RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / Name of the candidate and address / Mr. Abdul Rasheed. M
I year M.Sc.(N)
Florence College of Nursing
Bangalore -43
2 / Name of the Institution / Florence College of Nursing
3 / Course of the study and subject / M.Sc.(N) Medical Surgical Nursing
4 / Date of Admission to course / 23rd November 2009
5 / Title of the Topic / “A study to evaluate the effectiveness of video assisted teaching program regarding knowledge on practice of pulmonary hygiene among patients with pulmonary disorders in selected hospitals, Bangalore.’’

6. BREIF RESUME OF INTENDED WORK

INTRODUCTION

“If I'd known I was going to live so long, I'd have taken better care of myself”
Leon Eldred

Respiration is the mechanism of the body where they exchange gases between the atmosphere and the blood, and the blood and the cells .Respiration involves ventilation (the movement of gases in and out of the lungs) diffusion (the movement of oxygen and carbon dioxide between the alveoli and red blood cells and perfusion (is the distribution of red blood cells to and from the pulmonary capillaries.1

Pulmonary diseases are considered to be those that affect the pulmonary or lung system in the body. Learning the basics about some of the most common pulmonary diseases today helps individuals identify potential trouble before conditions worsen. Seeking early diagnosis and treatment of a pulmonary disease may influence long-term health, quality-of-life issues and life expectancy. Chronic Obstructive Pulmonary Disease (COPD) is one of the most common forms of pulmonary disease which involves emphysema, & bronchitis. COPD damages the alveoli in the lungs, small air sacs found at the end of the lung branches, which transports oxygen to the sacs. Weakened sac walls inhibit adequate oxygen flow into and out of the sacs, causing constant shortness of breath or dysponea. Dysponea or shortness of breath is one of the most common and significant complaints of patients with disorders of lower airways. The experience of dysponea is generally associated with much anxiety and should be consistently evaluated and treated. 2, 3

COPD is a slowly progressive disorder characterized by air flow obstruction (FEV < 80%) COPD may include diseases that cause airflow obstruction (e.g. emphysema, chronic bronchitis) or any combination of these disorders .Other diseases such as bronchiectiasis, and asthma that classified as chronic pulmonary disorders.2COPD is a disease state characterized by airflow limitation that is not fully reversible .This newest definition of COPD ,provided by the Global Initiative for Chronic Obstructive Lung disease (GOLD)is a broad description that better explains this disorder and its sign and symptoms(GOLD, WHO ,&National Heart Lung Blood Institute (NHLBI)2004)4

In 2003 10.3 million American were affected by COPD. It is more common among whites than black and affects men more frequently than women. The death rate from COPD continues it raise among Black and American and Indian male & female of all ethnic age group. The death rate is stable in white Hispanics and Asian .In 2002 COPD and other GOLD accounted more than 1250,00 deaths (NHLBI 2004).In addition COPD morbidity is significant In people under age 65years COPD is second only to heart disease as a cause of disability resulting in an estimated 250 million.5

Chronic Bronchitis is one of the common COPD disorder and is defined as chronic cough and expectoration which persists for at least 3 months period for at least 2 consecutive years. The cause of chronic bronchitis is related to long term irritation of the tracheobronchial tree. The most common cause of irritation is cigarette smoking. Other causes are air pollution, bronchial infections and occupational diseases.5Conventional methods like chest physical therapy, active cycle of breathing technique, Airway clearance techniques like postural drainage, percussion, vibration, shaking and forced expiratory techniques are used for mucus clearance in chronic bronchitis patients.6 Recent methods like positive expiratory technique using flutter device and Autogenic drainage are also used for improving bronchial hygiene in chronic obstructive pulmonary disease patients.6

6.1 NEED FOR THE STUDY

Worldwide, pulmonary disorder is the sixth leading cause of death and is the only condition in the top 10 causes of death with an increasing prevalence and mortality. The Global Burden of Disease study undertaken by the World Bank and the World Health Organization concluded that COPD will become the third leading cause of death worldwide by 2020, and its ranking relative for number of disability-adjusted life-years lost will increase from 12th to 5th currently, oxygen therapy for hypoxemic patients and cigarette-smoking cessation are the only interventions known to alter the natural history of COPD.7

