CHAPTER - II

REVIEW OF LITERATURE
Review of literature is systematic identification, critical analysis and reporting of existing
information on the topic of material for the study. The review of literature is a key step in
research process excessive review of literature relevant to research was alone to collect
maximum information for laying foundation of this study. The purpose of the review of
literature is to gain maximum relevant information and perform the study in a scientific m
Review of literature is systematic identification, critical analysis and reporting of existing
information on the topic of material for the study.

Section I: Literature related to asthma

Pratik (2022) To assess the knowledge regarding bronchial asthma among adults. To
associate the knowledge score with demographical variables. A quantitative research
approach using non-experimental descriptive research design was adopted for the study using
non-probability purposive sampling technique 100 adults was selected from urban areas of
Pune city. Modified questionnaire was used to collect the data during October 2018 to
November 2018 to obtain the knowledge level. Results: findings of the study shows that
52.00% of samples were had average knowledge regarding bronchial asthma, 45.00% of
sample had good knowledge, whereas only 3.00% of sample had poor knowledge category.
Also there was an association between the knowledge and occupation regarding bronchial
asthma as the P value was 0.003 which is less than 0.05. And also there was an association
between the income and the knowledge regarding bronchial asthma as the P value was 0.012
which is less than 0.05.

Sheetu Singh (2022) The objective of this subanalysis of data from centres across urban
areas in India of the Global Asthma Network (GAN) was to study 1) the prevalence of
symptoms of asthma in children and adults, 2) the change in prevalence of asthma and its
trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC),
and 3) current asthma treatment practice. The GAN Phase I study included 20 084 children in
the 6–7-year age group, 25 887 children in the 13–14-year age group and 81 296 parents. The
prevalence of wheeze in the previous 12 months was 3.16%, 3.63% and 3.30% in the three
groups, respectively. In comparison to the ISAAC studies, there was a significant reduction in
the prevalence of current wheeze (p<0.001). Bivariate analysis revealed a significant
reduction in the prevalence of trigger factors. Almost 82% of current wheezers and 70% of
subjects with symptoms of severe asthma were not clinically diagnosed as having asthma.
The daily use of inhaled corticosteroids (ICS) was less than 2.5% in subjects with current
wheeze and those with symptoms of severe asthma but less than 1% used daily ICS when
asthma remained undiagnosed.

BARREIRO E, (2022) in his study to assess the extent of application of guidelines for
treating exacerbations of asthma and to describe the clinical and epidemiological
characteristics of patients function and treatment variables during the emergency and when
the patient was stable, at which time we also administered the Asthma Quality of Life
Questionnaire (AQLQ). This score, along with social restriction, were lowest in the group of
patients with chronic airflow obstruction.

VERMA SK (2022) conducted a comparative study on association between environmental

allergens and asthma is well established. A great number of substances found in the
environment can precipitate or aggravate respiratory symptoms in asthmatics. Almost all the
patients started avoiding their triggers in follow-ups in the study group. In control group this
change was only for few triggers. More and more patients started using inhalers on exposure
to dust or triggering weather conditions. They started slowing down for exercises and
diverted their attentions against triggering emotional situations

FASCIGLIONE MP, (2022) conducted a study on asthma prevalence. The study attempted
to determine the characteristics and the impact of educational interventions on asthma by
means of the following: a) an updated review of the various educational b) the identification
of aspects that are common to all of these interventions; and c) the analysis of the findings in
the literature regarding the impact. The conclusion of this study suggests that educational
interventions are effective in improving the health and quality of life of asthma patients, as
well as in reducing the use and costs of health resources.

DAVID JOHNSON (2022) conducted a study on occurrence, clinical presentation,

diagnosis, treatment and natural history cough variant asthma. Asthma is a common problem
among all ages that frequency goes unrecognized pulmonary function as measured by
spirometry is often within normal limits, any patient with a non productive nocturnal cough
lasting more than two weeks, should receive an empire trial of bronchodilators, whereas for
many patients, cough resolves without need for further treatment.

