Pursed Lip Breathing: Abstracts and References
This web page provides mainly abstract of medical research studies
devoted to analysis of effects of pursed lip breathing exercises,
suggestions, hypothesis, and results of clinical trials.
For detailed analysis of the pursed lip breathing technique exercises,
with health conditions addressed (including COPD, asthma, emphysema, cystic
fibrosis, stroke, hypertension, and some others), effects, instructions, and
analysis, visit Pursed Lip Breathing.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008 Oct;20(10):607-10.
[A randomized controlled trial study of pulmonary rehabilitation with
respiratory physiology as the guide on prognosis in patients with chronic
obstructive pulmonary disease].
[Article in Chinese]
Zhang ZQ, Chen RC, Yang QK, Li P, Wang CZ, Zhang ZH.
Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital,
Guangzhou Medical College, Guangzhou 510120, Guangdong, China.
OBJECTIVE: To observe the effect of pulmonary rehabilitation with
respiratory physiology as guide in patients with chronic obstructive
pulmonary disease (COPD).
METHODS: Sixty patients of severe and very severe COPD as categorized by
global proposed diagnostic criteria for COPD (GOLD, 2006) were enrolled for
study. They were randomly divided into three groups, and with 20 patients in
each group. The patients in group A were given pulmonary rehabilitation
guided by respiratory physiology thrice a day, 15 minutes each time for 8
weeks. The patients in group B were given pulmonary rehabilitation with
pursed lip respiration thrice a day, 15 minutes per time for 8 weeks. The
patients in group C were given no pulmonary rehabilitation. Six
minute-walk-distance (6MWD), medical research council (MRC) dyspnea scale,
activities of daily living (ADL), maximal expiratory pressure (MEP), maximal
inspiratory pressure (MIP), and quality of life (QOL) were determined before
and after respective pulmonary rehabilitation course.
RESULTS: (1) There were 3, 5, 5 patients in group A, group B, group C
dropped off in the course of rehabilitation respectively. (2) The patients'
MRC grade after pulmonary rehabilitation in group A and group B decreased
compared with that before pulmonary rehabilitation (both P<0.01), but the
difference was not significant between two groups (P>0.05). (3) 6MWD, ADL,
MEP, MIP of patients in group A and group B increased after pulmonary
rehabilitation compared with that before pulmonary rehabilitation, and 6MWD,
ADL, MEP, MIP of patients in group A were increased after pulmonary
rehabilitation more than those in group B (P<0.05 or P<0.01). (4)The
patients' body status, shortness of breath, social activity, home chores in
group A and group B, and uneasiness in group A after pulmonary
rehabilitation were improved more than those before pulmonary rehabilitation
(P<0.05 or P<0.01), but the difference in state of mind, headache, appetite
was not markedly different before and after pulmonary rehabilitation in two
groups (all P>0.05). The difference in QOL was not marked between group A
and group B after pulmonary rehabilitation (all P>0.05).
CONCLUSION: (1) The pulmonary rehabilitation with pursed lip respiration and
the pulmonary rehabilitation with the guide of respiratory physiology
ameliorates dyspnea, improves ADL, QOL, exercise tolerance, function of
respiratory muscle in the severe and very severe COPD patients remarkably.
(2) The effect of the pulmonary rehabilitation with the guide of respiratory
physiology is better than that of the pulmonary rehabilitation with pursed
lip respiration, and it can be considered as a more effective pulmonary
rehabilitation method for the patients with severe and very severe COPD.
Int J Chron Obstruct Pulmon Dis. 2006;1(4):381-400.
Hyperinflation and its management in COPD.
Puente-Maestu L, Stringer WW.
Hospital General Universitario Gregorio Mara��n, Servicio de Neumologia,
Madrid, Spain. [email protected]
Chronic obstructive pulmonary disease (COPD) is characterized by poorly
reversible airflow limitation. The pathological hallmarks of COPD are
inflammation of the peripheral airways and destruction of lung parenchyma or
emphysema. The functional consequences of these abnormalities are expiratory
airflow limitation and dynamic hyperinflation, which then increase the
elastic load of the respiratory system and decrease the performance of the
respiratory muscles. These pathophysiologic features contribute
significantly to the development of dyspnea, exercise intolerance and
ventilatory failure. Several treatments may palliate flow limitation,
including interventions that modify the respiratory pattern (deeper, slower)
such as pursed lip breathing, exercise training, oxygen, and some drugs.
