Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Nutsupa Ubolnuar, Anong Tantisuwat, Premtip Thaveeratitham, Somrat Lertmaharit, Chathipat Kruapanich, Witaya Mathiyakom, Nutsupa Ubolnuar, Anong Tantisuwat, Premtip Thaveeratitham, Somrat Lertmaharit, Chathipat Kruapanich, Witaya Mathiyakom

Abstract

Objective: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients.

Methods: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration's tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively.

Results: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05).

Conclusion: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

Keywords: Breathing exercises; Chronic obstructive pulmonary disease; Dyspnea; Meta-analysis; Ventilation.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flow diagram of included studies selection process.
Fig. 2.
Fig. 2.
Forest plot of mean difference in respiratory rate (RR) comparing pursed-lip breathing (PLB) and control.
Fig. 3.
Fig. 3.
Forest plot of standard mean difference in tidal volume (VT) comparing pursed lip-breathing (PLB) and control.
Fig. 4.
Fig. 4.
Forest plot of mean difference in inspiratory time (Ti) comparing pursed lip-breathing (PLB) and control.
Fig. 5.
Fig. 5.
Forest plot of mean difference in total respiratory time (Ttot) comparing pursed lip-breathing (PLB) and control.
Fig. 6.
Fig. 6.
Forest plot of mean difference in oxygen consumption (VO2) comparing ventilatory feedback (VF) and exercise.
Fig. 7.
Fig. 7.
Forest plot of mean difference in respiratory rate (RR) comparing ventilatory feedback (VF) plus exercise and exercise.
Fig. 8.
Fig. 8.
Forest plot of mean difference in inspiratory capacity (IC) comparing ventilatory feedback (VF) plus exercise and exercise.
Fig. 9.
Fig. 9.
Forest plot of mean difference in breath hold comparing singing and control.
Fig. 10.
Fig. 10.
Forest plot of mean difference in PCS domain of SF-36 comparing singing and control. PCS, physical component summary; SF-36, Short Form-36 Questionnaires.
Fig. 11.
Fig. 11.
Forest plot of standard mean difference in respiratory rate (RR) comparing diaphragmatic breathing exercise (DBE) and control.
Fig. 12.
Fig. 12.
Forest plot of mean difference in respiratory rate (RR) comparing combined breathing exercises (BEs) and control.

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