The intensity, duration, and potential long-term complications of Covid-19 virus symptoms vary greatly from person to person. Some might present with a few days of mild influenza-like symptoms, while it may present itself with severe pneumonia and breathing disorders in others. Studies have shown that almost 23% of individuals infected with COVID-19 had severely impaired lung functions and exercise capacity, even one year after the infection. (1). Moreover, some other long-term complications that were found in people associated with the SARS-Cov-2 infection included prolonged mechanical ventilation, excessive use of neuromuscular blockers, and ICU weakness with severe or critical COVID-19, which can consist of prolonged mechanical ventilation, sedation, and use of neuromuscular blocking agents and have a long-term effect on the physical function of the body.

Pulmonary Rehabilitation after Covid-19

Pulmonary rehabilitation is an effective strategy to help the individual get back on their feet after infection with the COVID-19 virus. Numerous existing programs may be followed for this purpose. Pulmonary rehabilitation programs aim to reduce the negative effects of prolonged sedation on the body and increase the individual's muscle strength and exercise capacity. (2)

What is the Pursed Lip Breathing?

Pursed-lip breathing is an effective method for the relaxation and improvement of physiological parameters. (3) It was previously used to treat respiratory conditions like chronic obstructive pulmonary disease, asthma, and pulmonary or cystic fibrosis. However, due to its therapeutic effect on the respiratory system, it is now one of the ways to rehabilitate an individual after a prolonged COVID-19 infection.

Mechanics of Pursed Lip Breathing

The pursed-lip methods work by enabling the buildup of positive pressure inside the airways to be split open. This allows the movement of air in and out of the lungs to be much easier and requires less effort on the part of the individual. Moreover, its ability to allow more air to exit the lung after each exhalation in the form of a prolonged exhalation increases the lung volume and prevents lung collapse.
Hence, the purse-lip methods allow:

1. More efficient breathing
2. Improved oxygenation of the tissues
3. Improvement in the feeling of dyspnea
4. Enhanced Oxygen Saturation of the Blood
5. A Better Tidal Volume

Benefits Of Pursed Lip Breathing

Pursed Lip Breathing helps in:

• Allowing more movement of air out of the body
• Increasing lung volume as FVC and FEV
• Reducing SOB (shortness of breath)
• Improving oxygenation
• Reducing the breathing rate
• Making breathing more efficient in terms of energy consumption

Contraindications

Certain conditions can make the pursed-lip breathing method challenging to follow for the individual or lead to a further worsening of their health instead of improving it. These include:

Diabetes

The pursed-lip method enhances the body’s sensitivity to glucose-lowering drugs and insulin, which in turn may lead to lower than normal blood sugar or even a hypoglycemic shock.

Depression

Depression can be aggravated by activation of the parasympathetic nervous system. Since the pursed-lip method allows the parasympathetic system to get activated, it may worsen one’s depression and its associated symptoms.

Age

The pursed lip method requires adequate technique and knowledge by the individual of what they are trying to achieve. Hence, it is recommended that children under the age of seven should not be encouraged to practice it.

Side Effects

The possible side effects that may be associated with the pursed lip breathing method include the following:
• Short-lived effects
• Possible fatigue of respiratory muscles
• Below-average levels of carbon dioxide
• A decrease in perfusion pressure can lead to syncope.
• Exacerbation of Air Trapping (4)
• Dehydration
• Dizziness

How is Pursed Lip Breathing Practiced?

Individuals practicing pursed-lip breathing start by inhaling through their nose, after which they slowly exhale through puckered or pursed lips at a controlled and steady flow. It must be made sure that the exhalation time is longer than the inhalation time to allow a positive pressure to be built up in the airways. Moreover, the person is encouraged to sit in a relaxed position and perform it once a day in 10 prolonged exhalations.

Recommendations

• Perform this technique once a day with ten repetitions during a COVID infection
• Take a relaxed state
• Try to blow for the most prolonged duration
• Keep distance from others while performing it in COVID infection

Precautions

• Keep the assistive device clean
• Keep a good supply of water for patients
• Perform this exercise in a clean environment

References

1. Hui, D. S., Wong, K. T., Ko, F. W., Tam, L. S., Chan, D. P., Woo, J., & Sung, J. J. (2005). The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest, 128(4), 2247–2261. doi.org/10.1378/chest.128.4.2247
2. Isis Grigoletto, Vinicius Cavalheri, Fabiano F. de Lima, Ercy Mara Cipulo Ramos, Recovery after COVID-19: The potential role of pulmonary Rehabilitation, Brazilian Journal of Physical Therapy, Volume 24, Issue 6, 2020, Pages 463-464, ISSN 1413-3555, doi.org/10.1016/j.bjpt.2020.07.002.
3. Sakhaei, S., Sadagheyani, H. E., Zinalpoor, S., Markani, A. K., & Motaarefi, H. (2018). The Impact of Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in COPD Patients. Open access Macedonian journal of medical sciences, 6(10), 1851–1856. doi.org/10.3889/oamjms.2018.407
4. Nguyen J, Duong H. Pursed-lip Breathing. [Updated 2020 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK545289/