Other therapies are aimed at its amelioration, such as bronchodilators, lung
volume reduction surgery or breathing mixtures of helium and oxygen. Finally
some interventions, such as inspiratory pressure support, alleviate the
threshold load associated to flow limitation. The degree of flow limitation
can be assessed by certain spirometry indexes, such as vital capacity and
inspiratory capacity, or by other more complexes indexes such as residual
volume/total lung capacity or functional residual capacity/total lung
capacity. Two of the best methods to measure flow limitation are to
superimpose a flow-volume loop of a tidal breath within a maximum
flow-volume curve, or to use negative expiratory pressure technique. Likely
this method is more accurate and can be used during spontaneous breathing. A
definitive definition of dynamic hyperinflation is lacking in the
literature, but serial measurements of inspiratory capacity during exercise
will document the trend of end-expiratory lung volume and allow establishing
relationships with other measurements such as dyspnea, respiratory pattern,
exercise tolerance, and gas exchange.
Behav Modif. 2003 Oct;27(5):710-30.
Behavioral interventions in asthma. Breathing training.
Ritz T, Roth WT.
Psychological Institute III, University of Hamburg, Germany. [email protected]
Breathing exercises are frequently recommended as an adjunctive treatment
for asthma. A review of the current literature found little that is
systematic documenting the benefits of these techniques in asthma patients.
The physiological rationale of abdominal breathing in asthma is not clear,
and adverse effects have been reported in chronic obstructive states.
Theoretical analysis and empirical observations suggest positive effects of
pursed-lip breathing and nasal breathing but clinical evidence is lacking.
Modification of breathing patterns alone does not yield any significant
benefit. There is limited evidence that inspiratory muscle training and
hypoventilation training can help reduce medication consumption, in
particular beta-adrenergic inhaler use. Breathing exercises do not seem to
have any substantial effect on parameters of basal lung function. Additional
research is needed on the psychological and physiological mechanisms of
individual breathing techniques in asthma, differential effects in subgroups
of asthma patients, and the generalization of training effects on daily
Medsurg Nurs. 2000 Aug;9(4):178-82.
Helping patients with COPD manage episodes of acute shortness of breath.
Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital,
Detroit, MI, USA.
The most disabling and frightening symptom experienced by patients with COPD
is dyspnea. Even with the use of bronchodilators, the symptom may not be
completely relieved. Patients often develop their own strategies for
managing shortness of breath, including the use of a breathing technique
called pursed-lip breathing. Although most nurses are familiar with this
breathing technique, they often have difficulty assisting patients to use it
during acute episodes of shortness of breath. A strategy is described which
nurses can use to assist patients in implementing pursed-lip breathing
effectively during episodes of acute dyspnea.
Nihon Kokyuki Gakkai Zasshi. 1998 Aug;36(8):679-83.
[Effects of a short-term pulmonary rehabilitation program on patients with
chronic respiratory failure due to pulmonary emphysema].
[Article in Japanese]
Onodera A, Yazaki K.
Division of Respiratory Medicine, Yuri Kumiai General Hospital, Akita,
To evaluate the effects of a short-term pulmonary rehabilitation program on
dyspnea, exercise capacity, and lung function, 15 patients with chronic
respiratory failure due to pulmonary emphysema were enrolled in such a
program for 3 weeks as inpatients. The program consisted of pursed lip
breathing, diaphragmatic breathing, respiratory muscle stretch gymnastics,
and walking with synchronized breathing. Dyspnea as measured with a visual
analogue scale at the end of a 6-minute walk before and after the program
(49.7 +/- 4.0% to 24.2 +/- 3.8%) decreased significantly (p < 0.01). As a
measure of functional exercise capacity, the 6-minute walking distance
(226.9 +/- 32.4 m to 292.1 +/- 35.8 m) increased significantly (p < 0.01).
