The effect of posture on asynchronous chest wall movement in COPD

Chronic obstructive pulmonary disease (COPD) patients often show asynchronous movement of the lower rib cage during spontaneous quiet breathing and exercise. We speculated that varying body position from seated to supine would influence rib cage asynchrony by changing the configuration of the respiratory muscles. Twenty-three severe COPD patients (forced expiratory volume in 1 s = 32.5 ± 7.0% predicted) and 12 healthy age-matched controls were studied. Measurements of the phase shift between upper and lower rib cage and between upper rib cage and abdomen were performed with opto-electronic plethysmography during quiet breathing in the seated and supine position. Changes in diaphragm zone of apposition were measured by ultrasounds. Control subjects showed no compartmental asynchronous movement, whether seated or supine. In 13 COPD patients, rib cage asynchrony was noticed in the seated posture. This asynchrony disappeared in the supine posture. In COPD, upper rib cage and abdomen were synchronous when seated, but a strong asynchrony was found in supine. The relationships between changes in diaphragm zone of apposition and volume variations of chest wall compartments supported these findings. Rib cage paradox was noticed in approximately one-half of the COPD patients while seated, but was not related to impaired diaphragm motion. In the supine posture, the rib cage paradox disappeared, suggesting that, in this posture, diaphragm mechanics improves. In conclusion, changing body position induces important differences in the chest wall behavior in COPD patients.

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Obesity modulates diaphragm curvature in subjects with and without COPD

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00173.2017 ◽

2017 ◽

Vol 313 (5) ◽

pp. R620-R629 ◽

Cited By ~ 6

Author(s):

Aladin M. Boriek ◽

Michael A. Lopez ◽

Cristina Velasco ◽

Azam A. Bakir ◽

Anna Frolov ◽

...

Keyword(s):

Forced Expiratory Volume ◽

Normal Weight ◽

The Body ◽

Diaphragm Muscle ◽

Chronic Obstructive ◽

Quiet Breathing ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Left Hemidiaphragm ◽

Residual Capacity

Obesity is a common comorbidity of chronic obstructive pulmonary disease (COPD) and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index (BMI) has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in non-COPD and COPD subjects are modulated by BMI. We recruited 48 COPD patients with postbronchiodilator forced expiratory volume in 1 s (FEV1)-to-forced vital capacity (FVC) < 0.7 and 29 age-matched smoker/exsmoker control (non-COPD) subjects, who underwent chest computed tomography (CT) at lung volumes ranging from functional residual capacity (FRC) to total lung capacity (TLC). We then computed maximum principal diaphragm curvature in the midcostal region of the left hemidiaphragm at the end of inspiration during quiet breathing (EI) and at TLC. The radius of maximum curvature of diaphragm muscle increased with BMI in both COPD and non-COPD subjects. The size of diaphragm ring of insertion on the chest wall also increased significantly with increasing BMI. Surprisingly, COPD severity did not appear to cause significant alteration in diaphragm shape except in normal-weight subjects at TLC. Our data uncovered important factors such as BMI, the size of the diaphragm ring of insertion, and disease severity that modulate the structure of the ventilatory pump in non-COPD and COPD subjects.

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Thixotropy of rib cage respiratory muscles in normal subjects

Journal of Applied Physiology ◽

10.1152/jappl.2000.89.5.1753 ◽

2000 ◽

Vol 89 (5) ◽

pp. 1753-1758 ◽

Cited By ~ 12

Author(s):

Ikuo Homma ◽

Karl-Erik Hagbarth

Keyword(s):