EHRLICH RI, (2022) conducted a cross-sectional study about local prevalence of bronchial
asthma. The study based on random community sample of schools with 955 samples of
parents. The findings of the study suggest that ways need to be found: (i) to increase the use
of current asthma treatment guidelines by practitioners; (ii) to provide access to
comprehensive care by children not on medical aid; and (iii) to improve education of parents
in home management measures such as severity assessment and avoidance of smoking,
allergen and dietary triggers.

BEHERA D. (2022) in his studies suggests that asthma continues to be a substantial cause of
morbidity. A total of 523 asthma patients were enrolled in the study. Out of these, 260
patients were included in the study group to whom self-care manual was provided and 263
were included in the control group to whom no specific instructions were given. However,
there was a significant decrease in hospital admissions and absence from school/or job in the
study group at one year as compared to the control group.

Mohammad (2022) explore the characteristics of knowledge and practice of physicians

towards asthma in Saudi Arabia. Overall, participants' knowledge was moderate. The average
percentage of physicians who reported practicing asthma management based on
recommended guidelines 63.7%. Younger age (30-34 years) and having a work experience of
(6-10 years) were significant predictors of being adherent to asthma practices guidelines (OR:
1.96 (95% CI: 1.21-3.17) (p=0.006) and OR: 1.67 (95% CI 1.05-2.67) (p=0.031),
receptively).

Kaur (2022) study aimed to evaluate the asthma knowledge among patients with Bronchial
asthma. Study was conducted to assess the effectiveness of structured asthma educational
program on self care management of Bronchial asthma. Experimental Pre test-post test
control group design was chosen. From the patients with confirmed diagnosis of asthma,
sample were selected to experimental (n=100) and control (n=50) groups. The Pre-test means
between experimental (19.9) and control (18.82) groups were not much significant. There is a
significant improvement within the pre test (mean 19.930; S.D 8.84)) and Post test scores in
the experimental group (mean 42.31/S.D 3.449). The post test means between experimental
(42.31) and control groups (21.28) supports the significant enhancement in the knowledge of
the experimental group after asthma education. Asthma education is an important means to
equip patients with knowledge and skills required to manage the condition effectively.
Adequate knowledge may further motivate patients towards behavior modification and long
term.
RON HALBERT ET AL (2020) Although smoking remains the predominant risk factor, it
needs to be emphasized that the prevalence of asthma in non-smokers suggests the existence
of other risk factors such as passive smoking, occupational exposure, and indoor air
pollution .Recently, exposure to biomass smoke resulting from household combustion of
solid fuels has been identified as an important risk factor for asthma, with rural women in
developing countries bearing most of this disease burden ). In addition to respirable
particulate matter, biomass combustion results in high levels of pollutants such as carbon
monoxide, oxides of nitrogen and sulphurformaldehyde, benzo(a)pyrene, and benzene that
are the major source of respiratory irritants in the etiopathogenesis of asthma Although
asthma affects twice as many males as females, this difference will diminish given the fact
than more and more females throughout the world have taken up smoking in the past few
years in developed countries, and non-smoking females are exposed to bio mass combustion
products in developing countries.

GUNEN.H ET AL (2020) A study conducted in different categories of asthma disease in

railway workers on Eastern India to evaluate the pulmonary function showed the pulmonary
function test values were significantly deteriorated in all categories of asthma disease patients
as compared to normal non- smokers, significant deterioration was observed emphysematous
patients when compared to other categories and asthma patients. Asthma is the fourth leading
cause of death and 13th leading cause of burden of diseases worldwide with projected
increases in its contributions over the next decade. The global initiative for chronic
obstructive lung disease (GOLD) has classified asthma as ‘a disease state characterized by
airflow limitation that is not fully reversible. The airflow limitation is usually both
progressive and associated with an abnormal inflammatory response of the lungs to noxious
particles or gases’ Active smoking is the major risk factor for asthma worldwide, and the risk
attributable to active smoking in asthma varies from 40 to 70% according to the country.

