PT  - JOURNAL ARTICLE
AU  - Mendes, Liliane PS
AU  - Moraes, Karoline S
AU  - Hoffman, Mariana
AU  - Vieira, Danielle SR
AU  - Ribeiro-Samora, Giane A
AU  - Lage, Susan M
AU  - Britto, Raquel R
AU  - Parreira, Verônica F
TI  - Effects of Diaphragmatic Breathing With and Without Pursed-Lips Breathing in Subjects With COPD
AID  - 10.4187/respcare.06319
DP  - 2019 Feb 01
TA  - Respiratory Care
PG  - 136--144
VI  - 64
IP  - 2
4099  - http://rc.rcjournal.com/content/64/2/136.short
4100  - http://rc.rcjournal.com/content/64/2/136.full
AB  - BACKGROUND: Breathing exercises, such as diaphragmatic breathing and pursed-lips breathing, play a role in some individuals with COPD and might be considered for those patients who are unable to exercise. However, in the literature are reports of some adverse effects of diaphragmatic breathing in patients with COPD. Thus, the purpose of this study was to assess the effects of diaphragmatic breathing and diaphragmatic breathing combined with pursed-lips on chest wall kinematics, breathlessness, and chest wall asynchrony in subjects with COPD, and also to assess whether the combination of both exercises reduces the adverse effects of diaphragmatic breathing while maintaining its benefits.METHODS: Seventeen subjects with COPD, mean ± SD, 65 ± 7 y of age, with a history of smoking and clinical stability without hospitalization or symptoms of exacerbation in the past 4 wk, were evaluated. On day 1, participants' characteristics were collected, and they learned diaphragmatic breathing and its combination with pursed-lips breathing. On day 2, the participants were evaluated by optoelectronic plethysmography with the participants in the seated position while performing breathing exercises.RESULTS: Diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing promoted a significant increase in chest wall tidal volume and its compartments as well as a reduction in breathing frequency compared with quiet breathing. No significant changes were observed in dyspnea or end-expiratory volume of the chest wall. A significant increase in asynchrony (inspiratory-expiratory phase ratio) was observed during diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing compared with quiet breathing, with no differences observed between the exercises.CONCLUSIONS: Despite the increase in asynchrony, both breathing exercises were able to improve chest wall volumes without affecting dyspnea. The combination of exercises maintained the benefits but did not reduce the adverse effects of diaphragmatic breathing.