Skeletal Muscles ◽

Respiratory Muscles ◽

Normal Subjects ◽

Chronic Obstructive ◽

Quiet Breathing ◽

Obstructive Pulmonary Disease ◽

Rib Cage ◽

Airway Occlusion ◽

Before And After ◽

Thixotropic Behavior

In this study, we searched for signs of thixotropic behavior in human rib cage respiratory muscles. If rib cage respiratory muscles possess thixotropic properties similar to those seen in other skeletal muscles in animals and humans, we expect resting rib cage circumference would be temporarily changed after deep rib cage inflations or deflations and that these aftereffects would be particularly pronounced in trials that combine conditioning deep inflations or deflations with forceful isometric contractions of the respiratory muscles. We used induction plethysmography to obtain a continuous relative measure of rib cage circumference changes during quiet breathing in 12 healthy subjects. Rib cage position at the end of the expiratory phase (EEP) was used as an index of resting rib cage circumference. Comparisons were made between EEP values of five spontaneous breaths immediately before and after six types of conditioning maneuvers: deep inspiration (DI); deep expiration (DE); DI combined with forceful effort to inspire (FII) or expire (FEI); and DE combined with forceful effort to inspire (FIE) or expire (FEE), both with temporary airway occlusion. The aftereffects of the conditioning maneuvers on EEP values were consistent with the supposition that human respiratory muscles possess thixotropic properties. EEP values were significantly enhanced after all conditioning maneuvers involving DI, and the aftereffects were particularly pronounced in the FII and FEI trials. In contrast, EEP values were reduced after DE maneuvers. The aftereffects were statistically significant for the FEE and FIE, but not DE, trials. It is suggested that respiratory muscle thixotropy may contribute to the pulmonary hyperinflation seen in patients with chronic obstructive pulmonary disease.

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Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10020269 ◽

2021 ◽

Vol 10 (2) ◽

pp. 269

Author(s):

Elisabetta Zinellu ◽

Alessandro G. Fois ◽

Elisabetta Sotgiu ◽

Sabrina Mellino ◽

Arduino A. Mangoni ◽

...

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Serum Albumin ◽

Pulmonary Disease ◽

Meta Analysis ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Standard Mean Difference ◽

Copd Patients

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airway inflammation and lung parenchyma damage. Systemic inflammation and oxidative stress also play a role in the pathogenesis of COPD. Serum albumin is a negative acute-phase protein with antioxidant effects and an important marker of malnutrition. The aim of this meta-analysis was to investigate differences in serum albumin concentrations between patients with stable COPD and non-COPD subjects. Methods: A systematic search was conducted, using the terms “albumin” and “chronic obstructive pulmonary disease” or “COPD”, in the electronic databases PubMed and Web of Science, from inception to May 2020. Results: Twenty-six studies were identified on a total of 2554 COPD patients and 2055 non-COPD controls. Pooled results showed that serum albumin concentrations were significantly lower in COPD patients (standard mean difference, SMD = −0.50, 95% CI −0.67 to −0.32; p < 0.001). No significant differences were observed in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) < 50% and those with FEV1 > 50%. Conclusions: Our systematic review and meta-analysis showed that serum albumin concentrations are significantly lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

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Immediate effect of Chest Proprioceptive Neuromuscular Facilitation on Respiratory Rate, Chest Expansion and Peak Expiratory Flow Rate in patients with Chronic Obstructive Pulmonary Disease

International Journal of Physiotherapy and Research ◽

10.16965/ijpr.2020.175 ◽

2021 ◽

Vol 9 (1) ◽

pp. 3724-3729

Author(s):

Hetal M Mistry ◽

◽

Rutuja V Kamble ◽

Keyword(s):

Respiratory Rate ◽

Peak Expiratory Flow ◽

Flow Rate ◽

Peak Expiratory Flow Rate ◽

Respiratory Muscles ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Chest Expansion ◽

Copd Patients ◽

Expiratory Flow

Background: In Chronic Obstructive Pulmonary Disease (COPD), as result of dynamic hyperinflation, primary respiratory muscles go into weakness and length tension relationship of muscles is altered. This leads to decreased ability of primary respiratory muscles to generate muscle tension. COPD patients mostly use accessory muscle for breathing and there is lack of facilitation of intercostal muscle and weakness of diaphragm. Few studies are conducted to assess the immediate effect of Chest Proprioceptive Neuromuscular Facilitation (PNF) i.e. intercostal stretch among COPD patients. Therefore, there is need to find out immediate effect of chest PNF- intercostal stretch on respiratory rate (RR), chest expansion, peak expiratory flow rate (PEFR) among patient with COPD. Objective: To find out immediate effect chest PNF on respiratory rate, chest expansion and peak expiratory flow rate. Methodology: Ethical clearance and participant consent was taken. Study design was Qausi experimental study. The 65 subjects were taken by convenient sampling. Intercostal stretch was applied over 2nd and 3rd rib bilaterally for 10 breaths with 1 minute rest with a 10 repetitions and Outcome measures were assessed before and immediately after giving chest PNF. SPSS 16 software was used to analyse the data. The normality of the data was assessed using parametric paired t test. Significance level was set at 0.05 and 95% Confidence Interval. Outcome Measures: Respiratory rate, Chest expansion, Peak expiratory flow rate. Result: Immediate effect of chest PNF showed that there was statistically significant increase in PEFR and chest expansion at three level (P=0.000) and there was statistically significant decrease in RR (P=0.000). Conclusion: There is immediate effect of Chest PNF- intercostal stretch on, Respiratory rate, Chest expansion at three level that is axillary, nipple and xiphisternal and Peak expiratory flow rate. It is an easy to use, less time consuming, easy to understand and cost effective technique. KEY WORDS: Chest PNF, intercostal stretch, COPD.