Section II: Literature related to effectiveness of breathing exercises on asthma patient

Thayla A (2022) To evaluate the evidence for the efficacy of breathing exercises in the
management of people with asthma. included nine new studies (1910 participants) in this
update, resulting in a total of 22 studies involving 2880 participants in the review. Fourteen
studies used Yoga as the intervention, four studies involved breathing retraining, one the
Buteyko method, one the Buteyko method and pranayama, one the Papworth method and one
deep diaphragmatic breathing. The studies were different from one another in terms of type of
breathing exercise performed, number of participants enrolled, number of sessions
completed, period of follow-up, outcomes reported and statistical presentation of data.
Asthma severity in participants from the included studies ranged from mild to moderate, and
the samples consisted solely of outpatients. Twenty studies compared breathing exercise with
inactive control, and two with asthma education control groups. Meta-analysis was possible
for the primary outcome quality of life and the secondary outcomes asthma symptoms,
hyperventilation symptoms, and some lung function variables. Assessment of risk of bias was
impaired by incomplete reporting of methodological aspects of most of the included studies.
We did not include adverse effects as an outcome in the review. Breathing exercises versus
inactive control For quality of life, measured by the Asthma Quality of Life Questionnaire
(AQLQ), meta-analysis showed improvement favouring the breathing exercises group at
three months (MD 0.42, 95% CI 0.17 to 0.68; 4 studies, 974 participants; moderate-certainty
evidence), and at six months the OR was 1.34 for the proportion of people with at least 0.5
unit improvement in AQLQ, (95% CI 0.97 to 1.86; 1 study, 655 participants). For asthma
symptoms, measured by the Asthma Control Questionnaire (ACQ), meta-analysis at up to
three months was inconclusive, MD of -0.15 units (95% CI -2.32 to 2.02; 1 study, 115
participants; low-certainty evidence), and was similar over six months (MD -0.08 units, 95%
CI -0.22 to 0.07; 1 study, 449 participants). For hyperventilation symptoms, measured by the
Nijmegen Questionnaire (from four to six months), meta-analysis showed less symptoms
with breathing exercises (MD -3.22, 95% CI -6.31 to -0.13; 2 studies, 118 participants;
moderate-certainty evidence), but this was not shown at six months (MD 0.63, 95% CI -0.90
to 2.17; 2 studies, 521 participants). Meta-analyses for forced expiratory volume in 1 second
(FEV1) measured at up to three months was inconclusive, MD -0.10 L, (95% CI -0.32 to
0.12; 4 studies, 252 participants; very low-certainty evidence). However, for FEV 1 % of
predicted, an improvement was observed in favour of the breathing exercise group (MD
6.88%, 95% CI 5.03 to 8.73; five studies, 618 participants). Breathing exercises versus
asthma education For quality of life, one study measuring AQLQ was inconclusive up to
three months (MD 0.04, 95% CI -0.26 to 0.34; 1 study, 183 participants). When assessed
from four to six months, the results favoured breathing exercises (MD 0.38, 95% CI 0.08 to
0.68; 1 study, 183 participants). Hyperventilation symptoms measured by the Nijmegen
Questionnaire were inconclusive up to three months (MD -1.24, 95% CI -3.23 to 0.75; 1
study, 183 participants), but favoured breathing exercises from four to six months (MD -3.16,
95% CI -5.35 to -0.97; 1 study, 183 participants).
study was to see how the Buteyko
breathing technique helps to
reduce breathing difficulty in
patients with bronchial asthma at
Saveetha
medical college and hospital. The
study used a quasi-experimental
pre-test and post-test research
design a total of 30 samples was
chosen with care. The moderate
Aaldrete score was used to
examine
the respiratory physiological
parameters on a regular basis.
The results reveal that there is
a
significant association of
selected demographic variables
with the post test respiratory
parameters
among patients with bronchial
asthma using descriptive and
Interferential statistical
approaches. It is
also shown statistically
significant association with the
post test level of respiratory
status among
patients with bronchial asthma at
p<0.05 level. The other
demographic variables had not
shown a
statistically significant
association with the post test
level of respiratory status among
patients with
bronchial asthma. The study
revealed that showed a significant
improvement in the level of
improvement in the respiratory
parameters following the
administration of Buteyko
breathing
technique was effective in
improving the respiratory
parameters and home
management of bronchial
asthma
R. Maheshwari (2022) study was to see how the Buteyko breathing technique helps to
reduce breathing difficulty in patients with bronchial asthma at Saveetha medical college and
hospital. The study used a quasi-experimental pre-test and post-test research design a total of
30 samples was chosen with care. The moderate Aaldrete score was used to examine the
respiratory physiological parameters on a regular basis. The results reveal that there is a
significant association of selected demographic variables with the post test respiratory
parameters among patients with bronchial asthma using descriptive and Interferential
statistical approaches. It is also shown statistically significant association with the post test
level of respiratory status among patients with bronchial asthma at p<0.05 level. The other
demographic variables had not shown a statistically significant association with the post
test level of respiratory status among patients with bronchial asthma. The study revealed
that showed a significant improvement in the level of improvement in the respiratory
parameters following the administration of Buteyko breathing technique was effective in
improving the respiratory parameters and home management of bronchial asthma.

