbidity and mortality in children worldwide and serious pediatric health concern. Symptoms including hypoxia, tachypnea, and dyspnea are brought on by inflammation and fluid buildup in the alveoli, which hinders gas exchange.Supportive oxygen therapy and antibiotics are usually used in conventional treatment, nonpharmacological therapies have become more prevalent to improve respiratory outcomes.Breathing techniques, such as bubble positive expiratory pressure (PEP) therapy and balloon blowing, are being used extensively to assist gas exchange, enhance lung function, and encourage airway clearing. These techniques are useful in children because these are easy to use, entertaining, and cost-effective.

This randomized clinical trial aims to compare the effects of Balloon Blowing Therapy (BBTG) and Bubble PEP Therapy (BPTG) on oxygen saturation, dyspnea, and perceived enjoyment in children with Pneumonia. Forty children aged 6-12 years diagnosed with pneumonia, fulfilling the eligibility criteria will be recruited through non-probability purposive sampling. Participants will be randomly assigned to two groups. Group A will receive Balloon Blowing Therapy along with baseline breathing techniques. Group B will receive Bubble PEP Therapy with the same baseline breathing techniques. Interventions will be administered twice daily in 5 consecutive days for 1 week. Outcome measures include oxygen saturation assessed via pulse oximeter, dyspnea assessed via Modified Borg Dyspnea Scale, and perceived enjoyment measured by a 5-point smiley Likert scale. Data will be analyzed using SPSS software.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, Phd; Phone Number: 923224390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Muhammad Asif Javed, MS-PT; Phone Number: 923224209422; Email: a.javed@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Gulab Devi Chest Hospital Lahore
      • Contact: Imran Amjad, Phd; Phone Number: 923224390125; Email: imran.amjad@riphah.edu.pk
      • Contact: Muhammad Asif Javed, MS-PT; Phone Number: 923224209422; Email: a.javed@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Children aged 6 to 12 years
• Medically stable and cleared to perform breathing exercises
• Both genders will be included
• Presence of dyspnea according to the patient's statement
• Peripheral oxygen saturation (SpO2) <94%

Exclusion Criteria:

• Children who are critically ill patients on bi-pep or a ventilator, as well as patients who were intubated and uncooperative
• Children with any oral surgery
• Participants were excluded from the study, if they had any contraindication to the use PEP therapy (severe haemoptysis)
• Refusal to participate or inability to complete full sessions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Balloon Blowing Therapy Group (BBTG); Participants receive balloon blowing therapy along with baseline breathing exercises	Device: Balloon Blowing Therapy; Balloon Blowing Therapy involves deep breathing followed by exhaling into a balloon to create positive pressure, improving lung expansion and airway clearance. It is combined with diaphragmatic and pursed-lip breathing, performed twice daily in 5 days for 1 week; Other Names: Baseline Breathing Exercises ( Diaphragmatic Breathing,Pursed-Lip Breathing)
Experimental: Bubble Positive Expiratory Pressure Group (Bubble PEP); Participants receive Bubble PEP therapy along with baseline breathing exercises	Device: Bubble PEP; Bubble PEP involves deep inhalation followed by exhalation through water to create resistance and positive pressure, improving lung expansion and airway clearance. It is combined with diaphragmatic and pursed-lip breathing, performed twice in 5 days for 1 week; Other Names: Baseline Breathing Exercises ( Diaphragmatic Breathing,Pursed-Lip Breathing)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulse oximeter	Oxygen saturation measured using a pulse oximeter to assess oxygen saturation in children with pneumonia.In healthy children, normal oxygen saturation (SpO₂) typically ranges from 95% to 100%, while values ≤92% indicate significant hypoxemia requiring medical attention.	1 week
Modified Borg Dyspnea Scale	It is a patient-reported numerical scale assessing breathlessness during activity, ranging from 0 to 10, where 0 indicates no breathlessness and 10 indicates maximal breathlessness. Higher scores represent greater dyspnea.	1 week
5-point Likert Scale with Faces	This 5-point Likert scale with faces measures children's enjoyment and engagement during therapy. Scores range from 1 (not enjoyable) to 5 (highly enjoyable), with higher scores indicating greater enjoyment.	1 week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Mahnoor ikram, MS-PT, Riphah International University

Publications and helpful links

General Publications

• Ding L, Jiang Y. Biomarkers associated with the diagnosis and prognosis of Mycoplasma pneumoniae pneumonia in children: a review. Front Cell Infect Microbiol. 2025 Mar 18;15:1552144. doi: 10.3389/fcimb.2025.1552144. eCollection 2025.

Study record dates

Study Major Dates

• Study Start (Actual): April 14, 2026
• Primary Completion (Estimated): May 20, 2026
• Study Completion (Estimated): June 5, 2026

Study Registration Dates

• First Submitted: May 5, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 11, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Pneumonia; Oxygen saturation; Bubble PEP; Balloon Blowing Therapy
• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; Respiratory Tract Diseases; Lung Diseases; Pneumonia
• Other Study ID Numbers: REC/RCR&AHS/24/Mahnoor

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No