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Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
A critical role for clinicians is patient education related to exacerbations of shortness of breath, and what the individual and family can do to help manage symptoms. A handheld, desktop, or small floor fan directed towards the face can reduce dyspnea or air hunger. Elevation of the head of the bed can help reduce breathlessness while attempting to sleep. Reduction of salt in the diet can help reduce fluid retention that can exacerbate breathlessness. Reducing the exposure to environmental allergens such as seasonal pollens, and limiting time out of doors in the presence of high air pollutants, can be beneficial. Good hand hygiene precautions should be utilized to reduce the risk of respiratory infection. Smoking cessation is a key component for individuals with tobacco use disorder (see Chapter 16). Relaxation techniques, and pacing for energy conservation, can be helpful (see Chapter 6 regarding Integrative Medicine). Pursed lip breathing and diaphragmatic breathing can also encourage optimal oxygen utilization and depth of respiration. Leaning forward onto something in sitting (e.g. palms/forearms on thighs or a tray table), also known as the orthopneic or tripod position, and/or leaning forward on something in standing (e.g. countertop or walker), can also reduce symptoms of breathlessness (see Figure 17.1). Tracking symptoms on a Borg scale can be helpful to keep a record of exacerbations, and/or triggers for exacerbations, associated with breathlessness.27
Acute respiratory illness
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
Perform a general inspection. Increased work of breathing and use of accessory muscles of respiration suggests severe respiratory compromise. Prolonged expiratory phase or pursed lip breathing occurs with COPD. Obesity is a marker of possible obstructive sleep apnoea or obesity hypoventilation.
Pulmonary rehabilitation: The development of a scientific discipline
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Linda Nici, Roger S. Goldstein
Some of the components of PR have been part of good medical care for centuries. During the mid-nineteenth century, organized programmes of sunshine, rest and nutrition were found to benefit patients with tuberculosis residing in European sanatoria (4). Soon after, it became clear that the judicious use of supervised exercise in between resting enabled patients to feel better. The first sanatorium in the United States opened in the Adirondacks in 1885, and the first Canadian sanatorium in Muskoka in 1897 (5). In addition to intensive hospital-based management, it was clear that ongoing management should include home support which became an early feature of chronic disease management (Figure 2.1). In the 1950s and 1960s, clinicians became aware of physiological approaches such as diaphragmatic and pursed lip breathing (6) for those with chronic obstructive pulmonary disease (COPD) as well as the importance of organizing individual components of care into a comprehensive programme (7–9). Combined interventions, such as breathing and bronchial hygiene techniques, walking exercises and supplemental oxygen were first reported in the form of non-controlled or historically-controlled studies by enthusiastic pioneers such as Alvin Barach and Thomas Petty (10–12). PR was given its first official definition in 1974 by the American College of Chest Physicians, and in 1981 the ATS published its first official statement on PR (13,14). Although today the ATS plays a huge role in teaching, research and clinical care of patients with respiratory disease, critical illness and sleep disorders, it was actually established in 1905 as the American Sanatorium Association to address the management of those with tuberculosis.
The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis
Published in Physiotherapy Theory and Practice, 2022
Ying Yang, Liuyi Wei, Shizhen Wang, Li Ke, Huimin Zhao, Jing Mao, Jie Li, Zongfu Mao
Breathing training is low-cost and easy to operate physical therapy for patients with COPD, which was considered as an important component of pulmonary rehabilitation (Wang, Wu, Liu, and Wang, 2016; Yan, 2019). As widely adopted breathing training techniques, pursed lip breathing (PLB) and diaphragmatic breathing (DB) played important roles in COPD management (Facchiano, Snyder, and Núñez, 2011). PLB was frequently performed in lung rehabilitation programs and during daily living activities, due to the fact that it provides certain benefits to patients with COPD (Nield, Soo, Roper, and Santiago, 2007; Ramos et al., 2009). Roberts, Stern, Schreuder, and Watson (2013) conducted a systematic review to determine the effects of PLB in patients with stable COPD. Although no high-quality evidence was identified, they suggested that PLB had beneficial effect on patients by reducing respiratory rate at rest, increasing oxygen saturation and tidal volume, and shortening time taken to recover to pre-exercise breathlessness levels. Mayer et al. (2018) also reported that the acute use of PLB during exercise was effective in reducing minute ventilation and respiratory rate in patients with COPD.
Six-month outcomes and effect of pulmonary rehabilitation among patients hospitalized with COVID-19: a retrospective cohort study
Published in Annals of Medicine, 2021
Yaoshan Dun, Chao Liu, Jeffrey W. Ripley-Gonzalez, Ping Liu, Nanjiang Zhou, Xun Gong, Baiyang You, Yang Du, Jiyang Liu, Bo Li, Suixin Liu
Pursed-lip breathing [21] and ACBT [22] were performed as previously described. Before the first set, each patient had a refresher set with the physiotherapist to optimize the technique. Pursed-lip breathing: (i) relaxed neck and shoulder muscles; (ii) breathe in slowly through the nose for two counts, keeping the mouth closed; (iii) pucker or “purse” lips as if going to whistle; (iv) breathe out slowly and gently through pursed lips while counting to four. ACBT: breathing control, thoracic expansion exercises and huffing.