Shijie (2022) study aimed to compare the effects of different types of exercise on pulmonary

function in adult patients with asthma using Network Meta-analysis A total of 28 randomized
controlled trials with 2,155 patients with asthma were finally included. The results of
Network Meta-analysis showed that compared with control group, breathing training
(BT)、aerobic training (AT) 、relaxation training (RT) 、yoga training (YG) and breathing
combined with aerobic training (BT + AT) improved Forced Expiratory Volume in the first
second (FEV1) levels; AT 、 BT 、 YG and BT + AT improved the level of Forced Vital
Capacity (FVC); BT、AT、RT、YG and BT + AT improved Peak Expiratory Flow (PEF);
BT 、 AT 、 and YG improved Forced Expiratory Volume in the first second/Forced Vital
Capacity (FEV1/FVC).The results of SUCRA probability ranking showed that RT had the
most significant effect on improving the FEV1[SMD = 1.13,95%CI(0.83,1.43), p<0.001]
levels, BT + AT had the most significant effect on improving the FVC[SMD =
0.71,95%CI(0.47,0.95), p<0.001] level; YG had the most significant effect on improving the
PEF[SMD = 0.79,95%CI(0.55,1.02), p<0.001] level.

Ki Jong (2022) present study investigated the effects of an intervention program to enhance
the pulmonary function and muscle activity of elderly smokers. Participants were randomly
assigned to one of two experimental groups or a control (CG) group. The experimental
groups performed exercises three times per week for six weeks, whereas the CG performed
no exercises. One of the experimental groups performed a Feedback Breathing Exercise
(FBE) for 15 minutes, and the other repeated three sets of Balloon-Blowing Exercises (BBE)
with sufficient rest of more than one minute between sets. In the experimental groups, FVC,
FEV1/FVC, PEF and muscle activity of the rectus abdominis significantly improved after
four weeks, but no significant differences were observed in FEV1 or VC after six weeks.

Gabriela (2022) To evaluate the evidence for the efficacy of breathing exercises in the
management of people with asthma. We included nine new studies (1910 participants) in this
update, resulting in a total of 22 studies involving 2880 participants in the review. Fourteen
studies used Yoga as the intervention, four studies involved breathing retraining, one the
Buteyko method, one the Buteyko method and pranayama, one the Papworth method and one
deep diaphragmatic breathing. The studies were different from one another in terms of type of
breathing exercise performed, number of participants enrolled, number of sessions
completed, period of follow‐up, outcomes reported and statistical presentation of data.
Asthma severity in participants from the included studies ranged from mild to moderate, and
the samples consisted solely of outpatients. Twenty studies compared breathing exercise with
inactive control, and two with asthma education control groups. Meta ‐analysis was possible
for the primary outcome quality of life and the secondary outcomes asthma symptoms,
hyperventilation symptoms, and some lung function variables. Assessment of risk of bias was
impaired by incomplete reporting of methodological aspects of most of the included studies.
We did not include adverse effects as an outcome in the review.

