Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Farinelli Breating Exercise on Respiratory Function and Symptoms in Patients with Chronic Obstructive Pulmonary Disease

  • Received : 2021.07.21
  • Accepted : 2021.12.27
  • Published : 2022.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Farinelli breathing (FB) exercise is a typical breathing exercise used by singers. This study aimed to compare effects of FB exercise and diaphragmatic breathing (DB) exercise on respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD). Methods: Sixteen patients aged 51-80 years with mild or moderate COPD were recruited for this study. They were divided into two groups: DB group (n=8) and FB group (n=8). Both groups received complete breathing exercise training five times per week for 8 weeks. Their respiratory functions, COPD symptoms, cytokine levels, and oxidative stress variables were analyzed during pre- and post-tests. Dependent variables were compared between pre- and post-tests using paired t-tests. An independent t-test was used to compare variables between the groups. Differences were considered significant at p<0.05. Results: The maximal expiratory pressure (MEP), maximum oxygen consumption (VO2max), and COPD Assessment Test (CAT) scores changed significantly in the DB group after the 8-week intervention compared to those at pre-test, whereas force vital capacity, forced expiratory volume in the first second, maximum voluntary ventilation, maximal inspiratory pressure (MIP), MEP, VO2max, CAT score, tumor necrosis factor-α, and malondialdehyde level changed significantly in the FB group at post-test compared to those at pre-test. Moreover, both MIP and MEP in the FB group were significantly higher than those in the DB group. Conclusion: FB exercise improved respiratory functions and COPD symptoms of patients with COPD. It might be an alternative breathing exercise in pulmonary rehabilitation programs for patients with COPD.

Keywords

Acknowledgement

The authors thank all participants and research assistants for helping and organizing this study. The authors also thank all nurses in Specialty Cline Pulmonary-Allergy & Immunology, Phramongkutklao hospital, Bangkok who provided a place for collecting data and Supranee Buranapraditkun, Ph.D. for cytokines and oxidative stress analysis.