Chronic pulmonary disorder was caused for 123013 deaths in people of all ages, regardless of gender. At present approximately 16 million people in the US have some form of COPD .The annual cost of COPD is approximately $32.1 billion, including health care expenditures of $18.0 billion and indirect costs of 14.1 billion (American Lung Association). 3

Diseases of respiratory system are the major causes of illness affecting a greater part of population worldwide. Chronic obstructive pulmonary disease (COPD) is the internationally preferred term encompassing chronic bronchitis, emphysema and asthma. COPD is the most common chronic pulmonary disorder afflicting 10 to 15% of adults over the age of 45, COPD is a disorder characterized by the presence of airflow obstruction that is generally progressive, accompanied by airway hyper reactivity and may be partially reversible. A review of population studies from India, estimated that total number of COPD patients aged 40 years and above in 2006 were 8.15 million males and 4.21 millions females.6

A study was conducted to evaluate the effectiveness on a home exercise video program on improve exercise tolerance and breathlessness in patients with moderate to severe COPD. Samples of 20 subjects were selected as intervention & control group. The intervention group (n=10), watched a 19-min video on the benefits of exercise for patients with COPD and controlled group(n-10) were given a 30-min exercise video, an illustrated exercise diary and an educational booklet about COPD, for use at home. The result shown that participation in a home exercise video program improved the exercise tolerance and breathlessness people with COPD.8

An experimental study was conducted to evaluate the short term effects on exercise endurance and health status in patients with COPD.A sample size of 119 adults with COPD was selected. About 8 week Comprehensive Rehabilitation Program (CRP) was given which included education, physical and respiratory therapy (RT) instruction and supervised excises training, or to an 8 week Education Control Program (ECP) which included bi-weekly class room instruction and discussion on RT, medical aspect of lung diseases and diet. The result showed that after 6 months of enrollment CRP showed much significance in exercise endurance whereas ECP showed no significant increase.9

A study was conducted to compare the effectiveness of a once-weekly supervised pulmonary rehabilitation program with a standard twice-weekly program. A sample size of 30 patients were selected randomly and divided in to two groups. The once-weekly group (n=15) received one supervised rehabilitation session per week, and the twice-weekly group (n=15) received two sessions per week, both for 8 weeks, together with a home-exercise plan. The result shown after pulmonary rehabilitation, the groups showed similar improvements in exercise tolerance. The findings suggested that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly program, but the health-related quality-of-life outcome appeared to be poorer for once-weekly supervision.10

From the available literature reviewed it was found that pulmonary disorders are the fourth leading cause of death worldwide. Long term home based pulmonary rehabilitation is much more importance in reducing the symptoms of common pulmonary disorders and improves the quality of life. Hence the researcher felt the need to provide home based pulmonary rehabilitative program with a view to improve the quality of life of patients with pulmonary disorders.

People with acute and chronic airway diseases often have secretions building up in their lungs. Bronchopulmonary hygiene physical therapy (BHPT) is a form of chest physical therapy that uses physical forces such as gravity and chest tapping to remove secretions from the lungs. The therapy is labour intensive. The review found there was not enough evidence to show the benefit of BHPT for people with airway diseases such as chronic bronchitis or bronchiectasis. Study suggests that more research is needed in this area.11

6.2 REVIEW OF LITRETATURE

A critical summary of research on a topic of interest, often prepared to put a research problem in context..Review of literature is a key step in the research process. It provides basis for further investigation, justifies the need for the study, throws light on the feasibility of the study, reveals constraints of data collection and relates findings from one study to another with a hope to establish a comprehensive study of scientific knowledge in personnel decipiline.12, 13

A study was conducted to examine the effect of bronchopulmonary hygiene physical therapy on patients with COPD and bronchiatisis and to determine the any difference between manual and mechanical physical therapy. A sample size of 126 patients with COPD and divided in to interventional and control group, for interventional group manual interventions, such as postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique, are offered. For control group coughing; and mechanical vibration were included. The result showed that statistically significant effect for the bronchopulmonary hygiene physical therapy. No trials found statistically significant effects on pulmonary function variables or differences between manual and mechanical techniques.14

