Int J Pharm Bio Sci 2017 Apr; 8(2): (B) International Journal of Pharma and Bio Sciences

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1 Research Article Allied Science International Journal of Pharma and Bio Sciences ISSN ASSESS THE EFFECTIVENESS OF PURSED LIP BREATHING EXERCISE ON SELECTED VITAL PARAMETERS AND RESPIRATORY STATUS AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. SOLOMON VIJAYAKUMAR * Clinical Instructor, Saveetha College of Nursing, Chennai, India ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) is a devastating lung disease that progressively robs a person s ability to breath. We are facing a dual challenge because not only COPD is rapidly increasing in prevalence, but also many people with COPD are unaware that they have the disease. With proper medication, aggressive rehabilitation, and the right attitude most patients regain some lost functions and enjoy a happier, more productive life. Objectives: To assess the vital parameters and respiratory status of patients with Chronic Obstructive Pulmonary Disease in experimental and control group before and after administration of pursed lip breathing exercise.evaluate the effectiveness of pursed lip breathing exercise among the patients with Chronic Obstructive Pulmonary Disease in experimental group. Methodology: Quasi-Experimental design was used. A total of 60 COPD patients were selected by Non probability purposive sampling technique from medical wards of Government Vellore Medical College and Hospital, Vellore. Descriptive and inferential statistics were used to analyse the data collected. The study result showed that there was definite improvement in mean score of vital parameters and respiratory parameters, ie., pulse -6.20, systolic BP -5.17, diastolic BP-4.33,respiratory rate -4.93, Sao and PEFR in the experimental group, P<0.001 by using pursed lip breathing exercise. Hence the study proved the purse lip breathing exercise to be a very simple yet effective measure in improving the vital parameters and respiratory status 10 of COPD patients KEY WORDS: Pursed lip breathing exercise, COPD, Respiratory status, Vital parameters, PEFR. SOLOMON VIJAYAKUMAR * Clinical Instructor, Saveetha College of Nursing, Chennai, India. Received on: Revised and Accepted on: DOI: B-795

2 INTRODUCTION COPD is not simply a "smoker's cough" but an underdiagnosed, life-threatening devastating lung disease that progressively robs a person s ability to breath.. Chronic obstructive pulmonary disease has become increasingly important cause of morbidity and mortality 1 in the modern world. In India, respiratory dysfunction continues to be a major health problem, since a deadly mix of socio-economic and environmental factors such as poverty, malnutrition, illiteracy and air pollution is prevalent. Cigarette smoking 2 is the most commonly encountered risk factor for COPD, all forms of smoking products such as cigarettes, beedis, chutta and chilum used in different states were found to be significantly associated with COPD, although in many countries, air pollution resulting from burning of wood and other biomass fuels 3,4 has also been identified as a COPD risk factor. Passive smoking carries serious risks, especially for children and those chronically exposed. Along with respiratory symptoms the COPD patients can develop features like cachexia, skeletal muscle wasting, osteoporosis, depression, anaemia and can have an increased risk of cardiovascular disease. Currently, there are about 98 million smokers in India and about 10, 00,000 Indians die due to smoking related disorders. In India, the total burden of COPD 6 is about million in 2011, doubled from 6.45 million in 1971 as per WHO. Management of patients with COPD, strategy includes pharmacological and non- pharmacological approaches which includes pulmonary rehabilitation occupying a vital part. Pulmonary rehabilitation 7,9 is an integral part of the clinical management and health maintenance, is a program of exercise, disease management and counselling coordinated to benefit the individual. Pulmonary rehabilitation has been shown to improve shortness of breath and exercise capacity. Breathing exercises 10 for people with chronic obstructive pulmonary disease (COPD) aim to alter respiratory muscle recruitment improve respiratory muscle performance and reduce dyspnoea. RESEARCH METHODOLOGY Research approach: Quantitative Approach Research design: Quasi-Experimental design Setting: Government Vellore Medical College and Hospital, Vellore Sample: Sample is the patient s with COPD admitted to Government Vellore Medical College and Hospital, Vellore Sample size: Sample size was 60. Sampling technique: Total of 60 COPD patients were selected by non probability purposive sampling technique from medical wards of Government Vellore Medical College and Hospital, Vellore, and placed in experimental and control group by randomization. Criteria for sample selection Inclusion Criteria Patients who are in the age group of 40 years and above. Both male and female patients with Grade 1, 2 and 3- Chronic Obstructive Pulmonary Disease patients Patients who are willing to participate in the study. Exclusion Criteria Patients who were acutely ill. Data collection tool Part I The demographic data was developed by the investigator by extensive literature search and with the consultation of experts in field of Nursing and General Medicine. Demographic data included Age, Sex, Education, Occupation, Monthly income, Marital status, Religion, Habits, Duration of illness, Associated co morbidity. Part II In this section, the Vital parameters - Temperature, Pulse, Systolic BP, Diastolic BP and Respiratory statusrespiratory rate, SaO2, PEFR were assessed in two groups - pre and post administration of pursed lip breathing exercise and effectiveness of the intervention analyzed. Analysis and interpretation Effectiveness of Pursed Lip Breathing Exercise on selected vital parameters and respiratory status among samples in experimental group (n=30). Table 1 Improvement Score (n=30) Paired t test Vital Parameter Mean S.D. and P value Temperature t = 3.788, P = Pulse t = 3.725,P = * Systolic BP t = 6.814,P = * Diastolic BP t = 5.981,P = * Respiratory Status Respiratory Rate t = 7.964, P = 0.001* SaO t = 6.774, P = 0.001* PEFR t = 8.344, P = 0.001* B-796

