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Effectiveness of breathing exercises in preventing pulmonary complications following open heart surgery.

The effectiveness of breathing exercises in preventing pulmonary complications was studied in 40 patients undergoing open-heart surgery. Both high- and low-risk patients in the experimental group received one preoperative teaching session and treatment twice a day for the first four days postextubation. Routine postoperative care was given to all 40 patients. Breathing exercises reduced the incidence of pulmonary complications and the necessity for percutaneous endotracheal catheters in the high-risk group. These results justify the use of breathing exercises with the high-risk open-heart surgical patient.

Adult

Effect of choices on breathing exercises post-open heart surgery.

Pulmonary complications following open heart surgery are a major cause of morbidity and mortality. Patients, especially pediatric patients, are reluctant to perform postoperative breathing exercises to prevent respiratory complications. This research provides the critical care nurse with a strategy to encourage the children to perform their breathing exercises more willingly.

Breathing Exercises

Assessment of percussion, vibratory-shaking and breathing exercises in chest physiotherapy.

While gravity-assisted positions (postural drainage) and the forced expiratory technique are known to promote sputum clearance, the additional value of percussion, vibratory-shaking and breathing exercises individually in chest physiotherapy is uncertain. These modalities have been evaluated in 8 patients with copious sputum production (mean: 44 g/day), using an inhaled radioaerosol technique. Tracheobronchial clearance was unaffected by the addition of either vibratory-shaking or percussion with and without breathing exercises to postural drainage. There was however a significant (p less than 0.01) increase in the dry weight of sputum produced during each of these treatments. The combination of postural drainage used in conjunction with the forced expiration technique is responsible for the majority of mucus mobilisation and should form the basis of routine chest physiotherapy programmes; the other modes appear to be of lesser value.

Breathing Exercises

Physiotherapy after coronary artery surgery: are breathing exercises necessary?

One hundred and ten men undergoing coronary artery bypass grafting took part in a prospective randomised study comparing three physiotherapy protocols. All patients were taught self supported huffing and coughing by a physiotherapist and encouraged to move about. This comprised the sole treatment for the 37 control patients (group 3). Additional physiotherapy included breathing exercises for the 35 patients in group 1 and use of an incentive spirometer for the 38 patients in group 2. Functional residual capacity (FRC) was measured daily at the bedside until the fifth postoperative day and arterial blood gas tensions were measured on the second and fourth postoperative days. After surgery patients developed a severe restrictive ventilatory defect and profound arterial hypoxaemia. There were no differences between the three groups. Mean FRC on day 2 was 1.90 litres (61% of the preoperative value), increasing to 2.32 1 by day 5 (76% of the preoperative value). The mean arterial oxygen tension was 7.37 kPa on day 2 and 8.58 kPa on day 4. Four patients in group 1, two in group 2, and five in group 3 developed a chest infection. It is concluded that the addition of breathing exercises or incentive spirometry to a regimen of early mobilisation and huffing and coughing confers no extra benefit after uncomplicated coronary artery bypass grafting.

Breathing Exercises

Breathing exercises for the medical patient: the art and the science.

The art of breathing exercises can be traced to the late 1800s. In the past 10 years, the increased demand for treatment for respiratory muscle failure of dysfunction has resulted in numerous studies evaluating methods of treatment or training. This article provides an overview of research and practice, focused on treating the medical patient experiencing dyspnea or loss of respiratory muscle strength and endurance.

Breathing Exercises

Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma.

The effects of two pranayama yoga breathing exercises on airway reactivity, airway calibre, symptom scores, and medication use in patients with mild asthma were assessed in a randomised, double-blind, placebo-controlled, crossover trial. After baseline assessment over 1 week, 18 patients with mild asthma practised slow deep breathing for 15 min twice a day for two consecutive 2-week periods. During the active period, subjects were asked to breathe through a Pink City lung (PCL) exerciser--a device which imposes slowing of breathing and a 1:2 inspiration:expiration duration ratio equivalent to pranayama breathing methods; during the control period, subjects breathed through a matched placebo device. Mean forced expiratory volume in 1 s (FEV1), peak expiratory flow rate, symptom score, and inhaler use over the last 3 days of each treatment period were assessed in comparison with the baseline assessment period; all improved more with the PCL exerciser than with the placebo device, but the differences were not significant. There was a statistically significant increase in the dose of histamine needed to provoke a 20% reduction in FEV1 (PD20) during pranayama breathing but not with the placebo device. The usefulness of controlled ventilation exercises in the control of asthma should be further investigated.

Adult

Functional evaluation of a physical rehabilitation program including breathing exercises and bicycle training in chronic obstructive lung disease.