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Randomised controlled trial to investigate the use of high-frequency airway oscillations as training to improve dyspnoea (TIDe) in COPD

Thorax ◽

10.1136/thoraxjnl-2021-217072 ◽

2021 ◽

pp. thoraxjnl-2021-217072

Author(s):

Enya Daynes ◽

Neil Greening ◽

Sally J Singh

Keyword(s):

Muscle Weakness ◽

High Frequency ◽

Controlled Trial ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Registration Number ◽

Randomised Controlled ◽

Double Blinded

BackgroundChronic obstructive pulmonary disease (COPD) is characterised by symptomatic dyspnoea and reduced exercise tolerance, in part as a result muscle weakness, for which inspiratory muscle training (IMT) may be useful. Excess mucus hypersecretion commonly coexists in COPD and may lead to reduce ventilation, further impacting on breathlessness. Devices for sputum clearance may be employed to aid mucus expectoration. This trial aimed to explore the effectiveness of a combined IMT and high-frequency airway oscillating (HFAO) device in the management of dyspnoea.MethodsThis was a double-blinded, randomised sham-controlled trial which recruited symptomatic patients with COPD. Patients were randomised to either a HFAO device (Aerosure) or sham device for 8 weeks, three times a day. The primary outcome was the Chronic Respiratory Questionnaire dyspnoea (CRQ-D) domain. Pre-specified subgroup analyses were performed including those with respiratory muscle weakness, excessive sputum and frequent exacerbators.Results104 participants (68% men, mean (SD) age 69.75 years (7.41), forced expiratory volume in 1 s per cent predicted 48.22% (18.75)) were recruited to this study with 96 participants completing. No difference in CRQ-D was seen between groups (0·28, 95% CI −0.19 to 0.75, p=0.24), though meaningful improvements were seen over time in both groups (mean (SD) HFAO 0.45 (0.78), p<0.01; sham 0.73 (1.09), p<0.01). Maximal inspiratory pressure significantly improved in the HFAO group over sham (5.26, 95% CI 0.34 to 10.19, p=0.05). Similar patterns were seen in the subgroup analysis.ConclusionThere were no statistical differences between the HFAO and the sham group in improving dyspnoea measured by the CRQ-D.Trial registration numberISRCTN45695543.

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Voluntary activation of the human diaphragm in health and disease

Journal of Applied Physiology ◽

10.1152/jappl.1998.85.6.2146 ◽

1998 ◽

Vol 85 (6) ◽

pp. 2146-2158 ◽

Cited By ~ 136

Author(s):

Christer Sinderby ◽

Jennifer Beck ◽

Jadranka Spahija ◽

Jan Weinberg ◽

Alex Grassino

Keyword(s):

Healthy Subjects ◽

Total Lung Capacity ◽

Voluntary Activation ◽

Chronic Obstructive ◽

Quiet Breathing ◽

Obstructive Pulmonary Disease ◽

Transdiaphragmatic Pressure ◽

Lung Capacity ◽

Copd Patients ◽

Crural Diaphragm

Intersubject comparison of the crural diaphragm electromyogram, as measured by an esophageal electrode, requires a reliable means for normalizing the signal. The present study set out 1) to evaluate which voluntary respiratory maneuvers provide high and reproducible diaphragm electromyogram root-mean-square (RMS) values and 2) to determine the relative diaphragm activation and mechanical and ventilatory outputs during breathing at rest in healthy subjects ( n = 5), in patients with severe chronic obstructive pulmonary disease (COPD, n = 5), and in restrictive patients with prior polio infection (PPI, n = 6). In all groups, mean voluntary maximal RMS values were higher during inspiration to total lung capacity than during sniff inhalation through the nose ( P = 0.035, ANOVA). The RMS (percentage of voluntary maximal RMS) during quiet breathing was 8% in healthy subjects, 43% in COPD patients, and 45% in PPI patients. Despite the large difference in relative RMS ( P = 0.012), there were no differences in mean transdiaphragmatic pressure ( P= 0.977) and tidal volumes ( P = 0.426). We conclude that voluntary maximal RMS is reliably obtained during an inspiration to total lung capacity but a sniff inhalation could be a useful complementary maneuver. Severe COPD and PPI patients breathing at rest are characterized by increased diaphragm activation with no change in diaphragm pressure generation.

