The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial

Background: Chronic inflammation in chronic obstructive pulmonary disease (COPD) causes respiratory muscle dysfunction and decreased respiratory muscle capacity. Incongruity of the capacity and the burden of the respiratory muscle results in increased symptoms of breathlessness, decreased inspiratory capacity, exercise capacity, and quality of life. The objectives of the study were to analyze the effect of harmonica exercise as a pulmonary rehabilitation modality on inspiratory capacity, shortness of breath symptoms, exercise capacity, and quality of life on stable COPD patient. Methods: Clinical trials with pre and post test group design were performed on 30 stable COPD patients at the respiratoy clinic at Dr. Moewardi Hospital Surakarta in August - September 2017 taken by purposive sampling. Evaluation of inspiratory capacity (IC) by spirometry, symptoms of breathlessness by mMRC, exercise capacity by 6MWT and quality of life by SGRQ were measured at baseline and after 6 weeks in the harmonic and control exercises group. Results: A total 30 stable COPD subjects met criteria and divided into two groups. The harmonica training group increased IC (1.78±0.30 litre) and 6MWT (420.00±35.49 meters), decreased mMRC score (1.00±0.458) and SGRQ score (33.87±6.05) after exercise were had significant differences (p

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Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease

Thorax ◽

10.1136/thx.56.9.713 ◽

2001 ◽

Vol 56 (9) ◽

pp. 713-720

Author(s):

J Hadcroft ◽

P M A Calverley

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Lung Volume ◽

Tidal Flow ◽

Airflow Limitation ◽

Alternative Methods ◽

Chronic Obstructive ◽

Flow Limitation ◽

Inspiratory Capacity ◽

Obstructive Pulmonary Disease

BACKGROUNDBronchodilator reversibility testing is recommended in all patients with chronic obstructive pulmonary disease (COPD) but does not predict improvements in breathlessness or exercise performance. Two alternative ways of assessing lung mechanics—measurement of end expiratory lung volume (EELV) using the inspiratory capacity manoeuvre and application of negative expiratory pressure (NEP) during tidal breathing to detect tidal airflow limitation—do relate to the degree of breathlessness in COPD. Their usefulness as end points in bronchodilator reversibility testing has not been examined.METHODSWe studied 20 patients with clinically stable COPD (mean age 69.9 (1.5) years, 15 men, forced expiratory volume in one second (FEV1) 29.5 (1.6)% predicted) with tidal flow limitation as assessed by their maximum flow-volume loop. Spirometric parameters, slow vital capacity (SVC), inspiratory capacity (IC), and NEP were measured seated, before and after nebulised saline, and at intervals after 5 mg nebulised salbutamol and 500 μg nebulised ipratropium bromide. The patients attended twice and the treatment order was randomised.RESULTSMean FEV1, FVC, SVC, and IC were unchanged after saline but the degree of tidal flow limitation varied. FEV1 improved significantly after salbutamol and ipratropium (0.11 (0.02) l and 0.09 (0.02) l, respectively) as did the other lung volumes with further significant increases after the combination. Tidal volume and mean expiratory flow increased significantly after all bronchodilators but breathlessness fell significantly only after the combination treatment. The initial NEP score was unrelated to subsequent changes in lung volume.CONCLUSIONSNEP is not an appropriate measurement of acute bronchodilator responsiveness. Changes in IC were significantly larger than those in FEV1and may be more easily detected. However, our data showed no evidence for separation of “reversible” and “irreversible” groups whatever outcome measure was adopted.

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