3 Effectiveness of pursed lip breathing exercise on respiratory parameters among Patients with COPD in experimental Group Major findings of the study The study revealed that in the experimental group, 50% were in the age group of 61 years and above and in the control group 53.3% of the subjects were in the age group of 61years and above. In the experimental group, the mean respiratory rate was with a standard deviation of 3.12 and the P<0.000 level, while the mean PEFR in the experimental group was and a standard deviation of and P<0.001 level. The pursed lip breathing exercise was shown to be effective as there was a significant improvement in respiratory parameters in the experimental group, P<0.001 level. And there was significant association of the demographic variables with respiratory parameters in post test in experimental group at P<0.01 level. The control group did not show major improvement during the post test period. DISCUSSION The main focus of this study is to assess the effectiveness of pursed lip breathing exercise on selected vital and respiratory parameters in patients with chronic obstructive pulmonary disease. In the post test out of 30 samples, in the experimental group, the mean pulse as 86.87,with a standard deviation of 12.79, and in the control group the mean was 88.60,with a standard deviation of The mean systolic blood pressure in the experimental group as , with a standard deviation of and the in the control group the mean systolic BP as 118.8, with the standard deviation being 11.99, the mean respiratory rate for experimental group was 32.30, and the standard deviation as 3.12, and in the control group the mean respiratory rate as with its standard deviation being and the mean PEFR score for experimental group was 275.0, while its standard deviation was And in the control group the mean PEFR was with the standard deviation being This study was supported by Ramos EMC whose study results showed that pursed lip breathing exercise (PLB) produced significant changes in HR, RR and SpO2, and did not alter BP in subjects with COPD. CONCLUSION There is an improvement of vital and respiratory status amongst patients with COPD after pursed lip breathing exercise in experimental group than control group. Hence the nurses have to implement this pursed lip breathing exercise at the earliest to reduce the respiratory rate and thereby the respiratory distress and promote comfort and wellbeing of the patients. Along with medications, pursed lip breathing exercise can be promoted as a very vital adjuvant therapy and through scientific education and training, the nurses can tremendously improve the health status of the clients. CONFLICT OF INTEREST Conflict of Interest declared none. REFERENCES 1. Lewis S, HeitKemper M, Dirksen S.R. Medical Surgical Nursing.9 th ed. Philadelphia: Mosby Company; Joyce M Black.Medical-Surgical Nursing- Clinical Management for Positive Outcomes.8th ed. New Delhi: Elsevier India; Morgan M, Singh S.Practical Pulmonary Rehabilitation.London: Chapman and Hall Medical Company; John R. Pulmonary Rehabilitation. 1 st ed, Philadelphia: Mosby Company; Holland AE, Hill CJ. Breathing exercises for chronic obstructive pulmonary disease:systematic reviews[internet].australia:sydney;2012[cited 2012 Apr 6].available from: 6. S K Jindal.COPD- The Unrecognized Epidemic in India. JAPI Feb:60(6): Izadi Avanji, Adib Hajbaghery M.Effects of Pursed Lip Breathing on Ventilation and Activities of Daily Living in Patients with COPD. Rehabilitation.2011 jun: 2(4): B-797

4 8. Jadranka Spahij.Factors Discriminating Spontaneous Pursed- Lips Breathing Use in Patients with COPD. Journal of Chronic Obstructive Pulmonary Disease.2010 Aug:7(4): Gian Galeazzo, Riari, Sforza, Stefano Centanni. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease Aug :4(1): Neil, Margaret A.Efficacy of Pursed-Lips Breathing- a breathing pattern retraining strategy for Dyspnea reduction. Journal of Cardiopulmonary Rehabilitation & Prevention July: 27(4): B-798

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