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Bronchoalveolar Lavage Fluid from COPD Patients Reveals More Compounds Associated with Disease than Matched Plasma

Metabolites ◽

10.3390/metabo9080157 ◽

2019 ◽

Vol 9 (8) ◽

pp. 157 ◽

Cited By ~ 2

Author(s):

Eitan Halper-Stromberg ◽

Lucas Gillenwater ◽

Charmion Cruickshank-Quinn ◽

Wanda Kay O’Neal ◽

Nichole Reisdorph ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Cell Metabolism ◽

Lavage Fluid ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

False Discovery ◽

Copd Patients ◽

Clinical Covariates

Smoking causes chronic obstructive pulmonary disease (COPD). Though recent studies identified a COPD metabolomic signature in blood, no large studies examine the metabolome in bronchoalveolar lavage (BAL) fluid, a more direct representation of lung cell metabolism. We performed untargeted liquid chromatography–mass spectrometry (LC–MS) on BAL and matched plasma from 115 subjects from the SPIROMICS cohort. Regression was performed with COPD phenotypes as the outcome and metabolites as the predictor, adjusted for clinical covariates and false discovery rate. Weighted gene co-expression network analysis (WGCNA) grouped metabolites into modules which were then associated with phenotypes. K-means clustering grouped similar subjects. We detected 7939 and 10,561 compounds in BAL and paired plasma samples, respectively. FEV1/FVC (Forced Expiratory Volume in One Second/Forced Vital Capacity) ratio, emphysema, FEV1 % predicted, and COPD exacerbations associated with 1230, 792, eight, and one BAL compounds, respectively. Only two plasma compounds associated with a COPD phenotype (emphysema). Three BAL co-expression modules associated with FEV1/FVC and emphysema. K-means BAL metabolomic signature clustering identified two groups, one with more airway obstruction (34% of subjects, median FEV1/FVC 0.67), one with less (66% of subjects, median FEV1/FVC 0.77; p < 2 × 10−4). Associations between metabolites and COPD phenotypes are more robustly represented in BAL compared to plasma.

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Cost-Effectiveness of Combination Therapy for Chronic Obstructive Pulmonary Disease

Canadian Respiratory Journal ◽

10.1155/2008/257618 ◽

2008 ◽

Vol 15 (8) ◽

pp. 437-443 ◽

Cited By ~ 15

Author(s):

Anderson Chuck ◽

Philip Jacobs ◽

Irvin Mayers ◽

Darcy Marciniuk

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Cost Effectiveness ◽

Combination Therapy ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Life Years

BACKGROUND: There is evidence that combination therapy (CT) in the form of long-acting beta2-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.METHODS: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV1] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV1less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality-adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.RESULTS: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.CONCLUSION: Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV1worsens and reaches 50% of predicted values, CT is recommended.

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Diaphragm Ultrasound Distinguishes Exacerbation From Stable Status in Chronic Obstructive Pulmonary Disease

10.21203/rs.3.rs-445185/v1 ◽

2021 ◽

Author(s):

Tai Joon An ◽

Yeun Jie Yoo ◽

Jeong Uk Lim ◽

Wan Seo ◽

Chan Kwon Park ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Operating Characteristic ◽

Forced Expiratory Volume ◽

Diaphragm Muscle ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

The Status

Abstract Background: The importance of evaluating the diaphragm muscle in chronic obstructive pulmonary disease (COPD) is widely accepted. However, the role of diaphragm ultrasound (DUS) in COPD is not fully understood. We set this study to evaluate the role of DUS for distinguishing the status of COPD. Methods: COPD patients who underwent DUS were enrolled between March 2020 and November 2020. The diaphragm thickening fraction (TFmax) and diaphragm excursion (DEmax) during maximal deep breathing were measured. Patients were divided into exacerbation and stable groups. Demographics, lung function, and DUS findings were compared between the two groups. Receiver operating characteristic (ROC) curve and univariate/multivariate logistic regression analyses were performed.Results: Fifty-five patients were enrolled. The exacerbation group had a lower body mass index (BMI) (20.9 vs. 24.2, p = 0.003), lower TFmax (94.8 ± 8.2% vs. 158.4 ± 83.5%, p = 0.010), and lower DEmax (30.8 ± 11.1 mm vs. 40.5 ± 12.5 mm, p = 0.007) compared to stable group. The areas under the TFmax (0.745) and DEmax (0.721) curves indicated fair results for distinguishing exacerbation. The patients were divided into low and high TFmax and DEmax groups based on calculated cut-off values. Low TFmax (odds ratio [OR] 8.40; 95% confidence interval [CI] 1.55–45.56) and low DEmax (OR 11.51; 95% CI 1.15–115.56) were associated with exacerbation after adjusting for age, sex, BMI, forced vital capacity and forced expiratory volume in 1 sec.Conclusion: TFmax and DEmax distinguished exacerbation from stable status. We describe the DUS cut-off values for determining an exacerbation status in this study.

