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Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1 105

Immediate effects of Active Cycle of Breathing Techniqueand Conventional Chest Physiotherapy in Subjects with

Bronchiectasis - A Comparative Study

S Ram Anand1, D Anandhi2

1Lecturer, Srinivas College of Physiotherapy & Research Centre, Mangalore, Karnataka, India, 2Associate Professor

SRM College of Physiotherapy& Research Centre, SRM University, Chennai,Tamil Nadu, India

ABSTRACT

Background: The prevalence of Bronchiectasis in India, is 10 fold increase in in persons with high

exposure to Arsenic caused skin lesions in West Bengal in 2005.The prevalence was higher among

women than men 71 vs 32/1, 00,000 and increased markedly with age 4/1, 00,000 for people aged 18-

34 years & 272/1, 00,000 for those aged 75.

Aim: The aim of the study is to compare the Immediate effects of Active Cycle of Breathing Technique

and Conventional Chest Physiotherapy in subjects with Bronchiectasis.

Methodology: StudyDesign-Experimental Design; Study Type-Comparative Study;Sample Size-

30Subjects; Sampling Method - Convenient Sampling;Sampling Specification - Group A-15 subjects

& Group B-15 subjects; Study Setting - Department of TUBERCULOSIS AND CHEST DISEASES,

SRM Medical college Hospital & Research centre, Kattankulathur. chennai. Tamilnadu, India. Study

Duration - 3 months.

Results:Comparing the values of Sputum volume between Group A and Group B, Group B showed

a significant difference than Group A. (P

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106 Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1

infected, non-functioning lung segment. RENE

LANNAC made the first description of bronchiectasis

in 1819 (European Journal of Cardio-Thoracic Surgery;

2001)2.

Incidence & Prevalence

According to NATIONAL HEART, LUNG, BLOODINSTITUTE 1999; Death rate extrapolations for U.S.A.

for Bronchiectasis was 969 per year; 80 per month; 18

per week; 2 per day4.

According to STARSHIP CHILDRENS HEALTH

CLINICAL GUIDELINES-in 2000 a retrospective

review of children attending the Bronchiectasis clinic

found a crude prevalence rate 1:6000 in the Auckland

paediatric population. A prospective national study

reporting all new cases diagnosed (2001-2003) using

the Newzland paediatric surveillance unit gave an

incidence of 3.7/1, 00,000 children per year. This is 7

times higher than the only other comparable national

study from Finland. 80% of the children were Maori

or pacific peoples indicating a disproportionate

prevalence of Bronchiectasis at 1/1875 for pacific

peoples, 1/4244 for Maori and 1/24,900 for European

groups. In 2008 March, >160 children are reported in

STARSHIP BRONCHIECTASIS CLINIC statistics for

Bronchiectasis.In England 2002-2003; 39% of hospital

consultant episodes for Bronchiectasis were men and

61% were women4.

In India, it was the recent finding of a 10 fold

increase in Bronchiectasis prevalence in persons with

high exposure to Arsenic caused skin lesions in West

Bengal in 2005.The prevalence was higher among

women than men 71 vs 32/1, 00,000 and increased

markedly with age 4/1, 00,000 for people aged 18-34

years & 272/1, 00,000 for those aged 75 or over 4.

METHODOLOGY

The study aims to establish the Immediate effects

of Active Cycle of Breathing Technique and

Conventional Chest Physiotherapy in subjects with

Bronchiectasis.

Research Specification

Study Design Experimental Design;Study Type

Comparative Study;Sample Size 30

Subjects;Sampling Method Convenient

Sampling;Sampling Specification Group A-15

subjects & Group B-15 subjects;Study Setting

Department of TUBERCULOSIS AND CHEST

DISEASES,SRM Medical college Hospital &

Research centre,Kattankulathur-Chennai;Study

Duration 3 months.

Materials Used

Sputum produced during and following the

treatment was collected into the Mucus Extractorand its volume measured in millilitres.

The Peak expiratory flow rate in liters/sec was

measured by using A mini-Wrights peak flow

meter.

Inclusion Criteria

Diagnosed cases of Bronchiectasis by Chest

Physician (X-RAY, CT, PFT)

Age group 35 60 years

Both Males and Females

Subjects with expectorated sputum quantity of

10ml - > 150 ml/day

Subjects with stable Hemodynamics

Subjects under medications for Bronchiectasis

(antibiotics, bronchodilators, etc)

Exclusion Criteria

Pulmonary hypertension

Angina

Diabetes mellitus

Pulmonary embolism

Pneumothorax

Tuberculosis

Bronchial Asthma

Any chest trauma

Corpulmonale

Recent Abdominal surgery

Children

Testing Procedure

A comparative study was done on subjects with

Bronchiectasis to establish the Immediate effects of

Active Cycle of Breathing Technique and Conventional

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Chest Physiotherapy in subjects with Bronchiectasis.

After selecting the sample, test procedure was

explained to the subjects, a written consent was

collected from the subjects to participate in the study.

The time taken for discussion and for the

determination of the individuals pre-test

measurements allowed for a period of rest prior totesting. The 30 subjects who fitted into the inclusion

criteria were randomized into 2 groups A &B.

Precautions

The subjects were asked to maintain the following

precautions

Avoid heavy meals within 2 hours of testing.

Wear comfortable clothing.

Pre&Post test measurements

Expectorated sputum in millilitres

Peak expiratory flow rate in litres/second

For both the groups, Peak expiratory flow rate was

measured using Pea expiratory flow meter.

For both the groups, expectorated sputum was

measured using Mucus Extractor.

