| Chronic obstructive pulmonary disease（COPD）is a chronic inflammatory lung disease,which is characterized by cough,sputum production and breathlessness.For COPD patients,a large amount of purulent secretions from repeated airway infections will further aggravate the disease,causing more respiratory symptoms and severe airflow obstruction,even death.Therefore,reducing airway inflammation and expectoration is particularly important for COPD patients.Active cycle of breathing technique（ACBT）can be used alone or supplemented with other techniques to expectoration,but the effectiveness of active cycle of breathing technique have mixed results.Actually,we deem that eliminating lung inflammation so that it no longer produces sputum is as important as expectoration.Phonophoresis has anti-inflammatory effects and can significantly reduce inflammatory reactions.So,we will combine ACBT with phonophoresis by nurses to improve respiratory symptoms,quality of life,as well as patients,anxiety.Objective:At present,the effect of ACBT is controversial,and thick sputum is also unresolved in COPD patients.There is no complete and effective sputum management intervention program for patients with COPD.Therefore,our study has developed a program combining ACBT and phonophoresis to explore effectiveness and safety on COPD patients.The aim of our study is to evaluate the efficacy of a program combining ACBT and phonophoresis on sputum viscosity,sputum production,lung function,blood oxygen saturation,quality of life and anxiety in patients with COPD.And to provide new strategies and methods for the treatment and development of COPD patients.Methods:This was a three-arms,parallel randomized controlled trial that screened 959COPD patients hospitalized in a department of respiratory medicine in Changchun,China.After inclusion and exclusion criteria,75 patients were finally determined and randomly divided into three groups.Participants in the intervention group performed the week-long nurse-led program combining ACBT and phonophoresis.The control groups will be treated with active cycle of breathing techniques and phonophoresis,respectively.The primary outcomes include sputum viscosity,sputum production,lung function,and blood oxygen saturation.The secondary outcome were quality and anxiety.Sputum viscosity measured by NDJ-1 viscometer,sputum production measured by calibrated containers,lung function measured by Spirometer,blood oxygen saturation measured by pulse oximeter,quality of life measured by COPD assessment test scale（CAT）and anxiety measured by Anxiety Inventory for Respiratory Disease scale（AIR）at baseline and after intervention.The analyses were conducted using SPSS software（version 26.0）and STATA 16.0.Hypothesis tests were 2-sided with P<0.05 considered statistically significant.Results:1.This study included 75 COPD patients,including 31 males and 44 females,with an average age of 55.06±12.16 years old.There were no difference in the baseline of sputum viscosity,FEV1/FVC,vital capacity,blood oxygen saturation,COPD assessment test scale and Anxiety Inventory for Respiratory Disease scale（P>0.05）.2.After week-long program,sputum viscosity,FEV1/FVC,vital capacity,the scores of COPD assessment test scale and Anxiety Inventory for Respiratory Disease scale were significantly improvement than baseline in these three groups（P<0.05）.And there were insignificant difference in blood oxygen saturation among ACBT patients（P>0.05）.The blood oxygen saturation of the other two groups was significantly improved（P<0.05）.3.After adjusted by a general linear model or generalized linear model,the three groups had significant differences in sputum viscosity,sputum production,lung function,blood oxygen saturation and quality of life（P<0.05）.There was no significant difference between the groups in the and anxiety（P>0.05）.The length of hospital stay,hospital cost and improvement,satisfaction,and completion of the intervention among these three groups were also not statistically significant（P>0.05）.4.The patients in the ACBT plus phonophoresis group were significantly better than the other two groups in terms of sputum viscosity,FEV1/FVC,and vital capacity（P<0.05）.And there were significantly improved in blood oxygen saturation and COPD assessment test scale scores than ACBT group（P<0.05）.There were no significant differences in sputum production and Anxiety Inventory for Respiratory Disease scale scores between groups（P>0.05）.And no adverse events occurred during the research.5.Different from the main analysis results,the intention analysis results showed that there was no significant difference in the quality of life of the three groups of patients（F=2.99,P=0.057）,and the hospital cost were significantly different between the groups（Z=6.759,P=0.034）.Sensitivity analysis showed that there was no significant difference in demographic characteristics between the population who did not complete the intervention plan and the population who completed the intervention,only in terms of marital status（χ2=-2.35,P=0.019）.Conclusions:The nurse-led combination of ACBT and phonophoresis can significantly improve the sputum viscosity,lung function,blood oxygen saturation and quality of life among patients with COPD,and reduce the anxiety.Compared with ACBT or phonophoresis,the nurse-led program combining ACBT and phonophoresis has a more significant effect in improving the sputum viscosity,sputum production,lung function,blood oxygen saturation of COPD patients.However,the effectiveness of quality of life,anxiety and cost-effectiveness are not significant compared to a single measure.No adverse events occurred during our study,and patients also preferred to use ACBT combined with phonophoresis to improve their symptoms.The nurse-led program combining ACBT and phonophoresis seems to be safer and more effective to accept for COPD patients. |