References

  1. Brandsma CA, Van den Berge M, Hackett TL, Brusselle G, Timens W. Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine. J Pathol 2020;250:624-35. https://doi.org/10.1002/path.5364
  2. Mathioudakis AG, Vanfleteren L, Lahousse L, Higham A, Allinson JP, Gotera C, et al. Current developments and future directions in COPD. Eur Respir Rev 2020;29:200289. https://doi.org/10.1183/16000617.0289-2020
  3. Orozco-Levi M. Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation? Eur Respir J Suppl 2003;46:41s-51s. https://doi.org/10.1183/09031936.03.00004607
  4. Anzueto A, Miravitlles M. Pathophysiology of dyspnea in COPD. Postgrad Med 2017;129:366-74. https://doi.org/10.1080/00325481.2017.1301190
  5. Rahman I. Oxidative stress in pathogenesis of chronic obstructive pulmonary disease: cellular and molecular mechanisms. Cell Biochem Biophys 2005;43:167-88. https://doi.org/10.1385/CBB:43:1:167
  6. Domej W, Oettl K, Renner W. Oxidative stress and free radicals in COPD: implications and relevance for treatment. Int J Chron Obstruct Pulmon Dis 2014;9:1207-24. https://doi.org/10.2147/COPD.S51226
  7. Leelarungrayub J, Puntumetakul R, Sriboonreung T, Pothasak Y, Klaphajone J. Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with COPD. Int J Chron Obstruct Pulmon Dis 2018;13:3909-21. https://doi.org/10.2147/COPD.S181428
  8. Kirkham PA, Barnes PJ. Oxidative stress in COPD. Chest 2013;144:266-73. https://doi.org/10.1378/chest.12-2664
  9. Ahmad A, Shameem M, Husain Q. Altered oxidant-antioxidant levels in the disease prognosis of chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2013;17:1104-9. https://doi.org/10.5588/ijtld.12.0512
  10. Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev 2007;27:237-44. https://doi.org/10.1097/01.HCR.0000281770.82652.cb
  11. Yamaguti WP, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge JM, et al. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Arch Phys Med Rehabil 2012;93:571-7. https://doi.org/10.1016/j.apmr.2011.11.026
  12. Jansang S, Mickleborough T, Suksom D. Effects of pursed-lip breathing exercise using windmill toy on lung function and respiratory muscle strength in the elderly. J Med Assoc Thai 2016;99:1046-51.
  13. Lu Y, Li P, Li N, Wang Z, Li J, Liu X, et al. Effects of home-based breathing exercises in subjects with COPD. Respir Care 2020;65:377-87. https://doi.org/10.4187/respcare.07121
  14. Ubolnuar N, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Kruapanich C, Mathiyakom W. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Ann Rehabil Med 2019;43:509-23. https://doi.org/10.5535/arm.2019.43.4.509
  15. Hill CJ, Lazzeri M, D'Abrosca F. Breathing exercises and mucus clearance techniques in pulmonary rehabilitation. In: Clini E, Holland AE, Pitta F, Troosters T, editors. Textbook of pulmonary rehabilitation. Cham: Springer International Publishing; 2018. p. 205-16.
  16. Roy AS, Bandyopadhyay A. Pulmonary function studies in female singers of Kolkata, India. J Hum Ergol (Tokyo) 2015;44:75-81.
  17. Imam MI JJ, Akor-Dewu MB. A cross sectional study on lung functions in athletes, singers, and individuals with sedentary lifestyles in Ahmadu Bello University, Zaria. Bayero J Pure Appl Sci 2017;10:83-7. https://doi.org/10.4314/bajopas.v10i2.14
  18. Seo K, Park SH, Park K. Effects of diaphragm respiration exercise on pulmonary function of male smokers in their twenties. J Phys Ther Sci 2015;27:2313-5. https://doi.org/10.1589/jpts.27.2313
  19. Visser FJ, Ramlal S, Dekhuijzen PN, Heijdra YF. Pursed-lips breathing improves inspiratory capacity in chronic obstructive pulmonary disease. Respiration 2011;81:372-8. https://doi.org/10.1159/000319036
  20. Zhang ZQ, Chen RC, Yang QK, Li P, Wang CZ, Zhang ZH. A randomized controlled trial study of pulmonary rehabilitation with respiratory physiology as the guide on prognosis in patients with chronic obstructive pulmonary disease. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2008;20:607-10.
  21. Salomoni S, van den Hoorn W, Hodges P. Breathing and singing: objective characterization of breathing patterns in classical singers. PLoS One 2016;11:e0155084. https://doi.org/10.1371/journal.pone.0155084
  22. Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease (COPD). Chron Respir Dis 2004;1:163-72. https://doi.org/10.1191/1479972304cd020rs
  23. Tamplin J, Baker FA, Grocke D, Brazzale DJ, Pretto JJ, Ruehland WR, et al. Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. Arch Phys Med Rehabil 2013;94:426-34. https://doi.org/10.1016/j.apmr.2012.10.006
  24. Cancelliero-Gaiad KM, Ike D, Pantoni CB, Borghi-Silva A, Costa D. Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Braz J Phys Ther 2014;18:291-9. https://doi.org/10.1590/bjpt-rbf.2014.0042
  25. Afrodite E, Eirini G, Emmanouil S, Aikaterini H, The effect of diaphragmatic breathing on dyspnea and exercise tolerance during exercise in COPD patients. Chest 2015;148(Suppl):704A. https://doi.org/10.1378/chest.2277852
  26. Budiman, Garnewi S. Effects of diaphragmatic breathing exercise on the degree of breathlessness in patients with chronic obstructive pulmonary disease. Iran Rehabil J 2021;19:69-74. https://doi.org/10.32598/irj.19.1.1094.1
  27. Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F. Validation of the modified pulmonary functional status and dyspnea questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol 2008;34:1008-18. https://doi.org/10.1590/S1806-37132008001200005
  28. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54:581-6. https://doi.org/10.1136/thx.54.7.581
  29. Cheng SL, Lin CH, Wang CC, Chan MC, Hsu JY, Hang LW, et al. Comparison between COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scores for evaluation of clinical symptoms, comorbidities and medical resources utilization in COPD patients. J Formos Med Assoc 2019;118:429-35. https://doi.org/10.1016/j.jfma.2018.06.018
  30. Suh MR, Kim DH, Jung J, Kim B, Lee JW, Choi WA, et al. Clinical implication of maximal voluntary ventilation in myotonic muscular dystrophy. Medicine (Baltimore) 2019;98:e15321. https://doi.org/10.1097/md.0000000000015321
  31. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-55. https://doi.org/10.1164/rccm.200703-456SO
  32. Garrod R, Marshall J, Barley E, Fredericks S, Hagan G. The relationship between inflammatory markers and disability in chronic obstructive pulmonary disease (COPD). Prim Care Respir J 2007;16:236-40. https://doi.org/10.3132/pcrj.2007.00047
  33. Cross TJ, Breskovic T, Sabapathy S, Zubin Maslov P, Johnson BD, Dujic Z. Respiratory muscle pressure development during breath holding in apnea divers. Med Sci Sports Exerc 2013;45:93-101. https://doi.org/10.1249/MSS.0b013e3182690e6a
  34. Mendes LP, Moraes KS, Hoffman M, Vieira DS, Ribeiro-Samora GA, Lage SM, et al. Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respir Care 2019;64:136-44. https://doi.org/10.4187/respcare.06319
  35. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta 2010;411:785-93. https://doi.org/10.1016/j.cca.2010.02.069
  36. Hanania NA, O'Donnell DE. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Int J Chron Obstruct Pulmon Dis 2019;14:1127-38. https://doi.org/10.2147/COPD.S188141
  37. Fernandes M, Cukier A, Feltrim MI. Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2011;8:237-44. https://doi.org/10.1177/1479972311424296
  38. Prescott E, Almdal T, Mikkelsen KL, Tofteng CL, Vestbo J, Lange P. Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study. Eur Respir J 2002;20:539-44. https://doi.org/10.1183/09031936.02.00532002
  39. McDonald V, Gibson P, Scott H, Baines P, Hensley M, Pretto J, et al. Obesity in COPD, how should it be managed?: the effect of weight loss and resistance training in obese COPD patients. Eur Respir J 2014;44:P3035.