RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
Annexure – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 / Name of the Candidate andAddress
[In Block Letters] / MR NITHYANANDA MOGERA
1ST YEAR MSc NURSING,
ALVA’S COLLEGE OF
NURSING, MOODBIDRI.
2. / Name of the Institution / ALVA’S COLLEGE OF
NURSING, MOODBIDRI.
3. / Course of the Study,
Subject / 1ST YEAR M.Sc NURSING,
MEDICAL SURGICAL NURSING
4. / Date of Admission to Course / 19-06-09
5. / Title of the Topic
“A study to evaluate the effectiveness of pursed lip breathing exercise on dyspnea among chronic obstructive pulmonary disease patients in selected hospitals of Mangalore and Karkala Taluk. ”
6.
7.
8. / Brief resume of the intended work:
6.1 Need for the study
"Only those who know how to breathe will survive."
- Pundit Acharya
Chronic obstructive pulmonary disease(COPD) is a highly prevalent and progressive disease associated with chronic symptoms and disabilities. In 2004 prevalence of chronic obstructive pulmonary disease is 280 million cases worldwide. COPD is the fourth leading cause of death in the world and is expected that by the year 2020, it will become the third leading cause of death. In India median prevalence rates of COPD were assessed as 5% in males and 2.7% in females¹.
Dyspnea is the most frequent symptom of COPD. It has been suggested that dyspnea is the single most important factor contributing to functional difficulties in COPD and is a better predictor of exercise tolerance and health related quality of life among COPD patiens². A study on 131 participants with COPD revealed that 84% experienced severe dyspnea, while 59% had at least one daily episode of dyspnea ³.
A comparative study was conducted to evaluate the impact of inspiratory muscle training on lung function and exercise tolerance among 35 patients with stable COPD in Madrid. The result showed that trained group experienced a significant decrease in dyspnea evaluated on the Borg scale(5.7±1.1 versus 4.7± 1.2, P<0.005) and an increase in time of submaximal exercise tolerance (5.5±2 versus 7±3 min, P<0.05).The study concluded that it is accompanied by a decreased sense of dyspnea 4 .
A randomized controlled trial was conducted to determine the impact of comprehensive pulmonary rehabilitation on depression, anxiety, dyspnea, and health related quality of life among 24 patients with severe COPD in Venezuela. The result showed that, there was a significant improvement in the severity of depression (P<0.01),a decrease in symptoms(P<0.05),an increase in daily living activities(P<0.05) and dyspnea measured by the Medical research council scale was significantly better in pulmonary rehabilitation group(P<0.01).The study concluded that pulmonary rehabilitation induces important changes in dyspnea 5.
Incidence and prevalence of COPD is high in Indian population. During his clinical postings investigator came across many cases of COPD in whom dyspnoea is the main symptom which affect their activities of daily living. Breathing exercises are aimed at improving symptoms of dyspnoea and ameliorate adverse physiological effects. Hence the investigator felt it necessary to assess the effectiveness of pursed lip breathing on dyspnea.
6.2 Review of literature: -
A randomized controlled trial was conducted to evaluate the efficacy of pursed lip breathing on dyspnea reduction among 40 COPD subjects in USA. The subjects aged 65 ±9(mean ± standard deviation)years, forced expiratory volume (FEV)1 sec, forced vital capacity(FVC%)=46±10, body mass index (BMI)=26±6kg/m, inspiratory muscle strength=69±22cm H2O were enrolled. The results showed that there is significant reduction in modified Borg scale(P=0.05) and improvement in physical function(P=0.02) from baseline to 12 weeks. The study concluded that pursed lip breathing provided sustained improvement in exertional dyspnea and physical function 6.
A clinical trial was conducted to assess the effect of exercise training on dyspnea measures among 44 patients with COPD attending an outpatient programme in USA. The results of the study showed that there were significant increase in FEV1, 7%; P=0.02, maximal inspiratory mouth pressure (PIMax) 17%; P<0.001 and transition dyspnea index focal score(3.4; P<0.001) and a significant decrease in the slope of dyspnea(0.12 versus 0.09 ; P=0.001) during exercises. The study concluded that after pulmonary rehabilitation there was a significant improvement in dyspnea 7.
