Penelitian

Efficacy of pursed-lips breathing: a breathing pattern

retraining strategy for dyspnea reduction.
Randomized controlled trial
Nield MA, et al. J Cardiopulm Rehabil Prev. 2007 Jul-Aug.
Show full citation
Abstract
PURPOSE: Breathing pattern retraining is frequently used for
exertional dyspnea relief in adults with moderate to severe
chronic obstructive pulmonary disease. However, there is
contradictory evidence to support its use. The study objective
was to compare 2 programs of prolonging expiratory time
(pursed-lips breathing and expiratory muscle training) on
dyspnea and functional performance.
METHODS: A randomized, controlled design was used for the
pilot study. Subjects recruited from the outpatient pulmonary
clinic of a university-affiliated Veteran Affairs healthcare center
were randomized to: 1) pursed-lips breathing, 2) expiratory
muscle training, or 3) control. Changes over time in dyspnea
[modified Borg after 6-minute walk distance (6MWD) and
Shortness of Breath Questionnaire] and functional performance
(Human Activity Profile and physical function scale of Short
Form 36-item Health Survey) were assessed with a multilevel
modeling procedure. Weekly laboratory visits for training were
accompanied by structured verbal, written, and audiovisual
instruction.
RESULTS: Forty subjects with chronic obstructive pulmonary
disease [age = 65 +/- 9 (mean +/- standard deviation) years,
forced expiratory volume 1 second/forced vital capacity % = 46
+/- 10, forced expiratory volume 1 second % predicted = 39 +/-
13, body mass index = 26 +/- 6 kg/m, inspiratory muscle
strength = 69 +/- 22 cm H2O, and expiratory muscle strength
(PEmax) = 102 +/- 29 cm H2O] were enrolled. No significant
Group x Time difference was present for PEmax (P = .93).
Significant reductions for the modified Borg scale after 6MWD
(P = .05) and physical function (P = .02) from baseline to 12
weeks were only present for pursed-lips breathing.
CONCLUSION: Pursed-lips breathing provided sustained
improvement in exertional dyspnea and physical function.
PMID 17667021 [PubMed - indexed for MEDLINE]
Arus Puncak Ekspirasi (APE) atau Peak Expiratory Flow atau ada
juga yang menyebut Peak Expiratory Flow Rate (PEFR) adalah
kecepatan ekspirasi maksimal yang bisa dicapai oleh seseorang,
dinyatakan dalam liter per menit (L/menit) atau liter per detik (L/
detik). Nilai APE didapatkan dengan pemeriksaan spirometri atau
menggunakan alat yang lebih sederhana yaitu peak expiratory flow
meter (PEF meter).
