Chest Wall Kinematics and Breathlessness During Pursed-Lip Breathing in Patients With COPD

doi:10.1378/chest.125.2.459

Chest

Volume 125, Issue 2, February 2004, Pages 459-465

https://doi.org/10.1378/chest.125.2.459 Get rights and content

Background

Pursed-lip breathing (PLB) is a strategy often spontaneously employed by patients with COPD during distress situations. Whether and to what extent PLB affects operational lung volume is not known. Also, conflicting reports deal with PLB capability of decreasing breathlessness.

Participants and measurements

Twenty-two patients with mild-to-severe COPD were studied. Volumes of chest wall (CW) compartments (rib cage [RC] and abdomen) were assessed using an optoelectronic plethysmograph. Dyspnea was assessed by a modified Borg scale.

Results

Compared to spontaneous breathing, patients with PLB exhibited a significant reduction (mean ± SD) in end-expiratory volume of the CW (Vcw) [Vcwee; − 0.33 ± 0.24 L, p < 0.000004], and a significant increase in end-inspiratory Vcw (Vcwei; + 0.32 ± 0.43 L, p < 0.003). The decrease in Vcwee, mostly due to the decrease in end-expiratory volume of the abdomen (Vabee) [− 0.25 ± 0.21 L, p < 0.00002], related to baseline FEV₁ (p < 0.02) and to the increase in expiratory time (Te) [r² = 0.49, p < 0.0003] and total time of the respiratory cycle (Ttot) [r² = 0.35, p < 0.004], but not to baseline functional residual capacity (FRC). Increase in tidal volume (Vt) of the chest wall (+ 0.65 ± 0.48 L, p < 0.000004) was shared between Vt of the abdomen (0.31 ± 0.23 L, p < 0.000004) and Vt of the rib cage (+ 0.33 ± 0.29 L, p < 0.00003). Borg score decreased with PLB (p < 0.04). In a stepwise multiple regression analysis, decrease in Vcwee accounted for 27% of the variability in Borg score at 99% confidence level (p < 0.008).

Conclusions

Changes in Vcwee related to baseline airway obstruction but not to hyperinflation (FRC). By lengthening of Te and Ttot, PLB decreases Vcwee and reduces breathlessness.

Section snippets

Patients

Twenty-two clinically stable patients with COPD and mild-to-severe airway obstruction participated in the study (Table 1). Eleven patients were truly hyperinflated (functional residual capacity [FRC]; range, 141 to 212% of the predicted value). They were selected to take part in an outpatient pulmonary rehabilitation program involving regular exercise on a bicycle and several evaluations of pulmonary function, and entered the pulmonary rehabilitation program after satisfying the following

Breathing Pattern

With PLB, Vt, Ti, Te, Ttot, and Vt/Ti all increased, whereas Rf and Ti/Ttot decreased (p < 0.02 to 0.000004) [Table 2].

CW Kinematics

The time course of Vcw compartment changes during QB and PLB in a representative patient is shown in Figure 1. With PLB, changes in Vcwee, Vabee, end-expiratory Vrc (Vrcee), and in end-inspiratory Vcw (Vcwei) and end-inspiratory Vrc (Vrcei) were significant (p < 0.03 to 0.000004) [Table 2]. These changes are shown in Figure 2.

Relationships

ΔVcwee (p < 0.02) and ΔVabee (p < 0.03) related to

Discussion

As shown, ΔVcwee related to baseline FEV₁ but not to FRC. The increase in Te with PLB resulted in a decrease in Vcwee, mostly at the abdominal level (Vabee). The decrease in Borg score significantly related to the decrease in Vcwee.

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Chest

Clinical InvestigationsCOPDChest Wall Kinematics and Breathlessness During Pursed-Lip Breathing in Patients With COPD

Background

Participants and measurements

Results

Conclusions

Section snippets

Patients

Breathing Pattern

CW Kinematics

Relationships

Discussion

Chest

Chest

Clin Chest Med

Pulmonary rehabilitation, 1999

Am J Respir Crit Care Med

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J Appl Physiol

The efficacy of PLB in patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

Effects of pursed lip expiration on the pulmonary pressure-flow relationship in obstructive lung disease

Am Rev Respir Dis

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Am Rev Respir Dis

Dyspnea: mechanisms, assessment, and management; a consensus statement

Am J Respir Crit Care Med

Effect of increased lung volume on perception of breathlessness, effort and tension

J Appl Physiol

Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Clinical Investigations
COPD
Chest Wall Kinematics and Breathlessness During Pursed-Lip Breathing in Patients With COPD