As an indicator of maximal exercise capacity, endurance time on an
incremental treadmill test did not improve. Spirometric data did not change
during the study. Total lung capacity (TLC) (8.44 +/- 0.70 L to 7.58 +/-
0.74 L) and residual volume (RV) (5.13 +/- 0.53 L to 4.28 +/- 0.59 L)
decreased significantly (p < 0.01). The findings suggest that this program
relieves dyspnea, increases functional exercise capacity, and decreases TLC
and RV on patients with chronic respiratory failure due to pulmonary
Chest. 1992 Jan;101(1):75-8.
The pattern of respiratory muscle recruitment during pursed-lip breathing.
Data from the present study indicate a change in the pattern of chest wall
muscle recruitment and improved ventilation with pursed-lip breathing (PLB)
in COPD. Pursed lip breathing led to increased rib cage and accessory muscle
recruitment during inspiration and expiration, increased abdominal muscle
recruitment during expiration, decreased duty cycle of the inspiratory
muscles and respiratory rate, and improved SaO2. In addition, PLB resulted
in no change in pressure across the diaphragm and a less fatiguing breathing
pattern of the diaphragm. Changes in chest wall muscle recruitment and
respiratory temporal parameters concomitant with the increased SaO2 indicate
a mechanism of improving ventilation with PLB while protecting the diaphragm
from fatigue in COPD. Alterations in the pattern of respiratory muscle
recruitment with PLB may be associated also with the amelioration of dyspnea.
Further investigation is necessary to explore the relationship between the
pattern of respiratory muscle recruitment during PLB and dyspnea.
Clin Rehabil. 2010 Mar;24(3):240-50. Epub 2010 Feb 15.
Respiratory muscle training improves cardiopulmonary function and exercise
tolerance in subjects with subacute stroke: a randomized controlled trial.
Sutbeyaz ST, Koseoglu F, Inan L, Coskun O.
OBJECTIVE: To determine whether two types of exercise--breathing retraining
(BRT) and inspiratory muscle training (IMT)--improve on cardiopulmonary
functions and exercise tolerance in patients with stroke.
DESIGN: A randomized controlled trial.
SETTING: Education and research hospital.
SUBJECTS: Forty-five inpatients with stroke (24 men, 21 women) were
recruited for the study. The subjects were randomized into three groups: 15
assigned to receive inspiratory muscle training (IMT); 15 assigned to
received breathing retraining, diaphragmatic breathing and pursed-lips
breathing (BRT); 15 assigned to a control group.
INTERVENTIONS: All study groups participated in a conventional stroke
rehabilitation programme. For the same period, the IMT and BRT groups
trained daily, six times a week, with each session consisting of one
half-hour of training for six weeks.
MAIN MEASURES: Each subject underwent pulmonary function and cardiopulmonary
exercise tests. Subjects were also assessed for exertional dyspnoea, stages
of motor recovery, ambulation status, activity of daily living and quality
RESULTS: After the training programme, the IMT group had significantly
improved forced expiratory volume at 1 second (FEV(1)), forced vital
capacity (FVC), vital capacity (VC), forced expiratory flow rate 25-75% (FEF
25-75%) and maximum voluntary ventilation (MVV) values compared with the BRT
and control groups, although there were no significant differences between
the BRT and control groups (P<0.01). Peak expiratory flow rate (PEF) value
was increased significantly in the BTR group compared with the IMT and
control groups. The IMT group also had significantly higher peak oxygen
consumption (Vo(2peak)) than the BRT and control groups, although there were
no significant differences between the BRT and control groups (P<0.001).
There was a statistically significant increase in maximum inspiratory
pressure (PI(max)) and maximum inspiratory and expiratory pressure (PE(max))
in the BRT group and, PI(max) in the IMT group compared with baseline and
the control group. In the IMT group, this was associated with improvements
in exercise capacity, sensation of dyspnoea and quality of life.