Alat ini mudah dibawa, tidak perlu sumber listrik dan harganya
relatif murah sehingga memungkinkan tersedia di berbagai tingkat
layanan kesehatan.
PEF meter
relatif mudah digunakan baik oleh dokter maupun penderita,
sebaiknya tersedia di rumah untuk memantau keadaan asmanya.
Nilai APE tidak selalu berkorelasi dengan hasil pemeriksaan faal
paru lainnya, selain itu APE juga tidak selalu berkorelasi dengan
derajat beratnya obstruksi. Karena itu pengukuran nilai APE
sebaiknya dibandingkan dengan nilai terbaik sebelumnya (bukan
nilai prediksi normal), kecuali tidak diketahui nilai terbaik penderita
yang bersangkutan.
Nilai prediksi normal faal paru setiap orang dipengaruhi oleh
banyak faktor seperti gender, tinggi badan, berat badan usia, ras,
dan lain-lain. Tim Pneumobile Project Indonesia pada tahun 1992
melakukan penelitian nilai faal paru rata-rata orang Indonesia.
Salah satu hasil penelitian tersebut adalah tabel nilai normal PEFR
orang Indonesia. Bila tidak tidak tersedia tabel tersebut, kita bisa
menggunakan rumus sebagai berikut:
Laki-laki: PEFR (L/dtk) = - 10,86040 + 0,12766 x
Umur + 0,11169 x TB - 0,0000319344 x Umur 3 +
1,70935
Perempuan: PEFR (L/dtk) = - 5,12502 + 0,09006 x
Umur + 0,06980 x TB - 0,00145669 x Umur 2 +
1,77692
Keterangan:
- Umur dengan satuan tahun, TB (tinggi badan) dengan satuan cm
- Bila menginginkan hasil dengan satuan L/menit, hasil
perhitungan dikali 60
Manfaat APE dalam diagnosis asma:
Reversibilitas, yaitu perbaikan nilai APE > 15%
setelah inhalasi bronkodilator (disebut uji
bronkodilator), atau bronkodilator oral 10-14 hari,
atau respons terapi kortikosteroid (inhalasi/oral
selama 2 minggu).
Variabilitas, menilai variasi diurnal APE yang dikenal
sebagai variabilitas APE harian selama 1-2 minggu.
Variabilitas juga dapat digunakan untukl menilai
derajad berat penyakit
http://etd.repository.ugm.ac.id/index.php?
mod=penelitian_detail&sub=PenelitianDetail&act=view&typ=html&buku_id=63462
PERBEDAAN ARUS PUNCAK EKSPIRASI
ANTARA ANAK ASMA DENGAN OBESITAS
DAN ANAK ASMA TANPA OBESITAS
Penulis
Nurul Hadi
Pembimbing: Dr. Maradina Julia, MPH, Ph.D, Sp.A(K)
Normal APE bila 80% nilai rata-rata
perkiraan dan tidak normal bila <80% nilai rata-rata perkiraan
(Polgar and Promadht, 1979) Analisi data dilakukan dengan uji chi-
square atau apabila syarat
http://pionas.pom.go.id/book/ioni-bab-3-sistem-saluran-napas/31-antiasma-dan-
bronkodilator
Eksaserbasi
asma sedang
Asma akut berat
pada dewasa dan
anak
Asma yang mengancam nyawa pada dewasa dan anak
Arus
puncak >
50-75% dari
nilai prediksi
atau nilai
terbaik

