Chronic obstructive pulmonary disease is combinations of disorders which is not fully reversible. There are two disease conditions that occurs in chronic obstructive pulmonary disease. i.e. emphysema and chronic bronchitis. Chronic bronchitis is the inflammation of the bronchial tubes which carry the air to and from the lungs. In emphysema there is damage to the walls of the alveoli of the lungs [1].

People suffering from chronic obstructive pulmonary disease are due to the workplace pollution, environmental pollution, industrial gases or cooking fumes. The risk factor for chronic obstructive pulmonary disease is long-term cigarette smoking. Pipe smokers, cigar smokers and marijuana smokers or second-hand smokers are also at the risk. Alpha-1-antitrypsin deficiency is also responsible for chronic obstructive pulmonary disease in young age [2].

Signs and symptoms of chronic obstructive pulmonary disease may include shortness of breath especially during physical activities, wheezing or Chest tightness. A chronic cough is produced and it is clear, white, yellow or greenish. Weight loss and frequent respiratory infections are also occurring in the people with chronic obstructive pulmonary disease [3].

Breathing exercises has been an essential part of a comprehensive pulmonary rehabilitation program, for Chronic obstructive pulmonary disease patients. Many types of breathing exercises such as slow and deep breathing, pursed-lip breathing, diaphragmatic breathing, and huff cough, have been prescribed to decrease lung hyperventilation, enhance respiratory muscle function, exercise tolerance in COPD patients. These breathing exercises have been used individually, or in combination of different types of breathing exercises [4,5]. The effect of respiratory muscle exercises on decreasing shortness of breath (dyspnea) in patients with chronic obstructive pulmonary disease at the centre for community lung health (BBKPM) Surakarta (Indonesian) [5-8].

Objectives of the Study

• To assess the difficulty in breathing among patient admitted with chronic obstructive pulmonary disease at Indira Gandhi Medical College and Hospital Shimla (H.P.)

• To demonstrate deep breathing exercises to patient admitted with chronic obstructive pulmonary disease at Indira Gandhi Medical College and Hospital Shimla (H.P.)

• To evaluate the effectiveness of deep breathing exercises among patients admitted with chronic obstructive pulmonary disease

•  To find out the association of breathing difficulty with their selected demographic variables in experimental and control group

• Research Approach: Quantitative research approach 

• Research Design: Quasi experimental research design

• Setting of the Study: Indira Gandhi Medical College and Hospital Shimla (H.P.)

• Study Population: Patients admitted with COPD 

• Sample Size: About 60

• Sampling Technique: Purposive sampling technique

• Informed Consent: Informed consent was taken from COPD patients

Inclusion Criteria

Both male and female patients suffering from chronic obstructive pulmonary disease who were willing to participate in the study and able to understand English/Hindi.

Exclusion Criteria

Patient who were critically and terminally ill, blind deaf and dumb with altered sensorium and mentally ill patients were not included in the study.

Description of Tool

The research tool was taken after literature review and expert’s opinion. Standardized Modified Borg dyspnoea scale was used for the breathing assessment:

• Validity of Tool: Consent validity was done by experts in the field.

• Permission: Obtained from the concerned authority of the hospital.

The data was divided into followings main sections:

• Section I: Findings related to percentage distribution of sample characteristics

• Section II: Findings related to assessment of pre-test and post-test level of breathing difficulty among patients admitted with COPD at IGMC Shimla in experimental and control group

• Section III: Findings related to effectiveness of deep breathing exercises among patients admitted with COPD at IGMC Shimla

• Section IV: Findings related to association of level of breathing difficulty with their selected demographic variables in experimental and control group

Section I

Findings related to percentage distribution of sample characteristics.

Table 1 depicts the sociodemographic variables of breathlessness among COPD patients in experimental and control group at I.GM.C.H Shimla, H.P. There were 60 sample (N) and divided into two groups i.e., experimental group (n = 30) and control group (n = 30).

According to age, majority of patients in experimental and control group,   56.7% were in the age group of >60 years.

As per gender, in experimental and control group majority of subjects i.e. 53.3% were male and 46.7% were females.

According to educational status in experimental group, majority of patients 53.3% had secondary education. And in control group, 40.0% had secondary education:

• As per occupational status, in experimental group majority of patients 66.7% were unemployed. While in control group 50% were unemployed. And according to marital status, in experimental and group, 83.3% were married

• As per monthly income of family, in experimental group 40% were <5000. In control 36.7% were >20,000 income

• Majority of patients in the experimental group 63.3% and in control group 56.7% patients were the habits of smoking

• Regarding the dietary pattern, in experimental group, majority of 66.7% and in control group 53.3% patients were non vegetarian

According to family history of chronic obstructive pulmonary disease, in experimental group 80% and in control group, 90% patients not had the history of COPD.

As per Duration of illness, in experimental group, 56.7% had <1 year of illness,  in control group, 66.7%) had <1 year of illness.

And as per treatment of chronic obstructive pulmonary disease, in experimental 76.7% and in control group 73.3% had taking the regular.

Table 1: Socio-Demographic Variables of COPD Patients

Section II

Findings related to assessment of pre-test and post-test level of breathing difficulty among patients admitted with COPD at IGMC Shimla in experimental and control group.