CONCLUSIONS: Significant short-term effects of the respiratory muscle
training programme on respiratory muscle function, exercise capacity and
quality of life were recorded in this study.
Neurology. 2007 Aug 7;69(6):582-5.
Respiratory countermaneuvers in autonomic failure.
Thijs RD, Wieling W, van den Aardweg JG, van Dijk JG.
Department of Neurology and Clinical Neurophysiology, Leiden University
Medical Centre, Leiden, the Netherlands. [email protected]
BACKGROUND: Selective increase of inspiratory impedance augments blood
pressure in healthy subjects through activation of the respiratory pump. We
studied the efficacy of respiratory maneuvers to reduce orthostatic
hypotension in autonomic failure.
METHODS: Mean arterial pressure (MAP) after standing up was recorded in 10
patients in five conditions: normal standing, leg muscle tensing,
inspiratory pursed lips breathing, inspiratory sniffing, and a device
causing inspiratory obstruction.
RESULTS: The maneuvers caused significant differences in standing MAP.
Inspiratory obstruction and leg muscle tensing increased MAP to a comparable
degree. The effect of inspiratory pursed lips breathing and inspiratory
sniffing depended on concomitant hyperventilation.
CONCLUSION: Respiratory maneuvers reduce orthostatic hypotension in
autonomic failure through activation of the respiratory pump, provided
hyperventilation is avoided.
Appl Psychophysiol Biofeedback. 2006 Mar;31(1):37-49.
Short-term effects of a brief respiratory training on baroreceptor cardiac
reflex function in normotensive and mild hypertensive subjects.
Reyes del Paso GA, Cea JI, Gonz�lez-Pinto A, Cabo OM, Caso R, Brazal J,
Mart�nez B, Hern�ndez JA, Gonz�lez MI.
Departamento de Psicolog�a, Facultad de Humanidades y CC.EE, Universidad de
Ja�n, 23071, Ja�n, Spain. [email protected]
Baroreceptor cardiac reflex sensitivity is reduced in hypertension and is
considered a powerful prognostic factor in cardiovascular health. This study
analyzes the acute effects of a brief respiratory training on baroreceptor
sensitivity and on two new proposed baroreflex parameters: baroreceptor
power (i.e., the percentage of cardiac beats regulated by the baroreflex)
and effectiveness (i.e., the frequency in which the baroreflex responds to
transient alterations in blood pressure). Twenty-two participants, 10
primary mild hypertensives and 12 normotensives, learned and practiced a
respiratory pattern characterized by breathing at 6 bpm, with time of
expiration being twice time of inspiration, predominantly abdominal, and
with pursed lips. Baroreceptor parameters are differentiated in terms of
increases ("up" sequences) or decreases ("down" sequences) in blood
pressure. Irrespective of the groups, the breathing manipulation increased
baroreceptor sensitivity (only in the "up" sequences), power, and
effectiveness (only in the "down" sequences). These results suggest that
this type of respiratory training could be used as a promising intervention
to increase baroreceptor cardiac function in primary hypertension.
Chest. 2006 Feb;129(2):278-84.
Heart rate variability biofeedback: effects of age on heart rate
variability, baroreflex gain, and asthma.
Lehrer P, Vaschillo E, Lu SE, Eckberg D, Vaschillo B, Scardella A, Habib R.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 671 Hoes
Lane, Piscataway, NJ 08854, USA. [email protected]
OBJECTIVES: To present additional analysis of data from a previously
published study showing that biofeedback training to increase heart rate
variability (HRV) can be an effective component in asthma treatment. HRV and
intervention-related changes in HRV are negatively correlated with age. Here
we assess the effects of age on biofeedback effects for asthma.
DESIGN: Ten sessions of HRV biofeedback were administered to 45 adults with
asthma. Medication was prescribed by blinded physicians according to
National Heart, Lung, and Blood Institute criteria. Medication needs were
RESULTS: Decreases in need for controller medication were independent of
age. There were larger acute decreases in forced oscillation frequency
dependence in the older group but larger increases in HRV variables in the
younger group. Differences between age groups were smaller among subjects
trained in pursed-lips abdominal breathing as well as biofeedback, than
among those receiving only biofeedback.
