Effectiveness Active Cycle of Breathing Technique (ACBT) with Pursed Lips Breathing Technique (PLBT) to tripod position in increase oxygen saturation

EnfermClin.2020;30(S5):164---167

www.elsevier.es/enfermeriaclinica

Effectiveness Active Cycle of Breathing Technique (ACBT) with Pursed Lips Breathing Technique (PLBT) to tripod position in increase oxygen saturation

in patients with COPD, West Sumatera ^夽

Zuriati Zuriati

^a,∗

, Melti Surya

^b

, Zahlimar

^c

aBinawanUniversityJakarta,Indonesia

bSTIKesAlifahPadang,Indonesia

cAkperSetihSetioMuaroBungoJambi,Indonesia

Received25September2019;accepted11November2019

KEYWORDS COPD;

Tripodposition;

ActiveCycleof Breathing;

Pursedlipsbreathing

Abstract ChronicObstructivePulmonaryDisease(COPD)isachroniclungdisease characte- rizedby obstructionorobstructionofairflowinareversibleorpartialnonreversibleairway.

DyspneaisacommonsymptominCOPDsufferers;thiscancauseproblemswithoxygensatura- tion,ortheoxygensaturationvalueisbelownormal.Non-pharmacologicalactionsgiveninthe formofbreathingexercisescanbedonebyanursetohelpreduceshortnessofbreathinCOPD patients.Theexerciseisgivenbyadjustingtherestingpositionthatiscomfortableandcom- fortablesothattheextrabreathmusclescanworkwell.Thepositionthatcandotheposition ofthetripodwithActiveCycleofBreathingandPursedlipsarebreathingsothatshortnessof breathisreducedandSaO2canhaveincreasedsothatmoreoxygenhasobtainedinLungHos- pital,WestSumatra.Thisresearchisquantitativeresearch,withquasi-experimentalresearch methods.Theyusedtwopre-test-posttestdesigngroups.Thesampleinthisstudyamounted to30peoplewithquotasamplingtechnique.Inthisstudyshowedthattherewasadifference intheincreaseinoxygensaturationofCOPDpatientswhichwaseffectiveinthetripodposi- tiongroupwithActiveCycleBreathingTechnique(ACBT)withap-valueof0.00whileinthe tripodpositiongroupwiththeActiveRespiratory andLipCycletherewasadifferenceofp- value0.023.IthasconcludedthatthetripodpositionwithACTandPBLTcouldincreaseoxygen saturationandnasalbreathlessnessreduced,butthetripodpositionwithACTismoreeffective

夽 Peer-reviewunderresponsibilityofthescientificcommitteeofthe3rdInternationalConferenceonHealthcareand AlliedSciences (2019).Full-textandthecontentofitisunderresponsibilityofauthorsofthearticle.

∗Correspondingauthor.

E-mailaddress:zuriati3781@gmail.com(Z.Zuriati).

https://doi.org/10.1016/j.enfcli.2019.11.046 1130-8621/PublishedbyElsevierEspa˜na,S.L.U.

EffectivenessACBTwithPLBTtotripodpositioninincreaseoxygensaturationinpatients 165 inCOPpatientsbecausewithchronicrespiratorypatientswhoareshortofbreathduetosputum buildup,thenwithACTwillcleantheairwayandtheflowoftheroadeffectivebreathingso thatshortnessofbreathhavereducedandoxygensaturationincreases. Furthermore,ithas recommendedthatinhospitals,especiallynurses,indealingwithCOPDpatientsinadditionto thecorrectpositionofbreathingexerciseswithACTtohelppatients.

PublishedbyElsevierEspa˜na,S.L.U.

Introduction

Chronic obstructive pulmonary disease (COPD) is a com- mondiseasethatisbothtreatableandpreventable.¹Ithas characterizedbyprogressiveairflowlimitationandhyperin- flation,associatedwithshortnessofbreathordyspneaand altered respiratory patterns, which become progressively worse andare themain cause ofmorbidity and mortality globally.²

COPDisacommonpulmonarydiseaseworldwideandis characterizedbyprogressivelypersistentairflowlimitation.

COPD will be the seventh leading cause of disability- adjusted life yearsand thefourth leading causeof death in 2030. Daily symptoms such as chronic and progressive dyspnea,cough,andsputumproductiondeservetheblame for the burden and lead to activity limitation and, ulti- mately,COPDpatients’ inability toworkand take careof themselves.Someofthesefactorsareamenabletoexercise trainingincorporatedasamajorcomponentofapulmonary rehabilitation(PR)program.