ARUS PUNCAK EKSPIRASI atau Peak

Expiratory Flow (PEF)
Arus Puncak Ekspirasi (APE) atau Peak Expiratory Flow atau ada
juga yang menyebut Peak Expiratory Flow Rate (PEFR) adalah
kecepatan ekspirasi maksimal yang bisa dicapai oleh seseorang,
dinyatakan dalam liter per menit (L/menit) atau liter per detik (L/
detik). Nilai APE didapatkan dengan pemeriksaan spirometri atau
menggunakan alat yang lebih sederhana yaitu peak expiratory flow
meter (PEF meter).
Alat ini mudah dibawa, tidak perlu sumber listrik dan harganya
relatif murah sehingga memungkinkan tersedia di berbagai tingkat
layanan kesehatan.
PEF meter
relatif mudah digunakan baik oleh dokter maupun penderita,
sebaiknya tersedia di rumah untuk memantau keadaan asmanya.
Nilai APE tidak selalu berkorelasi dengan hasil pemeriksaan faal
paru lainnya, selain itu APE juga tidak selalu berkorelasi dengan
derajat beratnya obstruksi. Karena itu pengukuran nilai APE
sebaiknya dibandingkan dengan nilai terbaik sebelumnya (bukan
nilai prediksi normal), kecuali tidak diketahui nilai terbaik penderita
yang bersangkutan.
Nilai prediksi normal faal paru setiap orang dipengaruhi oleh
banyak faktor seperti gender, tinggi badan, berat badan usia, ras,
dan lain-lain. Tim Pneumobile Project Indonesia pada tahun 1992
melakukan penelitian nilai faal paru rata-rata orang Indonesia.
Salah satu hasil penelitian tersebut adalah tabel nilai normal PEFR
orang Indonesia. Bila tidak tidak tersedia tabel tersebut, kita bisa
menggunakan rumus sebagai berikut:
Laki-laki: PEFR (L/dtk) = - 10,86040 + 0,12766 x
Umur + 0,11169 x TB - 0,0000319344 x Umur 3 +
1,70935
Perempuan: PEFR (L/dtk) = - 5,12502 + 0,09006 x
Umur + 0,06980 x TB - 0,00145669 x Umur 2 +
1,77692
Keterangan:
- Umur dengan satuan tahun, TB (tinggi badan) dengan satuan cm
- Bila menginginkan hasil dengan satuan L/menit, hasil
perhitungan dikali 60
Manfaat APE dalam diagnosis asma:
Reversibilitas, yaitu perbaikan nilai APE > 15%
setelah inhalasi bronkodilator (disebut uji
bronkodilator), atau bronkodilator oral 10-14 hari,
atau respons terapi kortikosteroid (inhalasi/oral
selama 2 minggu).
Variabilitas, menilai variasi diurnal APE yang dikenal
sebagai variabilitas APE harian selama 1-2 minggu.
Variabilitas juga dapat digunakan untukl menilai
derajad berat penyakit
http://www.klikparu.com/2013/07/arus-puncak-ekspirasi-atau-peak.html?m=1
Perbedaan Nilai Arus Puncak Ekspirasi
(APE) pada Pasien Asma dengan Terapi
Kortikosteroid Oral dan Inhalan
: Sunarto
: G0007160
: 2010
: Dr. Reviono dr.,Sp.P(K)
: Suyatmi dr,Mbiomed,Sci
: Yusup Subagio Sutanto dr.,Sp.P
: Margono dr.,M.Kes.
Hasil penelitian: Dari hasil analisis data yang dilakukan,
didapatkan nilai p > 0.05. Sehingga h0 diterima dan h1 ditolak.
Atau dengan kata lain tidak terdapat perbedaan nilai APE antara
pasien asma dengan terapi kortikosteroid oral dan inhalan.
Simpulan penelitian: Tidak terdapat perbedaan yang bermakna
perubahan nilai APE pada pasien asma dengan terapi
kortikosteroid oral dan inhalan.
http://fk.uns.ac.id/index.php/abstrakskripsi/baca/375
Peak Expiratory Flow (PEF)
Peak expiratory flow (PEF) or forced expiratory volume in one
second (FEV1) is used to guide treatment
The patient should monitored the PEF every morning before
taking medication
PEF > 80%, treatment is considered effective. Bronchodilators
are continued every 3-4 hours for next 48 hours, inhaled
corticosteroids are doubled from the usual dose for next 7-10
days. The provider should be contacted for follow-up within 3
days
PEF between 50-80% of personal best: the treatment is not
satisfactory. The effects of bronchodilators not sustained.
Continue with bronchodilator, add a corticosteroid, and contact
the provider
PEF < 50%: warrant a medical emergency. Repeat the
bronchodilator immediately and seek medical attention. The
emergency treatment will involve oxygen, bronchodilators, and
possible intravenous administration of corticosteroids
and adding an oral corticosteroid to the regimen
Asthma action plan, including use of peak flow meters to
assess the peak expiratory flow (PEF). The personal best is the
highest value that the patient can achieve. Zones are green
(80% or greater than personal best, which indicates good
control), yellow (50-80%, indicating a need to adjust therapy),
or red (under 50%- a medical emergency). Its important for
patients to know their PEF baseline and personal best