CONCLUSIONS: Age-related attenuation of biofeedback effects on
cardiovascular variability does not diminish the usefulness of the method
for treating asthma among older patients. Additional training in pursed-lips
abdominal breathing obliterates the effects of age on HRV changes during
Chest. 2005 Sep;128(3):1524-30.
Effects of 8-week, interval-based inspiratory muscle training and breathing
retraining in patients with generalized myasthenia gravis.
Fregonezi GA, Resqueti VR, G�ell R, Pradas J, Casan P.
Departament de Pneumology, Area de Rehabilitaci�n Respiratoria, Hospital de
la Santa Creu i de Sant Pau Av, Sant Antoni Maria Claret, 167 08025,
Barcelona, Spain. [email protected]
STUDY OBJECTIVE: To assess the effect of interval-based inspiratory muscle
training (IMT) combined with breathing retraining (BR) in patients with
generalized myasthenia gravis (MG) in a partial home program.
DESIGN: A randomized controlled trial with blinding of outcome assessment.
SETTING: A secondary-care respiratory clinic.
PATIENTS: Twenty-seven patients with generalized MG were randomized to a
control group or a training group.
INTERVENTIONS: The training group underwent interval-based IMT associated
with BR (diaphragmatic breathing [DB] and pursed-lips breathing [PLB]) three
times a week for 8 weeks. The sessions included 10 min each of DB,
interval-based IMT, and PLB. Interval-based IMT consisted of training series
interspersed with recovery time. The threshold load was increased from 20 to
60% of maximal inspiratory pressure (P(Imax)) over the 8 weeks.
MEASUREMENTS AND RESULTS: Lung function, respiratory pattern, respiratory
muscle strength, respiratory endurance, and thoracic mobility were measured
before and after the 8 weeks. The training group improved significantly
compared to control group in P(Imax) (p = 0.001), maximal expiratory
pressure (P(Emax)) [p = 0.01], respiratory rate (RR)/tidal volume (V(T))
ratio (p = 0.05), and upper chest wall expansion (p = 0.02) and reduction (p
= 0.04). Significant differences were seen in the training group compared to
baseline P(Imax) (p = 0.001), P(Emax) (p = 0.01), maximal voluntary
ventilation (p = 0.02), RR/V(T) ratio (p = 0.003), Vt (p = 0.02), RR (p =
0.01), total time of RR (p = 0.01), and upper chest wall expansion (p =
0.005) and reduction (p = 0.005). No significant improvement was seen in
lower chest wall or lung function.
CONCLUSIONS: The partial home program of interval-based IMT associated with
BR is feasible and effective in patients with generalized MG. Improvements
in respiratory muscle strength, chest wall mobility, respiratory pattern,
and respiratory endurance were observed.
Chest. 2004 Aug;126(2):352-61.
Biofeedback treatment for asthma.
Lehrer PM, Vaschillo E, Vaschillo B, Lu SE, Scardella A, Siddique M, Habib
Department of Psychiatry, Robert Wood Johnson Medical School, The University
of Medicine and Dentistry of New Jersey, Piscataway, NJ 08854, USA. [email protected]
STUDY OBJECTIVES: We evaluated the effectiveness of heart rate variability (HRV)
biofeedback as a complementary treatment for asthma.
PATIENTS: Ninety-four adult outpatient paid volunteers with asthma.
SETTING: The psychophysiology laboratory at The University of Medicine and
Dentistry of New Jersey-Robert Wood Johnson Medical School, and the private
outpatient offices of participating asthma physicians.
INTERVENTIONS: The interventions were as follows: (1) a full protocol (ie,
HRV biofeedback and abdominal breathing through pursed lips and prolonged
exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4)
a waiting list control.
DESIGN: Subjects were first prestabilized using controller medication and
then were randomly assigned to experimental groups. Medication was titrated
biweekly by blinded asthma specialists according to a protocol based on
National Heart, Lung, and Blood Institute guidelines, according to symptoms,
spirometry, and home peak flows.