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EFEKTIVITAS TEKNIK PURSED LIPSBREATHING PADA PASIEN PENYAKIT PARU OBSTRUKSI KRONIK (PPOK): STUDY SYSTEMATIC REVIEW

Jurnal Kesehatan ◽

10.24252/kesehatan.v12i2.10180 ◽

2019 ◽

Vol 12 (2) ◽

pp. 137

Author(s):

Barakatul Qamila ◽

Maria Ulfah Azhar ◽

Risnah Risnah ◽

Muhammad Irwan

Keyword(s):

Systematic Review ◽

Respiratory Muscles ◽

Chronic Obstructive ◽

Inclusion Criteria ◽

Breathing Patterns ◽

Obstructive Pulmonary Disease ◽

Main Complaint ◽

Copd Patients ◽

Research Questions ◽

Quantitative Descriptive

Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases characterized by limited air flow contained in the respiratory tract. Breathing shortness becomes the main complaint feeling by COPD patients. Pursed lips breathing (PLB) technique can increase pulmonary compliance to retrain the respiratory muscles to function properly and prevent respiratory distress. This study aims to determine the effectiveness of pursed lips breathing technique in COPD patients. The research used a quantitative descriptive design with a systematic review approach. There were 315 articles published from 2015-2019. From 315 articles, 7 articles that met the inclusion criteria and research questions. Based on the result of the Systematic Review that has been conducted on pursed lips breathing technique in COPD patients, it was concluded that the PLB technique is effective to reduce breathing frequency and improve oxygen saturation. PLB technique given 3 times per day in every morning, afternoon, and evening with a time of 6-30 minutes for 3 consecutive days. The PLB technique is effective in reduce frequency respiratory and increase oxygenation in COPD patients with ineffective breathing patterns. Furthermore, it is suggested that PLB techniques can be applied as one of the nurses' independent interventions in nursing care for COPD patients to reduce patients complaints of breathing shortness.ABSTRAKPenyakit paru obstruksi kronik (PPOK) merupakan salah satu penyakit kronik yang ditandai dengan terbatasnya aliran udara yang terdapat di dalam saluran pernapasan. Sesak napas menjadi keluhan utama yang dirasakan oleh pasien PPOK. Teknik pernapasan pursed lips breathing (PLB) merupakan teknik pernapasan yang membantu meningkatkan compliance paru untuk melatih kembali otot pernapasan berfungsi dengan baik serta mecegah distress pernapasan. Penelitian ini bertujuan untuk mengetahui efektivitas teknik pursed lips breathing pada pasien PPOK. Penelitian menggunakan desain deskriptif kuantitatif dengan pendekatan systematic review. Terdapat 315 artikel yang dipublikasi dari tahun 2015-2019. Dari 315 artikel 7 artikel yang sesuai dengan kriteria inklusidan pertanyaan penelitian, dimana kriteria inklusi tersebut ialah artikel tahun 2015-2019 full text yang sesuai dengan topik penelitia yaitu teknik PLB pada pasien PPOK, terdapat ISSN dan atau DOI, artikel yang berfokus pada intervensi terapi Pursed Lips Breathing, artikel yang berfokus pada pemenuhan oksigenisasi dan frekuensi pernapasan sebagai alat ukur. Berdasarkan hasil Systematic Review yang telah dilakukan tentang teknik pursed lips breathing pada pasien PPOK disimpulkan bahwa teknik PLB efektif menurunkan frekuensi pernapasan dan meningkatkan pemenuhan oksigenisasi dalam tubuh. Dengan demikian pemberian latihan yaitu 3x sehari setiap pagi, siang, dan sore dengan waktu 6-30 menit selama 3 hari berturut-turut. Teknik PLB efektif dalam menurunkan frekuensi pernapasan dan meningkatkan pemenuhan oksigenisasi pada pasien PPOK dengan pola napas tidak efektif. Selanjutnya, disarankan teknik PLB dapat dijadikan sebagai salah satu intervensi mandiri perawat dalam melakukan asuhan keperawatan pada pasien PPOK untuk mengurangi keluhan sesak.

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