Table 2 depicts that in pre-test, experimental group majority of 83.3% of COPD patients had severe breathlessness, 10% had moderate breathlessness and 6.7% had mild breathlessness. None of the subject in the experimental group had very severe and maximal breathlessness. In control group 73.3% of COPD patients had severe breathlessness, 26.7% had moderate breathlessness. None of the subject in the control group had mild, very severe and maximal breathlessness.

Table 2:   Frequency and Percentage Distribution of Pre-Test Breathing Difficulty among COPD Patients Admitted at IGMC Shimla in Experimental and Control Group

Table 3 depicts that in post-test, experimental group majority of 23.3% of COPD patients had severe, 63.3% had moderate and 13.3% had mild breathlessness. In control group 76.7% of COPD patients had severe breathlessness, 20 % had moderate breathlessness and 3.3% had mild breathlessness.

Table 3: Frequency and Percentage Distribution of Post-Test Level of Breathlessness among COPD Patients Admitted at IGMC Shimla in Experimental and Control Group

Table 4 depicts that in pre-test of experimental group 83.3% had severe, 10% had moderate and 6.7% had mild breathlessness. In pre-test control group, 73.3% had severe and 26.7% had moderate breathlessness.

Table 4:   Frequency and Percentage Distribution of Pre-Test and Post-Test Level of Breathlessness among Patients Admitted with COPD in Experimental and Control Group

Section III

Findings related to effectiveness of deep breathing exercises among patients admitted with COPD at IGMC Shimla.

Table 5 reveals that by using paired t test, it was found that there is significant change in post-test level of breathlessness in experiment group with t value 14.699 with degree of freedom 29, which is significant at <0.05 level of significance.  While paired t test was not significant for pre and post-test level of breathlessness in control group where t value 1.720 with degree of freedom 29, which is not significant at <0.05 level of significance. 

Similarly, by using unpaired t test, it is found that, there was no significant difference between pre-test level of breathlessness score of experimental and control group at t value 0.519 with degree of freedom 58 but there is significant difference in post-test level of breathlessness score of experimental and control group at t value 4.570 with degree of freedom 58.

Table 5:   Comparison within the Group with Paired ‘t’ Test and Comparison between the Groups with Unpaired ‘t’ Test Regarding Effectiveness of Deep Breathing Exercises on the level of Breathlessness 

*Level of significance <0.05

Section IV

Findings related to association of level of breathing difficulty with their selected demographic variables in experimental and control group. The study results showed that there was no significant association of level of breathing difficulty with their selected demographic variables in experimental and control group.

In the present study. It was found in pre-test, experimental group majority of 83.3% of COPD patients had severe, 19% had moderate and 6.7% had mild breathlessness. In control group 73.3% of COPD patients had severe and 26.7% had moderate breathlessness.

In post-test, experimental group majority of 23.3% of COPD patients had severe, 63.3% had moderate and 13.3% had mild breathlessness. In control group 76.7% of COPD patients had severe, 20 % had moderate and 3.3% had mild breathlessness.

By using paired t-test, it was found that there is significant change in post interventional level of breathlessness and with decrease in pre-test mean score i.e. 7.23 to 5.53 post-test at table value 17.405 with degree of freedom is 29. Standard deviation was 1.357 in pretest while in post-test, it become 1.279.

The findings revealed that there is significant effect of deep breathing exercises to reduce the difficulty in breathing among COPD patients.

The study results shows that there is no significant association between the level of breathlessness score and socio-demographic variables in experimental and control group.

In pre-test, experimental group majority of 83.3% of COPD patients had severe breathlessness, and in control group 73.3% of COPD patients had severe breathlessness, in post-test, experimental group majority of 23.3% of COPD patients had severe breathlessness and control group 76.7% of COPD patients had severe breathlessness. Hence findings revealed that breathing difficulty is reduced in COPD patients after the interventions of deep breathing exercises.

Future Implications 

This study considered the situation in the government hospital only. Future studies should be conducted to assess the effectiveness in the community area also. A pre-experimental study can be done to assess the knowledge and attitude of nursing officers regarding breathing exercise in reducing breathing difficulty among patients with chronic obstructive pulmonary disease.

Acknowledgment 

The author acknowledges all the teachers for their valuable suggestions and support.

Ethical Approval

Research proposal was approved by the research ethical committee prior to the pilot and main study. Official permission was sought from the ethical committee of S.N.G.N.C, I.G.M.C.H, Shimla (H.P). After that the permission was sought from the Medical Superintendent I.G.M.C.H, Shimla (H.P).

1. World Health Organization. “Chronic respiratory diseases: chronic Obstructive Pulmonary Disease (COPD): definition.” World Health Organization, http://www.who.int/respiratory/copd/en. Accessed February 2020.

2. Global Initiative for Chronic Obstructive Lung Disease. “Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2021 report.” GOLD, 2021, https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.0-16Nov20_WMV.pdf. Accessed March 2020.

3. World Health Organization. “Chronic Obstructive Pulmonary Disease (COPD).” World Health Organization, 2017, https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd). Accessed March 2020.

4. Vitaloka, A.G. The effect of respiratory muscle exercises on decreasing shortness of breath (dyspnea) in patients with chronic obstructive pulmonary disease at the centre for community lung health (BBKPM) Surakarta (Indonesian). PhD dissertation, Universitas Muhammadiyah Surakarta, 2015.

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8. Charususin, N. et al. “Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: A review.” Expert Review of Respiratory Medicine, vol. 12, no. 1, 2018, pp. 67–79.