MEASUREMENTS: Subjects recorded daily asthma symptoms and twice-daily peak
expiratory flows. Spirometry was performed before and after each weekly
treatment session under the HRV and placebo biofeedback conditions, and at
triweekly assessment sessions under the waiting list condition. Oscillation
resistance was measured approximately triweekly.
RESULTS: Compared with the two control groups, subjects in both of the two
HRV biofeedback groups were prescribed less medication, with minimal
differences between the two active treatments. Improvements averaged one
full level of asthma severity. Measures from forced oscillation pneumography
similarly showed improvement in pulmonary function. A placebo effect
influenced an improvement in asthma symptoms, but not in pulmonary function.
Groups did not differ in the occurrence of severe asthma flares.
CONCLUSIONS: The results suggest that HRV biofeedback may prove to be a
useful adjunct to asthma treatment and may help to reduce dependence on
steroid medications. Further evaluation of this method is warranted.
Appl Psychophysiol Biofeedback. 2000 Sep;25(3):193-200.
Respiratory sinus arrhythmia biofeedback therapy for asthma: a report of 20
unmedicated pediatric cases using the Smetankin method.
Lehrer P, Smetankin A, Potapova T.
Department of Psychiatry, Robert W. Johnson Medical School, Piscataway, NJ
This multiple case study describes pulmonary function changes in 20
asthmatic children from 30 consecutive cases undergoing biofeedback training
for increasing the amplitude of respiratory sinus arrhythmia (RSA). The
Smetankin protocol was used, which, in addition to RSA biofeedback, includes
instructions in relaxed abdominal pursed-lips breathing. Ten individuals
were excluded, including 6 who had been taking asthma medication, 2 who
developed viral infections during the treatment period, and 2 who dropped
out prior to completing treatment. Patients each received 13 to 15 sessions
of training. Asthma tended to be mild, with mean spirometric values close to
normal levels. Nevertheless, significant improvements were noted in 2
spirometry measures taken during forced expiratory maneuvers from maximum
vital capacity: FEV1 and FEF50. These preliminary uncontrolled data suggest
that the Smetankin protocol warrants further evaluation as a
nonpharmacological psychophysiological treatment for this condition,
although these data could not definitively prove that the method is
Arch Phys Med Rehabil. 2000 Apr;81(4):472-8.
Pursed lips breathing improves ventilation in myotonic muscular dystrophy.
Ugalde V, Breslin EH, Walsh SA, Bonekat HW, Abresch RT, Carter GT.
Department of Physical Medicine and Rehabilitation, School of Medicine,
University of California, Davis, USA.
OBJECTIVE: To determine the effects of pursed lips breathing on ventilation,
chest wall mechanics, and abdominal muscle recruitment in myotonic muscular
DESIGN: Before-after trial.
SETTING: University hospital pulmonary function laboratory.
PARTICIPANTS: Eleven subjects with MMD and 13 normal controls.
INTERVENTION: Pursed lips breathing.
OUTCOME MEASURES: Electromyographic (EMG) activity of the transversus
abdominis, external oblique, internal oblique, and rectus abdominis was
recorded with simultaneous measures of gastric pressure, abdominal
plethysmography, and oxygen saturation. Self-reported sensations of dyspnea,
respiratory effort, and fatigue were recorded at the end of each trial.
RESULTS: Pursed lips breathing and deep breathing led to increased tidal
volume, increased minute ventilation, increased oxygen saturation, reduced
respiratory rate, and reduced endexpiratory lung volume. Dyspnea,
respiratory effort, and fatigue increased slightly with pursed lips
breathing. EMG activity of the transversus abdominis and internal oblique
muscles increased in MMD only and was associated with an increase in gastric
CONCLUSIONS: Pursed lips breathing and deep breathing are effective and
easily employed strategies that significantly improve tidal volume and
oxygen saturation in subjects with MMD. Abdominal muscle recruitment does
not explain the ventilatory improvements, but reduced end-expiratory lung
volume may increase the elastic recoil of the chest wall. Further clinical
studies are needed to ascertain if the ventilatory improvements with pursed
lips breathing and deep breathing improve pulmonary outcomes in MMD.
