1. BELLARMINE UNIVERSITY, LOUISVILLE, KY Among persons with COPD, is pursed lip breathing or diaphragmatic breathing a more effective technique to improve symptoms and efficiency of breathing? Meredith Alvey, Abby Naville, Alex Piedmonte, Lauren Speelman

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY Factors Analyzed Respiratory rate Work of breathing Dyspnea Oxygen

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY Breathing Techniques www.st-joseph.kramesonline.com Pursed Lip Breathing Diaphragmatic Breathing www.my.clevelandclinic.org

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY Respiratory Rate Pursed Lip Breathing Slowed breathing frequency from 17.3 to 12.8 (Jones, 2003) Lowers oxygen costs (Jones, 2003) Increased tidal volume (Gosselink, 2004) Diaphragmatic Breathing Slowed breathing frequency from 17.3 to 15 (Jones, 2003) Increase in tidal volume (Vitacca, 1997)

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY Work of Breathing Pursed Lip Breathing Often adopted naturally (Dechman, 2004) Utilizes the subject’s natural inspiratory breathing pattern (Jones, 2003) Diaphragmatic Breathing Causes respiratory muscle fatigue (Gosselink, 2004) Decrease in mechanical efficiency (Dechman, 2004; Gosselink, 1995)

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Oxygen Pursed Lip Breathing Improves oxygen saturation in resting conditions (Gosselink, 2004) No improvements in blood gases with exercise (Gosselink, 2004) Decreased oxygen consumption compared to spontaneous breathing (Jones, 2003) –164.8 mL/min Diaphragmatic Breathing Partial pressure of oxygen increased (Vitacca, 1997) Decreased oxygen consumption compared to spontaneous breathing (Jones, 2003) –165.8 mL/min

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Dyspnea Pursed Lip Breathing Two articles reported improvements Diaphragmatic Breathing Three studies stated dyspnea increased with this technique Visual analog scale (Vitacca, 1997) –33 to 54

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Scoreboard Pursed Lip BreathingDiaphragmatic Breathing Resipiratory Rate Work of Breathing Oxygen Consumption Dyspnea

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusion Pursed lip breathing is supported over diaphragmatic breathing Carryover effect Future studies needed

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY COPD Support Groups http://betterbreathers.freeservers.com/groups.h tmhttp://betterbreathers.freeservers.com/groups.h tm

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Questions? www.en.hdyo.org

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY References 1.Dechman G, Wilson C. Evidence Underlying Breathing Retraining in People With Stable Chronic Obstructive Pulmonary Disease. Physical Therapy [serial online]. December 2004;84(12):1189-1197. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 24, 2013 2.Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease (COPD). Chronic Respiratory Disease [serial online]. 2004;1(3):163-172. Available from: MEDLINE, Ipswich, MA. Accessed October 24, 2013 3.Gosselink R, Wagenaar R, Rijswijk H, Sargeant A, Decramer M. Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease. American Journal Of Respiratory And Critical Care Medicine [serial online]. April 1995;151(4):1136-1142. Available from: MEDLINE, Ipswich, MA. Accessed October 24, 2013 4.Jones A, Dean E, Chow C. Comparison of the Oxygen Cost of Breathing Exercises and Spontaneous Breathing in Patients With Stable Chronic Obstructive Pulmonary Disease. Physical Therapy [serial online]. May 2003;83(5):424-431. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 24, 2013. 5.Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency. The European Respiratory Journal [serial online]. February 1998;11(2):408-415. Available from: MEDLINE, Ipswich, MA. Accessed October 24, 2013.