Community Application And Effect Evaluation Of Three-ball Breathing Trainer Based On Family Physician Contract Service In Stable Chronic Obstructive Pulmonary Disease

Objective In recent years,pulmonary rehabilitation in patients with chronic obstructive pulmonary disease（COPD）has received increasing attention,but there is no quantitative standard for routine labial reduction and abdominal breathing exercise.This study aims to conduct community pulmonary rehabilitation management for patients with stable COPD with the help of a three-ball breathing trainer on the basis of contracted services by the family doctor team,evaluate the curative effect of community pulmonary rehabilitation by observing changes in pulmonary function and quality of life,and meanwhile improve patients’understanding of the disease and self-pulmonary rehabilitation awareness.To explore the application effect of the community"respiratory expert-family doctor-family"disease management model in COPD pulmonary rehabilitation with the support of medical conjoined respiratory medicine experts and the family doctor team as the intermediate bridge,so as to provide a theoretical basis for the optimization of respiratory muscle function exercise plan.Methods1.From a community health service center in Shanghai in the outpatient doctor workstation to choose between December 2013 and March 2019 period patients information,screening of GOLD guide 2018 COPD diagnosis standard,and live for a long time in the community has been signing plateau COPD patients as the research object,according to the computer random number table is divided into control group and observation group,according to the distribution of 1:1.The control group received at least6 months of routine labial and abdominal breathing exercises under the management of the family physician team;The participants in the observation group were combined with a three-ball breathing apparatus on the basis of breathing exercise in the control group for at least 6 months.2.Through the literature^[1]access to regular lip abdominal breathing exercise and use three ball breathing exercise training FEV1 of mean and standard deviation,respectively（1.38±0.26）and（1.53±0.21）L,it is concluded that combination of the standard deviation S is 0.24,this study set alpha=0.05,and hope to have 80%confidence（1-beta）found that the real differences between the groups,according to the formula Nc=(μ_1-α/2+μ_1-β)²S ²（1+1/k）/（μ_o-μ_c）²calculated for 41 cases in the control group,A total of 82 cases were assigned to the two groups according to 1:1.3.The family doctor team will conduct telephone follow-up every 2 weeks（including exercise guidance,follow-up appointment,vaccination reminder,etc.）to supervise whether the subjects do breathing exercise as required;Respiratory specialists were invited to conduct health knowledge training for the subjects every 3 months.Two groups respectively,6 months prior to the group into the determination of main indicators lung function（FEV1,FEV1%pred,FEV1/FVC%,IC,PEF,MMEF）,chronic obstructive pulmonary disease score（CAT）,ST George’s respiratory questionnaire（SGRQ）scale to evaluate the quality of life,6 minutes walking distance（6MWDS）assessment exercise capacity,improve the British medical association for the study of assessment scale（MRC）m.dyspnea breathing difficulties.The differences between the two groups and the components before and after were analyzed to explore the effects of three-ball breathing apparatus on respiratory muscle function exercise under the disease management mode of"respiratory specialist-family doctor-family".4.Before the study,the center’s family doctors were investigated on the cognition of COPD pulmonary rehabilitation,and the medical consortium respiratory medicine experts were invited to carry out interpretation of global COPD Initiative Guidelines（GOLD）and pulmonary rehabilitation knowledge training,so as to improve the family doctors’COPD community management ability.5.After the end of the study,the satisfaction of the observation group was assessed with the satisfaction questionnaire of the community application of the three-ball breathing trainer,so as to provide reference advice for the optimization of the breathing exercise program.6.All the questionnaires were sorted out and numbered,and EXCEL was used to establish a database.SPSS19.0 statistical software was used for statistics and analysis of all the data.Results There was no statistical difference between FEV1 in the control group and that of the former treatment（P>0.05）.The indexes of FEV1,FEV1、FEV1%pred、PEF in the observation group were improved and higher than those in the control group,with statistically significant differences（P<0.05）.There was no significantly difference in the results of SGRQ,m MRC and 6MWD in the two groups of the former treatment（P>0.05）.After treatment,the scores of SGRQ and m MRC has decreased in two groups.Meanwhile,the scores in the observation group were lower than those in the control group.However,6MWD was prolonged in both groups.And it was longer in the observation group than that of the control group,with statistically significant differences（P<0.05）.Conclusion According to the disease management model about"respiratory experts-family doctor-COPD family"in the community,the three-balls breath training device can effectively relieve short-breath symptom,improve activity restriction and decrease the influence of COPD on daily activity among COPD patients in stable stage.However,it seems to be less effects of lung function improving and its related indexes,which may relates to the time length of observation so that we should encourage patients to take part in again and revalue the three-balls breath training device in lung function improving process.