20 patients suffering from chronic obstructive lung disease (COLD) were submitted to a 6-month rehabilitation program including breathing exercises only (A) or coupled with bicycle training (B). Functional results obtained at rest were the following: for A: nonsignificant changes in FRC, RV, FEV1, Raw, Pa O2, pH, Pp, VO2 max SL but significant changes (p less than 0.05)for TLC (+ 214 cm3), VC (+ 171 cm3), DL CO (+ 1.79 ml), Pa CO2 (-2.9 mm Hg). For B: similar changes as for A with additional significant changes in PaO2 (+ 7.4 mm Hg) VO2 max SL (+ 250 ml) and Pp (-4 mm Hg). These results, although minimal, are attributed to improved respiratory muscle strength and improved alveolar ventilation. Exercise training adds an increased ability to sustain higher loads.

Breathing Exercises

Analysis of breath-by-breath exercise data from field studies.

We describe a system useful for collecting and analyzing breath-by-breath exercise test data in the field. In studies of untrained subjects, analysis of artifacts is particularly important. Our system uses pattern-recognition criteria to reject breaths if the breathing valves do not operate satisfactorily or if deviations from the calibrating baseline occur.

Altitude

A comparison of two breathing exercise programs for patients with quadriplegia.

This study compared the use of abdominal weights (AbWts) to inspiratory resistive muscle training (IMT) on selected measures of pulmonary function. Eleven patients, aged 16 to 41 years (mean = 27.8, SD = 8.3) with complete cervical injuries were randomly assigned to either an AbWts or IMT treatment group. Subjects in both treatment groups received daily treatments (five times weekly) for 7 weeks. Forced vital capacity (FVC), inspiratory capacity (IC), maximal voluntary ventilation (MVV), peak expiratory flow rate (PEFR), and inspiratory mouth pressure (PImax) were measured weekly. Analysis of variance for repeated measures showed no difference between the AbWts and IMT treatments; there were significant differences within each respective treatment group for all five variables. Although the data did not support the effectiveness of one method of training over the other, the larger increase in MVV with the IMT protocol may be indicative of an endurance training effect with this protocol. Future research should compare the effects of breathing exercise training to spontaneous recovery of the respiratory muscles in control subjects.

Adolescent

Exercise breathing pattern during chronic altitude exposure.

Breathing pattern in response to maximal exercise was examined in four subjects during a 7-day acclimatisation to a simulated altitude of 4247 m (barometric pressure, PB = 59.5 kPa). Graded exercise tests to exhaustion were performed during normoxia (day 0), and on days 2 and 7 of hypoxia, respectively. Ventilation was significantly augmented in the hypoxic environment, as were both the mean inspiratory flow (VT/TI) and inspiratory duty cycle (TI/TTOT) components of it. VI/TI was increased due to a significant increase in tidal volume (VT) and a corresponding decrease in inspiratory time duration (TI). Throughout a range of exercise ventilation, TI/TTOT was increased due to an apparently greater decrease in expiratory time duration (TE) with respect to TI. In all cases, the relation between VT and TI displayed a typical range 2 behaviour, with evidence of a range 3 occurring at very high ventilatory rates. There was essentially no difference observed in the VT-TI relation during exercise between the normoxic and hypoxic conditions. No significant changes were observed in the breathing pattern in response to exercise within the exposure period (from day 2 to day 7), although there was a discernible tendency to a higher stage 3 plateau by day 7 of altitude exposure.

Acclimatization

Influence of exercise hyperthermia on exercise breathing pattern.

Passive elevation of the body core temperature (Tc) induces rapid, shallow breathing in resting man. We wondered if exercise-induced Tc elevation would also lead to decreased tidal volume (VT) and increased breathing frequency (f) during exercise. To investigate this question, 10 subjects each performed 47 min of cycle ergometer exercise at 50--60% of the maximal aerobic capacity, with the work rate adjusted to maintain ventilation (VE) constant. This long ride raised mean Tc (rectal) 0.8 degrees C. Before and immediately after the long ride, ranges of VE and VT were obtained from short 6-min rides that progressed from unloaded pedaling to the anaerobic threshold. At the constant VE of the long ride, f rose and VT fell as Tc rose (P less than 0.05). The fall in VT was associated with a fall in inspiratory time (TI); drive (VT/TI) and timing (TI/Ttot)components of VE were unchanged. These effects were consistent over the entire range of VE obtained from the short 6-min rides. Passive heating in warm water to produce equal Tc elevation in the same subjects yielded similar exercise breathing-pattern changes. These findings suggest that increased Tc mediates the VT fall during prolonged exercise, possibly through stimulation of the central respiratory pacemaker.

Body Temperature