Clinical Observation Of Quantitative Resistance Exhalation And Pursed-lip Breathing In The Treatment Of COPD Combined With Type â…¡ Respiratory Failure During Stable Phase

BackgroundFollowing with the entry of human society into an aging period, smoking and worsening and expansion of air pollution, the morbidity and mortality of chronic obstructive pulmonary disease, asthma, lung cancer, and the incidence of pulmonary infection have seen a significant increase. Minor symptoms, such as cough and expectoration, affect breathing while severe symptoms lead to difficulty in breathing, hypoxia, or death due to respiratory failure. It is the third leading cause of death in city and leading cause of death in rural area. COPD is one of the common diseases of respiratory system and epidemiological study with more than 20,000 people coming from seven regions showed a COPD prevalence rate of 8.2% in people with the age above 40. Based on the prediction proposed by WHO, COPD will rise to be the third leading cause of death from its current being sixth leading cause of death by 2020 and which will become a severe public health problem and bring heavy social and economic burden. Reduction of incidence, extension of survival time and improvement in life quality are crucial issues facing physicians of respiratory department. Pulmonary rehabilitation training has always been a primary concern for clinical physicians.Till now, several successful respiratory rehabilitation researches in COPD patients using resistant exhalation, diaphragm pacing and pursed-lip breathing haven been reported. But these methods are not without their problems, for example, absence of specific protocol for resistant exhalation, diaphragm pacing, being a passive diaphragm exercise, requires coordination of active respiratory muscle training during in vitro pacing. Phrenic nerve is not easily excited with in vitro pacing and acceptance of invasive diaphragm pacing can be difficult. Pursed-lip breathing is easy and simple, but resistance during exhalation can not be controlled with accuracy. So new methods for respiratory rehabilitation training should be explored not only to effectively restore normal respiration, but also improve pathological changes due to hypoxia and carbon dioxide retention, as well as exercise tolerance level. As insufficiency of ventilation is the main cause of COPD combined with type II respiratory failure and intrinsic positive pressure in the end of exhalation is one of the reasons that leads to insufficiency of ventilation, we tried to make COPD patients combined with type II respiratory failure during stable phase undertake respiratory rehab training using quantitative resistance exhalation method. Preliminary results indicated that it was a simple and easy method with higher compliance. To further analyze the efficacy of such method, a perspective, controlled method was used to demonstrate its clinical efficacy.ObjectiveTo explore the effects of quantitative resistance exhalation and pursed-lip breathing on the treatment of patients with COPD combined with type II respiratory failure.To assess if quantitative resistance exhalation can achieve similar clinical effect with pursed-lip breathing.Methods60 COPD patients combined with type Ⅱ respiratory failure admitted to Angang General Hospital from Oct 2010 to Dec 2013 were selected and divided into two groups by randomized controlled trial. Every group had 30 individuals.The two groups were treated three times a day,once 30 minutes for 6 weeks with quantitative resistant exhalation(group A) and pursed-lip breathing(group B) methods for pulmonary rehabilitation and their clinical data, including age, gender and manifestations, blood gas analysis and results during pre- and post-treatment and six minutes walk test results and the results of pulmonary function were compared and retrospectively analyzed.Results1. the influence of pulmonary rehabilitation to pH,PaO2,PaCO2:The differentia of patients’ PaO2(54.2±3.6mmHg,57.1±2.6 mmHg), PaCO2 (67.3±3.5mmHg, 63.8±5.2 mmHg) were very significant (P< 0.05). and the differentia of patients’PH(7.325±0.013,7.324±0.012) was’t significant in group A before and after pulmonary rehabilitation respectively(P>0.05); The differentia of patients’ PaO2(54.5±3.7mmHg,56.9±2.7mmHg), PaCO2 (66.6±4.8mmHg,63.0±5.6mmHg) were very significant (P<0.05), and the differentia of patients’PH(7.324±0.012, 7.325±0.012) was’t significant in group A before and after pulmonary rehabilitation respectively(P>0.05).2. the influence of pulmonary rehabilitation to exercise tolerance:The patients’ 6MWD in group A after pulmonary rehabilitation (179.23±19.05m) was longer than that of patients before pulmonary rehabilitation (159.08±17.98m) (P<0.05); The patients’ 6MWD in group B after pulmonary rehabilitation (166.06±18.67m) was longer than that of patients before pulmonary rehabilitation (156.46±16.55m) (P< 0.05). The patients’ 6MWD in group A after pulmonary rehabilitation (179.23± 19.05m) was longer than the patients’6MWD in group B after pulmonary rehabilitation (166.06±18.67m) (P<0.05).3. the influence of pulmonary rehabilitation to pulmonary function:The patients’ MW (18.1±2.1L/min) in group A after pulmonary rehabilitation was higher than that of MVV(16.5±1.4L/min) in group A before pulmonary rehabilitation respective (P<0.05), and the differentia of PEF (0.69±0.09 L/s,0.72±0.08L/s)、FEV1 (0.57 ±0.09L,0.,60±0.08L)、FEV1%(28.9±3.3,29.9±3.5)、FEV1/FVC(27.7±3.4,28.9 ±3.7) were not significant in group A before and after pulmonary rehabilitation respectively (P>0.05); The patients’ MVV(18.2±2.3L/min) in group B after pulmonary rehabilitation was higher than that of MW (16.7±1.3L/min) in group B before pulmonary rehabilitation respective (P<0.05), and the differentia of PEF(0.68 ±0.09 L/s,0.71±0.09L/s)、FEV1 (0.58±0.07L,0.59±0.07L)、FEV1%(29.0 ±3.3,29.5±4.3)、FEV1/FVC (27.8±3.6,28.7±4.1) were not significant in group A before and after pulmonary rehabilitation respectively (P>0.05).ConclusionQuantitative resistance exhalation and pursed-lip breathing treatment can improve status of hypoxia and carbon dioxide retention in COPD patients with type II respiratory failure. Besides, quantitative resistant exhalation method can improve patients exercise tolerance. Quantitative resistance exhalation level to achieve rehabilitation pursed-lip breathing. According to the patient’s differ levels of intrinsic positive end-expiratory pressure,we can render a fixed level of expiratory resistance. Compared with pursed-lip breathing, the patient can be given extrinsic positive end-expiratory pressure on more accurate and stable level, to prevent overload of breath. Quantitative resistance exhalation is a convenient, simple, safe and effective method with higher patient compliance and easy clinical application and promotion.