Br J Surg. 1997 Nov;84(11):1535-8.
Randomized controlled trial of prophylactic chest physiotherapy in major
Fagevik Ols�n M, Hahn I, Nordgren S, L�nroth H, Lundholm K.
Department of Physiotherapy, University of G�teborg, Sweden.
INTRODUCTION: This randomized controlled study evaluated the clinical
benefit and physiological effects of prophylactic chest physiotherapy in
open major abdominal surgery.
METHODS: A group of 174 patients received chest physiotherapy including
breathing with pursed lips, huffing and coughing, and information about the
importance of early mobilization. In addition high-risk patients were given
resistance training on inspiration and expiration with a mask. The
resistance used during inspiration was -5 cmH2O and that during expiration
+10 cmH2O. The control group (194 patients) received no information or
treatment unless a pulmonary complication occurred.
RESULTS: Oxygen saturation on postoperative days 1-3 was significantly
greater in the treatment group. Treated patients were mobilized
significantly earlier. No difference was noted in peak expiratory flow rate
or forced vital capacity. Postoperative pulmonary complications occurred in
6 per cent of patients in the treatment group and in 27 per cent of controls
(P < 0.001). In high-risk patients the numbers with pulmonary complications
were six of 40 and 20 of 39 respectively. Pulmonary complications were
particularly common in patients with morbid obesity.
CONCLUSION: Preoperative chest physiotherapy reduced the incidence of
postoperative pulmonary complications and improved mobilization and oxygen
saturation after major abdominal surgery.
Physiother Res Int. 1997;2(3):167-77.
Respiratory muscle activity and pulmonary function during acutely induced
van der Schans CP, de Jong W, de Vries G, Postma DS, Ko�ter GH, van der Mark
Department of Rehabilitation, University Hospital, Groningen, The
BACKGROUND: Patients with airway obstruction may spontaneously breathe with
a positive expiratory pressure by pursing their lips during expiration,
especially in case of dyspnea. Dyspnea seems to be related to increased
activity of the respiratory muscles. A potential explanation for the use of
pursed lips breathing (PLB) is that this type of breathing leads to a
reduction of respiratory muscle activity. The purpose of this study was to
assess the effect of breathing with a positive expiratory pressure of 5 cm
H2O, simulating pursed lips breathing (SPLB), on respiratory muscle activity
and pulmonary function during induced airway obstruction.
METHODS: In twelve asthmatic patients, tonic and phasic electromyographic (EMG)
activity of the following muscles was obtained: scalene muscle, parasternal
muscle, and abdominal muscles. Pulmonary function and EMG measurements were
performed before and after propranolol induced airway obstruction.
RESULTS: Simulated pursed lips breathing resulted in a significant increase
of functional residual capacity and tidal volume both at baseline and during
airway obstruction. Phasic respiratory muscle activity during PEP breathing
increased especially at baseline. We conclude that beneficial effects of
breathing with a positive expiratory pressure of 5 cm H2O, which is similar
to pursed lips breathing, cannot be explained by changes in respiratory
muscle activity or pulmonary function.
Zhonghua Jie He He Hu Xi Za Zhi. 1991 Oct;14(5):283-4, 319.
[Application of pursed lips breathing to chronic obstructive pulmonary
disease patients with respiratory insufficiency].
[Article in Chinese]
Zhongshan Hospital, Shanghai Medical University.
Eighteen COPD patients with respiratory insufficiency received the treatment
of pursed lips breathing. The results showed that respiratory rate reduced
(from 21.4 +/- 12.6 to 14.8 +/- 4.1 breath/min) and tidal volume increased
(from 356.9 +/- 96.7 to 462.0 +/- 147.1 ml) significantly. In the meantime,
arterial partial pressure of carbon dioxide decreased and arterial partial
pressure of oxygen increased significantly (all p values less than 0.01).
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