Ifitinvolvesextensivedamagetothelungparenchyma, the client will usually experience shortness of breath, increasedbreath frequency, andusing breathingmuscles.

Shortnessof breathoccursdue toconditionsofimperfect lungdevelopment(atelectasis)wheretheaffectedpartof the lung does not contain air or collapse, this can cause problemswithoxygensaturation,ortheoxygensaturation valueisbelownormal.

Body and breathing positioning techniques are phys- iotherapy techniques commonly used to relieve dyspnea.

Overcoming dyspnea is an important goal of COPD treat- ment,someconventionaltreatmentsthatcanbegivensuch asbronchodilatortherapy, exercisetraining, oxygenther- apy,breathingcontrolexercises,whicharealsoappliedto reduce the degree of dyspnea. Breath control is a term thatcoversallrangesforexercise,activeexpiration,slow anddeepbreaths, breathingwhilepursing lipstechniques (PLBT),relaxationtherapy,certainbodypositions,inspiring muscleexercises,andabdominalbreathing.³

Handlingoftheairwaycleansingandshortnessofbreath can have done by administering bronchodilators, supple- mentaloxygenpharmacologicallywhileasanurseproviding a nursing interventionwith non-pharmacology,one of the actionsisbyadjustingthepositionandbreathingexercises.

TheexactpositiongiventoCOPDpatientsisatripodposition withtheadditionof ActiveCycleof BreathingTechniques (ACBT) and Pursed Lips Breathing Technique (PLBT) with thiscombinationtoovercometheairwayclearancesothat shortnessofbreathhasreducedandoxygensaturationcan increasecanbeincreasedwithoxygenobtainedmore.

Method

This research is a quantitative study with a quasi- experimental design. Two experimental groups were classified;thefirstgroupusedatripodpositionwiththrust lipbreathingexercises andthetwotripodpositiongroups withan activebreathingcycle,andthen theauthorscon- ductedapretestandposttestaftertheinterventiongiven, thisresearchconductedattheLungHospitalinWestSuma- train2019. Thepopulationin thisstudywereallpatients with accidental sampling COPD, totaling 30 respondents.

Datacollectionhave donethroughdirectobservation.The dependentvariableinthisstudywasanincreaseinoxygen saturation,andtheindependentvariablewastheposition ofatripodwithpursedlipsandanactivebreathingcycle.

Dataanalysiswascarriedoutunivariatelyineach variable andbivariatewithaparametricpairedT-test.

Result

BasedonTable1,ithasshownthatmeanscoreofpre-testsin TripodACBTgroupis88.27andpost-test90.13.Theresultof statisticaltestwitht-independenttestisp=0.000(p>0.05), meaningthatthereissignificantdifferencebetweenOxygen SaturationbeforetreatmentbothintheTripodACBTgroup.

Discussion

The results of the study proved that there was a differ- ence in the increase of SaO2 between before and after the administration of the tripod position with the Active CycleofBreathingTechniques(ACBT)p-value=0.00andthe tripod position with the Pursed Lips Breathing Technique (PLBT)p-value0.023.T-testresults,whichmeangivingatri- podpositionwithTheActiveCycleofBreathingTechniques (ACBT)inCOPDpatients,canreducetightnessandincrease oxygensaturation.Givingthisinterventioniscarriedoutfor threeconsecutivedayswith5min.

Basedonresearchconducted(Zuriati& Suriya,2018),⁴ The Effectiveness of Walking Exercise and Yoga Training EffectComparisontoIncreaseExpirationPeakTowardSleep Quality for COPD. The results of the average difference betweenwalkingpracticeandYogatreatment;ithasknown thatYogatrainingismoreeffectivethanwalkingexerciseto improvethesleepqualityofCOPDpatients.

Chronicobstructivepulmonarydisease(COPD)isacom- mondiseasethatisbothtreatableandpreventable.¹Ithas characterizedbyprogressiveairflowlimitationandhyperin- flation,associatedwithshortnessofbreathordyspneaand

166 Z.Zuriatietal.

Table1 Effectiveness ActiveCycle ofBreathingTechnique (ACBT) with PursedLips Breathing Technique (PLBT) totripod positioninincreaseoxygensaturationinpatientswithCOPD.