A comparative study was conducted to assess the effects of breathing retraining on exercise tolerance among 22 COPD patients in USA. Out of which 12 subjects(control) exercised for 3 weeks and other 10 subjects received exercise conditioning plus breathing retraining. The results showed that increments in the exercise performance were significantly greater in the breathing retraining subjects than in controls(P<0.002),respiratory rate during exercise decreased(P<0.005) and tidal volume and PaO2 during exercise increased(P<0.05).The study concluded that breathing retraining increases exercise performance in subjects with COPD 8.
A study was conducted to evaluate the effects of imposed pursed lip breathing on respiratory mechanics and dyspnea at rest and during exercise among 8 COPD patients with a mean (± standard deviation) age of 58±11 years and a mean FEV1 of 1.34±0.44L in Canada. Results showed that pursed lip breathing promoted a slower and deeper breathing pattern both at rest and during exercises. Changes in dyspnea scores with pursed lip breathing during exercise were correlated with changes in end expiratory lung volume(r2=0.82,P=0.002).The study concluded that pursed lip breathing has a positive effect on dyspnea 9.
A randomized controlled trial was conducted to evaluate the effect of home based respiratory muscle endurance training on exercise performance among 36 patients with moderate to severe COPD in Netherland. Results showed thatpatients receiving respiratory muscle endurance training had significant improvement in endurance exercise capacity(18min versus 28 min, P<0.001), in perception of dyspnea(Borg score;8.4 versus5.4,P<0.001) and respiratory muscle endurance capacity(25cmH2O versus 31cm H2O ,P=0.005)and quality of life(78.7 to 86.6,P=0.001).Thus respiratory muscle endurance training leads to significant improvement on perception of dyspnea10.
A randomized controlled trial was conducted to assess the effect of breathing exercises in improving respiratory muscle contraction among 324 patients with stable COPD in China. The subjects were randomly assigned to either breathing exercises or placebo medicine as control. Patient in breathing exercises group were compared with those in the control group by measuring maximum inspiratory pressure(MIP), maximum expiratory pressure(MEP), inspiratory trans diaphragmatic pressure(Pdi), and maximum diaphragmatic pressure(Pdimax) after 1-20 months. In breathing exercises group MIP increased by 30.42%,MEP 32.10%,Pdi 30.94% and Pdimax 65.59% (P<0.001).No significant change was observed in the control group. The study concluded that breathing exercises has potent and lasting effect on respiratory muscle contraction11.
6.3 Problem Statement: -
“A study to evaluate the effectiveness of pursed lip breathing exercise on dyspnea among chronic obstructive pulmonary disease patients in selected hospitals of Mangalore and Karkala Taluk”
6.4 Objectives of the study: -
The objectives of the study are to;
1. assess the pretest dyspnea score among experimental group and control group.
2. assess the post test dyspnoea score among experimental group and control group.
3. evaluate the effectiveness of pursed lip breathing on dyspnea among experimental group.
4. compare the post test dyspnea score between experimental group and control group.
5. find the association between post test dyspnea score and selected demographic variables among experimental group.
6.5 Operational definitions: -
1. Effectiveness:.In this study effectiveness refers to an intended or expected result produced from the pursed lip breathing as measured by dyspnea scale.
Pursed lip breathing: Pursed lip breathing is a technique in which air is inhaled slowly though the nose and mouth and exhaled slowly through pursed lip; used by patients with COPD to improve their breathing by increasing resistance to airflow, forcibly dilating small bronchi.
Dyspnea: Dyspnea is a debilitating symptom that is the experience of unpleasant or uncomfortable respiratory sensation.
Chronic obstructive pulmonary disease: Chronic obstructive pulmonary disease is a group of pathological condition in which there is a chronic, partial or complete obstruction to the airflow at any level from trachea to the smallest airways resulting in functional disability of the lungs.
6.6 Assumptions: -
The study assumes that:
1. pursed lip breathing will reduce dyspnea among chronic obstructive pulmonary disease patients.
2. pursed lip breathing will improve the prognosis of chronic obstructive pulmonary disease patients.
6.7 Delimitations: -
The study is limited to:
1. chronic obstructive pulmonary disease patients who are willing to
participate
2. chronic obstructive pulmonary disease patients of selected hospitals of
Mangalore and Karkala Taluk.
6.8 Projected Outcome (Hypothesis):-
The study is based on the hypothesis
H1 : There will be significant difference in pretest and post test dyspnea
scores among experimental group.