Group A

Active Cycle of Breathing Technique

Subjects were made to sit with back support and

asked to maintain a good breathing pattern with

relaxed shoulders and neck and breathe in through

the nose and out through the mouth. Breathing out

should be slow, like sighing out. This minimizes any

wheezing19.

Breathing Control: Rest one hand on abdomen,

keeping shoulders and upper chest relaxed and allowtheir hand to rise gently as they breathe in. (If they

imagine air filling the abdomen like a balloon this may

help) Sigh out gently and ensure that the shoulders

remain relaxed. Over a few seconds, gradually increase

depth of breathing while maintaining relaxation.

Breathing control is an essential part of the cycle to

allow rest19.

Deep Breathing Exercises: Take 3 4 deep breaths

in, allowing the lower chest to expand. Try to ensure

neck and shoulders remain relaxed. At the end of the

breath in, hold the air in for 3 seconds .Let the air out

gently19.

Forced Expiration Technique/Huff: Huffs are

combined with breathing control and they were asked

to take a half breath in and blow air out steadily

through an open mouth. Follow this with breathing

control as secretion moves into larger airways. Take a

deep breath in and blow air out again through an open

mouth. A typical cycle consists of: Breathing control, 3

4 deep breaths, breathing control, forced expiration

technique/Huff. The total treatment session was 30

minutes19. The treatment sessions were performed

under supervision and at the same time of the day.

Group B

Conventional Chest Physiotherapy

All the 15 subjects in the Group B were allocated to

Conventional Chest Physiotherapy. The Conventional

Chest Physiotherapy consists of Postural drainage,

Percussion, Pressure-vibration, active bilateral

respiratory exercises. The total treatment session was

performed under supervision and at the same time of

the day. All usual medications are to be administrated

during the study days19, 31.

Statistical Analysis

The independent variables are Sputum & Peak

Expiratory Flow Rate. The Statistical Package Graph

Pad Prism was used for data analysis.

The statistical tools used in this study are pairedt

test and independentt test

Pairedt test

Pairedt test was used to find out the significant

difference in improvement between pre and posttreatment values between Group A and Group B for

Sputum & Peak expiratory flow rate.

Studentt test

The student independentt test is used to compare

the significant differences between group A and group

B for Peak expiratory flow rate.

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Data Analysis

Table 1. Comparison Between Group a and Group B Post-test Sputum Volume

Sputum Group A Group B Df Calculated Table PValue value Value

Mean S.D Mean S.D

Post Treatment 3.73 1.486 6.00 1.512 28 4.141 1.701 0.9503

There is significant difference between the post- test sputum volume between Group A and Group B (P< 0.05).

Graph 1. A Comparison Between Post-test Sputum Volume In Group A And Group B

Total Number of Subjects

Mean

Table 2. Comparison Between Pre and Post Peak Expiratory Flow Rate Values in Group A

PEFR Group A Calculatedvalue Tablevalue Df P Value

mean S.d

Pre 192 62.01 9.727 3.787 14 0.0001

Post 210 63.74

PEFR- Peak Expiratory Flow Rate

There is significant difference between Pre and Post test values of Group A in Peak expiratory flow rate (P< 0.05).

Graph 2. Comparison Between Pre And Post Pefr In Group A

Mean


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Table 3. Comparison Between Pre and Post Peak Expiratory Flow Rate Values In Group B

PEFR Group B Calculatedvalue Tablevalue Df P Value

mean S.d

Pre 192 43.9 10.31 3.787 14 0.0001

Post 288 49.01


There is significant difference between Pre and Post test values of Group B in Peak expiratory flow rate (P< 0.05).

Graph 3. Comparison Between Pre And Post Pefr In Group B

Mean


Table 4. Comparison Of Post Test Values Of Peak Expiratory Flow Rate Between Group A and Group B

Sputum Group A Group B Df Calculated Table PValue value Value

Mean S.D Mean S.D

Post Treatment 210.6 63.7 288 49.01 28 0.834 1.701 0.410


There is no significant difference between the post-test Peak expiratory flow rate values between Group A and Group B (P > 0.05).

Graph 4. Comparison Between Group-A and Group-B Post PEFR

Mean


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RESULTS

The purpose of the study was to compare the

Immediate effects of Active Cycle of Breathing

Technique and Conventional Chest Physiotherapy in

subjects with Bronchiectasis.

From Tables 1, 2, 3 and 4 the following inferencesare made.

From Table 1: Group B (6.00) showed improved

sputum volume than Group A (3.73) with t-value

of (4.141) and P-value of (0.9503).

From Table 2: Peak expiratory flow rate values

improved in Group A between Pre test (192) and

Post-test (210) with t-value of (9.729) and P-value

(0.0001).

From Table 3: Peak expiratory flow rate valuesimproved in Group B between Pre test (192) and

Post-test (288) with t-value of (10.31) and P-value

(0.0001).

From Table 4: Peak expiratory flow rate values

between Group A (210.6) and Group B (288) with

t-value of (0.834) and P-value (0.410) does not show

significant difference in Post test Peak expiratory

flow rate.

Hence, by comparing the values of Sputum volume

between Group A and Group B, Group B showed asignificant difference than Group A. (P

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ACKNOWLEDGEMENT

Srm University, Department of Physiotherapy &

Rc,Department of Tuberculosis and Chest Diseases

&Rc, Srm Multi-speciality Hospital & Rc,

Kattankulathur, Kancheepuram. distChennai,Tamil

Nadu, India.

Conflict of Interest: None (There is No Objection to

Anyone For My Study).

Source of Funding: No Agency or Trust is Sponsered

for my Study.

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