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Pulmonary Rehabilitation For Asthma, Cystic Fibrosis, COPD, Emphysema

Pursed lip breathing is most often practiced to treat asthma, pulmonary or cystic fibrosis, and chronic obstructive pulmonary disease (COPD). The purpose of PLB is to create positive pressure inside the airways to splint them open. Moving air then takes less work. Additionally, it prolongs exhalation and allows more air out of the body, therefore increasing lung volumes (FEV, FVC).

This leads to:

  • More efficient breathing
  • Improved oxygenation
  • Reduced breathing rate
  • Reduced shortness of breath 

Contraindications

Diabetes

If you suffer from diabetes and use insulin or other blood glucose-lowering medication, the pursed-lip breathing exercise can increase your sensitivity to medication. This can make your blood glucose level lower than usual. You may then suffer from hypoglycemic shock, which is much more dangerous than high blood sugar. You should have a small snack immediately after the breathing session.

Depression

Breathing with longer exhalations triggers the parasympathetic nervous system, the rest-and-digest response. If you suffer from depression, this can further aggravate it as you tend to predominantly activate your parasympathetic system, putting the body in a state of relaxation but increasing a lack of motivation.

Severe Personality Disorders

Personality disorders, psychopathic disorders, severe forms of depression, mania, obsessive-compulsive disorder, and delirium In these disorders, the patient is more likely to interpret a breathing exercise in the context of his or her personality disorder, in which the therapist no longer has sufficient control over the therapy's effect.

Age

Kids under 7 years should use the product in assistance with their parents or caregivers.

Psychoactive Substances

Opioids, benzodiazepines and caffeine may decrease the effectiveness of therapy.

Side Effects

  • Dehydration
  • Dizziness

Practicing pursed-lip breathing expels air that was previously trapped in the lungs. This air is saturated with water and CO2, resulting in dehydration. Thus, the patient is required to drink some water after the exercise.

In elderly patients, short-term dizziness is possible; therefore, after exercise, the patient should rest for a while.

Guidelines

Exercise should be provided at least once daily in the form of ten (10) prolonged exhalations (blows). Exercises should be carried out in a relaxed sitting position. The aim is to achieve the longest blow possible.

Warnings

  • Supply patients with extra drinking water
  • Before and after use, clean headset with dry tissue
  • Store the headset in a clean and dry environment

Did you know? With each exhalation, humans eliminate water from their bodies. The chemical equation is: glucose + oxygen = carbon dioxide + water + energy (ATP). That's why you feel thirsty after playing breathing games.

References

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Bingham, P. M., Lahiri, T. & Ashikaga, T. Pilot Trial of Spirometer Games for Airway Clearance Practice in Cystic Fibrosis. Respiratory Care 57, 1278–1284 (2012).
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Joo, S., Shin, D. & Song, C. The Effects of Game-Based Breathing Exercise on Pulmonary Function in Stroke Patients: A Preliminary Study. Med Sci Monit 21, 1806–1811 (2015).
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Chiang, L.-C., Ma, W.-F., Huang, J.-L., Tseng, L.-F. & Hsueh, K.-C. Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: A randomized controlled trial. International Journal of Nursing Studies 46, 1061–1070 (2009).
1.
Create an Asthma Action Plan | American Lung Association. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/create-an-asthma-action-plan.html. (Accessed: 12th October 2017)
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Bott, J. et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 64 Suppl 1, i1-51 (2009).
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Ritz, T., Meuret, A. E., Wilhelm, F. H. & Roth, W. T. Changes in pCO2, Symptoms, and Lung Function of Asthma Patients During Capnometry-assisted Breathing Training. Appl Psychophysiol Biofeedback 34, 1–6 (2009).
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Lehrer, P. M. Emotionally triggered asthma: a review of research literature and some hypotheses for self-regulation therapies. Appl Psychophysiol Biofeedback 23, 13–41 (1998).
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de F. Fregonezi, G. A., Resqueti, V. R. & Güell Rous, R. Pursed Lips Breathing. Archivos de Bronconeumología ((English Edition)) 40, 279–282 (2004).
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Spahija, J., de Marchie, M. & Grassino, A. EFfects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in copd*. Chest 128, 640–650 (2005).
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Ingham, R. H. & Schilder, D. P. Effect of Pursed Lips Expiration on the Pulmonary Pressure-Flow Relationship in Obstructive Lung Disease. Am Rev Respir Dis 96, 381–388 (1967).
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Garrodl, R., Dallimore, K., Cook, J., Davies, V. & Quade, K. An evaluation of the acute impact of pursed lips breathing on walking                distance in nonspontaneous pursed lips breathing chronic obstructive pulmonary                disease patients. Chron Respir Dis 2, 67–72 (2005).
1.
Ramos, E. M. C. et al. Influence of pursed-lip breathing on heart rate variability and cardiorespiratory parameters in subjects with chronic obstructive pulmonary disease (COPD). Brazilian Journal of Physical Therapy 13, 288–293 (2009).
1.
Breathing exercises for chronic obstructive pulmonary disease.
1.
Mueller, R. E., Petty, T. L. & Filley, G. F. Ventilation and arterial blood gas changes induced by pursed lips breathing. Journal of Applied Physiology 28, 784–789 (1970).
1.
Thoman, R. L., Stoker, G. L. & Ross, J. C. The Efficacy of Pursed-Lips Breathing in Patients with Chronic Obstructive Pulmonary Disease. Am Rev Respir Dis 93, 100–106 (1966).