Ailenne George (2022) The main aim of the study was to assess the effectiveness of deep
breathing exercise with incentive Spirometer on the respiratory status of patients who have
undergone cardio thoracic and vascular surgery in selected hospitals of Puducherry. Research
design used for the study was quasi experimental one group pre-test post-test design. The
study was conducted on 30 patients who have undergone cardio thoracic and vascular surgery
at Cardio Thoracic and Vascular wards of Mahatma Gandhi medical College and Research
Institute (MGMC&RI), Puducherry and A G Padmavathy hospital, Puducherry. Stratified
random sampling technique was used. Data collection tool consisted of demographic
variables and assessment of respiratory status using Respiratory Rate, Modified Borg
Dyspnea Scale, Peak Flow Meter and Pulseoxymeter. Data were collected by pre assessment
questionnaire and observation method. The collected data was tabulated, analyzed and
interpreted by using descriptive and inferential statistics. The result showed that deep
breathing exercise with incentive spirometer was highly effective among patients who have
undergone cardio thoracic and vascular surgery. The obtained P-value 0.000 was highly
significant

Dipti Agarwal (2021) To assess the efficacy of breathing exercises (Pranayamas) added to
regular optimal medications in asthma patients in improving health impairment using St.
George's Respiratory Questionnaire (SGRQ). Of 60 asthma patients, 34 were females and 26
were males, and their mean age was 25.45 ± 5.41 years. Their baseline spirometric values
were as follow: Forced expiratory volume in 1 s (FEV 1) - 2.492 ± 0.358 L and peak
expiratory flow rate (PEFR) - 283.82 ± 51.12 L/min. The SGRQ scores after breathing
exercises intervention decreased from 45.98 ± 5.61 to 38.78 ± 4.92 for symptom subset, from
15.45 ± 3.33 to 12.34 ± 2.39 for activity subset, from 17.95 ± 4.22 to 12.12 ± 3.82 for impact
subset, and from 25.83 ± 8.31 to 19.20 ± 7.09 for total scores. All these reductions were
statistically highly significant (P < 0.001). Decrease in symptoms, activity, and total SGRQ
scores each was significantly correlated with FEV 1, FEV1/forced vital capacity (FVC) ratio,
and PEFR; decrease in impact score was significantly related only with FEV1/FVC ratio.

FS Ram (2021) to assess the evidence for the effectiveness of breathing re-training in the
treatment of patients with asthma. Abstracts were identified and 32 full text papers were
obtained for assessment and possible inclusion of studies in the review. Twenty seven papers
were excluded. A total of five papers were included in this review. Most were small. One
large study (106 patients) showed an improvement in PEFR and reduction in rescue
bronchodilator use. Otherwise benefit of breathing exercises was found in isolated outcome
measures in single small studies.

The goal of the study was to see

how the Buteyko
breathing technique helps to
reduce breathing difficulty in
patients with bronchial asthma at
Saveetha
medical college and hospital. The
study used a quasi-experimental
pre-test and post-test research
design a total of 30 samples was
chosen with care. The moderate
Aaldrete score was used to
examine
the respiratory physiological
parameters on a regular basis.
The results reveal that there is
a
significant association of
selected demographic variables
with the post test respiratory
parameters
among patients with bronchial
asthma using descriptive and
Interferential statistical
approaches. It is
also shown statistically
significant association with the
post test level of respiratory
status among
patients with bronchial asthma at
p<0.05 level. The other
demographic variables had not
shown a
statistically significant
association with the post test
level of respiratory status among
patients with
bronchial asthma. The study
revealed that showed a significant
improvement in the level of
improvement in the respiratory
parameters following the
administration of Buteyko
breathing
technique was effective in
improving the respiratory
parameters and home
management of bronchial
asthma.
Dr. G. Bhuvneshwari (2021) The goal of the study was to see how the Buteyko breathing
technique helps to reduce breathing difficulty in patients with bronchial asthma at Saveetha
medical college and hospital. The study used a quasi-experimental pre-test and post-test
research design a total of 30 samples was chosen with care. The moderate Aaldrete score was
used to examine the respiratory physiological parameters on a regular basis. The results
reveal that there is a significant association of selected demographic variables with the post
test respiratory parameters among patients with bronchial asthma using descriptive and
Interferential statistical approaches. It is also shown statistically significant association with
the post test level of respiratory status among patients with bronchial asthma at p<0.05 level.
The other demographic variables had not shown a statistically significant association with
the post test level of respiratory status among patients with bronchial asthma. The study
revealed that showed a significant improvement in the level of improvement in the
respiratory parameters following the administration of Buteyko breathing technique was
effective in improving the respiratory parameters and home management of bronchial
asthma.