H2 : There will be significant difference in post test dyspnea scores between
experimental and control group.
H3: There will be significant association between post test dyspnea scores
and selected demographic variables.
MATERIAL AND METHOD: -
7.1 Source of data
Data will be collected from the chronic obstructive pulmonary disease patients who will fulfill the inclusion criteria.
7.1.1 Research Design
The design adopted is quasi experimental design
Group / Pretest / Intervention / Post Test
Experimental / O1 / X / O2
Control / O1 / - / O2
7.1.2 Settings
The setting consists of selected hospitals of Mangalore and Karkala Taluk.
7.1.3 Population
The population for the study consists of chronic obstructive pulmonary disease patients between the age group of 30-65years in selected hospitals of Mangalore and Karkala Taluk.
7.2 Method of Data collection
7.2.1 Sampling procedure
Non probability purposive sampling technique
7.2.2 Sampling size
Sample consists of 60 COPD patients (30 each for experimental and control group) of selected hospitals of Mangalore and Karkala taluk.
7.2.3 Inclusion criteria for sampling
1. COPD patients available at the time of study.
2. COPD patients with in the age group of 30-65years.
3. COPD patients with mild to moderate dyspnea.
7.2.4 Exclusion criteria for sampling
1. COPD patients above the age of 65years.
2. COPD patients with severe dyspnea.
7.2.5 Instruments used
Tool 1: Demographic proforma
Tool 2: Dyspnea scale
7.2.6 Data collection method
Data will be collected from 60 COPD patients by direct administration of
demographic proforma and dyspnea scale.
7.2.7 Plan of data analysis: -
Data will be analyzed using descriptive and inferential statistics.
1. Demographic data will be analyzed using frequency and percentage.
2. Dyspnea scores will be analyzed by computing mean, median, mean percentage and standard deviation
3. Paired ‘t’ test will be used to find out the effectiveness of pursed lip breathing among experimental group.
4. Independent ‘t’ test will be used to compare the post test dyspnea scores between the experimental and control group.
5. Chi-square test will be used to find out the association between post test dyspnea scores among experimental group and selected demographic variables.
7.3 Does the study require any investigation to be conducted on patient or other human or animals? If so please describe briefly?
Yes, administration of pursed lip breathing.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the concerned authority.
LIST OF REFERENCES:
1. Jindal SK, Gupta D, Aggarwal AN. Guidlines for management of COPD in India. Indian J chest Dis Allied Sci 2004;46:137-8.
2. Kohlman VC, Gormley JM. Dyspnoea and affective response during exercise training in obstructive pulmonary disease. Nursing research 2001 may/june ;50(3):136.
3. Wu HS, Chi wu S, Lin JG. Effectiveness of acupressure in improving dyspnoea in COPD. Jour Ad Nursing 2004;45:253.
4. Siminiani A, Tatay E, Marcos JM. Training of inspiratory muscles in chronic obstructive lung disease. Arch Bronchoneumol 1998 Feb;34(2):64-70.
5. Diaz PH, Lopez JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnoeaand health status in patients with COPD. Am J Phys Med Rehabil 2007 Jan;86(1):30-6.
6. Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed lips breathing;a breathing retraining strategy for dyspnoea reduction. J Cardiopulm Rehabil Prev 2007 Jul-Aug;27(4):237-44.
7. Ramirez VA,Ward JL, Olmstead EM, Tosteson AN, Mahler DA. Effect of exercise training on dyspnoea measures in patients with COPD. J Cardiopulm Rehabil 1997 Mar-Apr;17(2):103-9.
8. Casciari RJ, Fairshter RD, Harrson A, Morrison JT, Blackburn C, Wilson AF. Effects of breathing retraining in patients with COPD. Chest 1981 Apr;79(4):393-8.
9. Spahija J, Marchie M, Grassino. Effects of imposed pursed lips breathing on respiratory mechanics and dyspnoea at rest and during exercise in COPD. Chest 2005 Aug;128(2):640-50.
10. Koppers RJ, Vos PJ, Boot CR, Folgering HT. Effect of home based respiratory muscle endurance training on exercise performance. Chest 2006 Apr;129(4):886-92.
11.Yan Q, Sun Y, Lin J. Effect of breathing exercises in improving respiratory
muscle contraction. Zhonghua Nei Ke Za Zhi 1996 Apr;35(4):235-8.
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