Group Variable N Mean Min---max SD t p-value

TripodACBT PreTest 15 88.27 1.223 6.088 0.000

PostTest 13 90.13 1.125

TripodPLBT PreTest 15 84.27 1.335 2.553 0.023

PostTest 13 85.47 1.407

altered respiratory patterns, which become progressively worseand arethe main causeof morbidity andmortality globally.²

A technique for positioning the body and breathing is a physiotherapy technique commonly used to relieve dyspnea.⁵ Giving thetripodpositionin COPDpatientswill increasethediaphragmandexternalintercostalmusclesin apositionofapproximately45degrees.Thediaphragmisthe maininspirationmuscle,andtheexternalintercostalmuscle isalsotheinspirationmuscle.Thediaphragmmuscle,which isata45-degreeposition,causestheearth’sgravityforce toworkadequatelyonthemaininspirationalmuscle,mak- ingiteasierfor themuscletomovedownward,increasing thevolumeofthethoraciccavitybyincreasingitsvertical length.Theenlargedthoraciccavitycausespressureinthe thoraciccavitytoexpand andforcesthelungstoexpand.

Anincreasedventilationprocessinpatientswithshortness ofbreaththathavepositionedinatripodwillincreasethe releaseofcarbondioxide andincreaseoxygen intakeinto theintra-alveolarsothatsaturationinthebodyincreases.⁶ Respiratorymuscletraining,especiallyInspiratoryMuscle Training(IMT), inpatients withCOPD induces an increase in inspiratory muscle strength and endurance, functional exercisecapacity,dyspnea,andqualityoflife.Asforbreath- ingexercises with Pursed-lipsbreathing consistsof a soft exhalationper-formedfor4---6againsttheresistanceofpar- tiallyclosedlipsandclenchedteeth.Itisfrequentlyadopted spontaneouslyandvoluntarilybysomesubjectswithCOPD tocontrol and relieve dyspnea and can be performed at rest or during exercise. Several studies have shown that thebenefitsofpursed-lipsbreathinginsubjectswithCOPD includedecreasedbreathingfrequencyandlunghyperinfla- tion,improvementsinthePCO₂andoxygenintheblood,and increasedtidalvolumeandoxygensaturation.However,dys- pneareliefremainspoorlyconsistent,becausethisresponse isdifferentamongsubjects.⁷

BasedontheresultsofthestudywiththetitleBreath- ing Exercise to Lung Capacity Improvement on Clients withChronicObstructivePulmonaryDisease,Obtainedthe results of the study aimed at the average value of lung capacityincreaseswiththeaveragedifferencebeforeand afteraveragepractice133.33ml/min,andtherearediffer- encesbreathingvaluep-value(0.00)after6minofwalking breathingexercise.⁸

OtherbreathingexercisesistheActiveCycleofBreathing Techniques (ACBT) is one way to help you to clear spu- tumfromyour chest.ACBT isaset ofbreathingexercises thatloosens and movesthe sputum fromyour airways. It isbesttobetaught ACBTby aphysiotherapist. The ACBT exercisesarebreathingcontrol,deepbreathing,andhuff- ing,whichareperformed ina cycleuntilyour chestfeels

clear.People withlungproblems oftencoughandproduce more phlegm (sputum) than is usual. It is important to removesputumfromyour lungstohelpyou breathemore easily,preventchestinfectionsandreduceboutsofcough- ing.Leavingsputuminyourchestcanmakeyourcondition worse.

Basedonthe resultsof researchand theoriesthat can haveconcludedcanbedrawnwithpatientswithchroniclung diseasewithsymptomsofshortnessofbreathduetooneof themistheaccumulationofsecretsothattheflowofairhas obstructedsothatoxygenreachesthealveolialittle.Sothis studywillhelppatientstoincreasetheiroxygensaturation, whichischaracterizedbyreducedshortnessofbreath,and saturationcanhaveincreasedsothatitcanhaveappliedby givingatripodpositionwithTheActiveCycleofBreathing Techniques(ACBT).

Basedonthe resultsof researchand theoriesthat can haveconcludedcanhavedrawnwithpatientswithchronic lung diseasewithsymptomsof shortnessof breathdueto oneofthemistheaccumulationofsecretsothattheflow of airhasobstructedsothatoxygen reachesthe alveolia little.So,this study willhelppatients toincrease oxygen saturation, which ischaracterized by decreased shortness ofbreath,andsaturationcanhaveincreased.

Conflict of interest

Theauthorsdeclarenoconflictofinterest.

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