Izadi-avanji FS, ET AL (2021) A true experimental study was conducted on deep breathing
exercise on dyspnea in moderate asthma patients. The subjects of the study were 240. Out of
which 120 subjects were manipulated and the rest were getting no intervention. The study, it
revealed that there were considerably more effective subjects given exercise rather than those
without intervention. Thus it proved that deep breathing exercise was better than those
compared to other groups.

Mc Glone ,ET AL (2021) A pre-experimental was conducted on the effectiveness of deep

breathing exercises in asthma. A randomized controlled clinical trial. 145 subjects were
included among them 100 men and 45 women. Deep breathing exercises are well tolerated in
asthma and significantly improve dyspnea randomized controlled trial study was conducted
on hospital based physiotherapeutic exercise in asthma self management among 142 patients.
Out of which 74 intervention and 68 control patients were included. This study demonstrates
that a hospital based re activation program improves exercise capacity in patients with
moderate and severe asthma. Exercise tolerance capacity is more in asthma patients. A study
was conducted on the effectiveness of deep breathing exercises in managing breathlessness in
respiratory illness. 220 subjects were included and the study revealed that breathlessness is a
debilitating and distressing symptom to manage. Therefore, a deep 25 breathing exercise was
one of the effective nonpharmacological interventions in treating dyspnea.
Minas M ,ET AL (2021) A experimental study was conducted on the impact of deep
breathing exercises on breathing pattern and dyspnea in severe asthma patients. The subjects
of the study were 125 patients. This study shows deep breathing exercise is effective in
improving breathing patterns and inpatient with asthma. A cohort study was conducted on 15
efficient integrated education for older patients with asthma using deep breathing exercises. A
total of 85 patients. This study shows that integrated education for older patients with asthma
effectively improved patients' deep breathing exercises.

Das S, Mukherjee S, ET AL (2021) A pre- experimental study wasconducted on

breathlessness in patients with asthma. Twenty-two patients with mild to severe asthma were
studied. A Modified Borg Scale assessed dyspnea. The patients with deep breathing exercises
exhibited a significant reduction in end-expiratory volume of the chest wall. Deep breathing
exercises decrease end-expiratory volume of the chest wall and reduce breathlessness. The
study showed that deep breathing exercises are more effective in reducing dyspnea in asthma
patients. Dyspnea at rest and during exercise in asthma. The eight asthma patients (6male and
2 2324 female) with a mean age of 11 years. Deep breathing exercises promoted a slower and
deeper breathing pattern both at rest and during exercise. Deep breathing has a variable effect
on dyspnea when performed voliticully during exercise by patients with asthma. The study
showed the effectiveness of deep breathing exercises in patient at rest.

Van der Schans CP, et al (2021) conducted a study to assess the effect of breathing with a
positive expiratory pressure of 5 cm H2O, simulating pursed lips breathing (SPLB), on
respiratory muscle activity and pulmonary function during induced airway obstruction. In
twelve asthmatic patients, tonic and phasic electromyography (EMG) activity of the
following muscles was obtained: scalene muscle, parasternal muscle, and abdominal muscles.
Pulmonary function and EMG measurements were performed before and after propranolol
induced airway obstruction. The results have shown that simulated pursed lips breathing
resulted in a significant increase of functional residual capacity and tidal volume both at
baseline and during airway obstruction. Phasic respiratory muscle activity during PEP
breathing increased especially at baseline. It shows the beneficial effects of breathing with a
positive expiratory pressure of 5 cm H2O, which is similar to pursed lips breathing and
cannot be explained by changes in respiratory muscle activity or pulmonary function.

Breslin EH, et al (2021) conducted the study to indicate a change in the pattern of chest wall
muscle recruitment and improved ventilation with pursed-lip breathing (PLB) in asthma.
Pursed lip breathing led to the increased rib cage and accessory muscle recruitment 16 during
inspiration and expiration, increased abdominal muscle recruitment during expiration,
decreased duty cycle of the inspiratory muscles and respiratory rate, and improved SaO2. In
addition, PLB resulted in no change in pressure across the diaphragm and a less fatiguing
breathing pattern of the diaphragm. Changes in chest wall muscle recruitment and respiratory
temporal parameters concomitant with the increased SaO2 indicate a mechanism of
improving ventilation with PLB while protecting the diaphragm from fatigue in asthma.
Alterations in the pattern of respiratory muscle recruitment with PLB may be associated also
with the amelioration of dyspnoea. The study suggested further investigation is necessary to
explore the relationship between the pattern of respiratory muscle recruitment during PLB
and dyspnea.

