COPD: breathing exercises yield multiple benefits in meta-analysis

Takeaway

• Breathing exercises improve ventilation (including respiratory rate and tidal volume) and QoL, but fail to improve dyspnoea in COPD, according to a small meta-analysis of randomised controlled trials.

Why this matters

• Clinicians should consider recommending breathing exercises more aggressively to patients with COPD, bearing in mind the low to moderate evidence quality.

Study design

• Meta-analysis of 19 trials (n=745) identified from a search of MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect.
• Evidence quality and risk for bias were assessed by 2 methods, including Grading of Recommendation Assessment, Development, and Evaluation (GRADE).
• Funding: Thailand Research Fund; others.

Key results

• Respiratory rate was improved by:
  • Pursed-lip breathing vs control (P<.00001).
  • Ventilatory feedback plus exercise vs control (P=.0002).
  • Diaphragmatic breathing exercise vs control (P=.05).
  • Combined breathing exercises vs control (P<.00001).
• Pursed-lip breathing vs control also increased:
  • Tidal volume (P=.0004).
  • Inspiratory time (P=.007).
  • Total respiratory time (P=.0004).
• Ventilatory feedback plus exercise vs control also increased inspiratory capacity (P=.0007).
• Singing vs control improved the physical component of QoL (P=.0005).
• All breathing exercises failed to improve dyspnea.

Limitations

• Quality of evidence by 2 methods was low to moderate.
• Small number of studies, participants.