A study was conducted to assess the effect of long term treatment of autogenic drainage (AD) and active cycles of breathing techniques (ACBT) in patients with COPD. The sample consists of 30 clinically stable male COPD patients randomly assigned to AD/ACBT treatment for 20 days treatment period. Patients were assessed through PFT, ABG 6 min walking before and immediately after walking test. The result shown AD improved Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV), FCV from 25 to 75%.The ACBT increases FVC, arterial oxygenation and exercise performance. AD was effective as the ACBT in cleaning secretions and improving lung function.15

A study was conducted to measure the short –term effects of mucus clearance after Forced Expiratory Technique (FET) combined with postural drainage (PD) or positive expiratory pressure (PEP). A sample size of 14 patients with COPD were selected, and subjected to measure mucocilliary clearance at rest and during physiotherapy. The subjects inhale the aerosol therapy containing 99mTc labeled aluminum colloid. Five steps of scintigraphic image were obtained with 22 min intervals. The first image was obtained directly after inhalation, second after a period of 22 min rest, the third after physiotherapy and the fourth and fifth after further periods of rest. Result shown mucus clearance during PD+FET was significantly higher than during PEP+FET .This study concluded that the patients found two methods equally efficient but most of the patients prefer PEP as treatment.16

A study was conducted to evaluate the effect of domiciliary pulmonary rehabilitation program in patients with COPD. A sample of 40 stable COPD patients randomly selected and divided in to experimental group and control group. Rehabilitation includes walking, breathing exercises, PD, controlled coughing and change in life activities. Exercises for 30 min were performed at home twice daily for four weeks supervision. Results shown the experimental group after four weeks changes in all the parameters which included six min walking distance, dysponea mastery, fatigue and emotional status were statistically significant as compared to the control group. The study concluded that domiciliary pulmonary rehabilitation for 4 weeks result in significant improvement in quality of life and exercise tolerance.17

A study was conducted on assess the effect of a short term treatment of autogenic drainage (AD) and active cycle of breathing techniques (ACBT) among in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Sample size of thirty male COPD patients with acute exacerbation was randomly assigned into two groups and they performed each technique on successive days. The results of this study indicate that AD was as effective as the ACBT in acutely clearing secretions and improving oxygen saturation without causing any undesirable effects in patient with AECOPD. These techniques can be used in COPD exacerbations according to patients’ and the physiotherapists’ preferences. 18

A study was conducted to evaluate the effectiveness of a bronchial drainage technique, expiration with the glottis open in the lateral posture (ELTGOL) in COPD exacerbations. A sample size of 59 patients hospitalized for the treatment of acute exacerbation of COPD, who were randomly assigned to a control group and an intervention group. The control group was treated with standard medical therapy while the intervention group was treated with ELTGOL plus medical therapy. The result shown at the time of hospital discharge, there was significantly improved in the ELTGOL group (4.3 ± 1.5 in the control group vs. 3.0 ± 1.8 in the ELTGOL group.19

A study was conducted to evaluate the effectiveness of respiratory rehabilitation in patients with bronchial asthma and COPD.A sample size of 38 patients who had bronchial asthma (n=14) &COPD (n=24).The patients were treated with kinestherapy and inhaled bronchodilator drugs ,a well as bronchial hygiene and performed breathing exercise. The result shown after the rehabilitation program FEV1 increased from 1.37 ± 0.62 to 1.54± 0.69. COPD patients improved their FEV1 significantly compared with asthma patients. Hence the researcher concluded that the pulmonary rehabilitation program increase the level of spontaneous physical activity and changes the quality of life in COPD patients. 20

A study was conducted to evaluate the influence of spontaneous pursed lips breathing on walking endurance and oxygen saturation in patients with moderate to severe COPD.A sample size of 32 patients with moderate to severe COPD patients were randomly selected. All patients performed two endurance shuttle walking tests in random order. During endurance shuttle walking test I a mouthpiece was used in order to prevent spontaneous pursed lips breathing. During endurance shuttle walking test II spontaneous pursed lips breathing was used freely. Result shown that the patients de saturated considerably during both walking tests but the average drop in oxygen saturation was 1.2% less when spontaneous pursed lips breathing was employed, the research study concluded that spontaneous pursed lips breathing could be a useful technique to increase walking endurance and reduce oxygen de saturation during walking in patients with moderate to severe chronic obstructive pulmonary disease.21