Nihon Kokyuki Gakkai Zasshi et al (2021) conducted a study to evaluate the effects of a
short-term pulmonary rehabilitation program on dyspnea, exercisecapacity, and lung
function.15 patients with chronic respiratory failure due to pulmonary emphysema was
enrolled in such a program for 3 weeks as an inpatient. The program consisted of pursed-lip
breathing, diaphragmatic breathing, respiratory muscle stretch gymnastics, and walking with
synchronized breathing. The results had shown that dyspnea as measured with a visual analog
scale at the end of a 6-minute walk before and after the program (49.7 +/- 4.0% to 24.2 +/-
3.8%) decreased significantly (p < 0.01). As a measure of functional exercise capacity, the 6-
minute walking distance (226.9 +/- 32.4 m to 292.1 +/- 35.8 m) increased significantly (p <
0.01). As an indicator of maximal exercise capacity, endurance time on an incremental
treadmill test did not improve. Spirometric data did not change during the study. Total lung
capacity (TLC) (8.44 +/- 0.70 L to 7.58 +/- 0.74 L) and residual volume (RV) (5.13 +/- 0.53 L
to 4.28 +/- 0.59 L) decreased significantly (p < 0.01). The findings suggest that this program
relieves dyspnea, increases the functional capacity and decreases the functional exercise
capacity, and decreases TLC and RV in patients with chronic respiratory failure due to
pulmonary emphysema.

Ritz T, et al (2021) conducted a review of the behavioral interventions in asthma and

breathing training. And the review found that the systematic documenting of the benefits of
these techniques in asthma patients. The physiological rationale for abdominal breathing in
asthma is not clear, and adverse effects have been reported in chronic obstructive states.
Theoretical analysis and empirical observations suggest positive effects of pursed-lip
breathing and nasal breathing but clinical evidence is lacking. Modification of breathing
patterns alone does not yield any significant benefit. There is limited evidence that inspiratory
muscle training and hypoventilation training can help reduce medication consumption, in
particular beta-adrenergic inhaler use. Breathing exercises do not seem to have any
substantial effect on the parameters of basal lung function. They suggested additional
research on the psychological and physiological mechanisms of individual breathing
techniques in asthma, differential effects in sub-groups of asthma patients, and the
generalization of training effects on daily life.

Collins EG, et al (2021) conducted a study regarding breathing pattern retaining and exercise
in persons with asthma. They used a method in pulmonary rehabilitation to help alleviate the
symptoms of dyspnea endured by people who suffer from airflow obstruction secondary to
asthma. Other techniques such as biofeedback also have been successfully used. The article
described the altered breathing patterns used by patients with asthma at rest and during
physical activity. The literature is reviewed regarding techniques of breathing pattern
retraining that have been developed to improve the capacity of persons with asthma to
perform activities of daily living, a primarily rehabilitative outcome.

EMMA DICKINSO N ET AL (2021) A study was conducted on asthma is a common

diseases, the early diagnosis of which allows effective management and treatment. The
prospective observational longitudinal study comprised 164 high-risk smokers aged 40 and
76 years. Age, sex, weight, height, and smoking habits were recorded and spirometry was
performed. Patients were informed of their results and given brief advice on how to stop
smoking. After 3 years, the patients underwent the same evaluation. The result of the study
revealed that 22% of smokers were diagnosed with asthma. Three years later, an additional
16.3 % were diagnosed as having asthma, and the disease had worsened in 38% of those
already diagnosed. Of the patients with FEV1 less than 90%, 44.8% develop asthma. An
accelerated decrease in FEV1 was found in 18% of the patients. Mean tobacco consumption
in 1999 was 28.1 pack years in subjects without asthma and 31.7 pack years in those with
asthma, whereas in 2002, consumption was 30.6 packs in the patients with asthma and 31.9
packs per year in those without. In the years, 22.8% had stopped smoking studies related to
deep breathing exercises.