http://www.istudentnurse.com/pharm-class/copd/
European journal of physical and rehabilitation medicine (Impa
Factor: 1.95). 04/2014; 51(1).
Source: PubMed
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20082015 researchgate.net. All rights reserved.
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Pursed lip breathing improves exercise tolerance in
COPD: a randomized crossover study
European journal of physical and rehabilitation medicine (Impa
Factor: 1.95). 04/2014; 51(1).
Source: PubMed
L. Ferracini Cabral T. Da Cunha D'Elia
W. Araujo Zin Fernando S Guimaraes
ABSTRACT Although pursed-lip breathing (PLB) has been
advocated to reduce respiratory rate and improve oxygen
saturation in patients with chronic obstructive pulmonary disea
(COPD) at rest, the evidence of its effects on dynamic
hyperinflation (DH) and exercise tolerance is scarce.
To evaluate the effect of PLB on exercise tolerance, breathing
pattern, dynamic hyperinflation and arterial oxygenation in COP
patients during high-intensity exercise.
Randomized crossover study.
Laboratory of Respiration Physiology, Federal University of Rio
Janeiro. Population: Forty stable COPD patients aged 4075 yea
and with FEV1<60%.
In a randomized order, all patients performed PLB and control
breathing (CB) during constant workrate exercise in an electric
braked cycloergometer. Dynamic hyperinflation, oxygen saturat
and breathing pattern were recorded at rest, in isotime and in p
exercise.
The nine patients who increased their endurance time by more t
25% during PLB (6.422.36 vs. 10.513.83 min; p<0.05) were
considered as the IMPROVER sub-group. Compared to the NON
IMPROVER subgroup, these patients presented a lower expirato
peak flow EPF (40.28.6 vs 53.317.8 % predicted, p<0.05). T
ROC curve analysis of the EPF as a percentage of the predicted
values (%pred) was performed to identify cutoff values that had
greater sensitivity and specificity in differentiating between
IMPROVER and NON-IMPROVER. We observed 61% sensitivity
89% specificity with a 47.7% pred EPF. At isotime, PLB yielded
higher inspiratory capacity (IC) and oxygen saturation (1.190.
to 1.350.39 L; p<0.05 and 93.14.6 to 94.04.1%; p<0.05), a
lower respiratory rate than CB only in IMPROVER. NON-IMPRO
patients showed thoraco-abdominal asynchrony during PLB in
isotime. At peak exercise, PLB improved the arterial oxygenatio
IMPROVER, but there were no changes in the breathing pattern
the analyzed subgroups.
In COPD patients with low PEF, pursedlip breathing reduces
dynamic hyperinflation and improves exercise tolerance, breath
pattern and arterial oxygenation at submaximal intensity exerci
This study points to a possible application of PLB in a selected
group of COPD patients aiming at improving the exercise
tolerance. PEF measurements can help to indicate PLB for COP
patients.
www.researchgate.net/publication/261292410_Pursed_lip_breathing_improves_exerc
ise_tolerance_in_COPD_a_randomized_crossover_study

The Combined Effects of

Controlled Breathing Techniques
and Ventilatory and Upper
Extremity Muscle Exercise on
cardiopulmonary responses in
Patients with Spinal Cord Injury
Sutbeyaz, S. T., Koseoglu, B. F., & Gokkaya, N. K.
O. (2005). The combined effects of controlled
breathing techniques and ventilatory and upper
extremity muscle exercise on cardiopulmonary
responses in patients with spinal cord injury. Inter
J of Rehab Res, 28, 273-276.
Abstract
Rebecca Conklin
The exercise program was designed for
individuals with SCI and required the
participants to train 60 minutes a day, three
times per week, for 6 weeks. The exercise
program consisted of 15 minutes of
diaphragmatic breathing exercises combined
with pursed-lips breathing, 5 minutes of air-
shifting techniques, 10 minutes of voluntary
isocapneic hyperpnea, and arm crank exercise,
which was started at 75% of the maximum VO2
achieved during baseline maximum
cardiopulmonary exercise testing. The exercise
intensity was gradually increased to maximal
exercise as tolerated over the 6 weeks.
Measurements were taken at baseline and at
the end of the training program, which included
forced vital capacity (FVC), forced expiratory
volume in 1s (FEV1), forced expiratory flow rate
25-75% (FEF%25-75), peak expiratory flow rate
(PEF), vital capacity (VC), the ratio of FEV1 to
FVC, and maximum voluntary ventilation.
http://www.nchpad.org/389/2140/The~Combined~Effects~of~Controlled~Breathing
~Techniques~and~Ventilatory~and~Upper~Extremity~Muscle~Exercise~on~Cardi
opulmonary~Responses~in~Patients~with~Spinal~Cord~Injury