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Comparison of the Oxygen Cost of Breathing Exercises and Spontaneous Breathing in Patients With Stable Chronic Obstructive Pulmonary Disease

AYM Jones, PT, PhD, FACP, is Associate Professor, Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (rsajones{at}inet.polyu.edu.hk). Address all correspondence to Dr Jones
E Dean, PT, PhD, is Professor and Coordinator of the Advanced Graduate Programs, School of Rehabilitation Sciences, T-325, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5, and Coordinator of the Post-Polio Clinic, University of British Columbia. She was Visiting Professor, Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, at the time of this study
CCS Chow, PT, MSc, is Physical Therapist, Caritas Medical Centre, Kowloon, Hong Kong

Background and Purpose. The oxygen demand of breathing exercises and the clinical implications have not been studied in detail. In this study, the oxygen cost of 3 common breathing exercises believed to reduce oxygen cost (ie, work of breathing) was compared with that of spontaneous breathing in patients with chronic obstructive pulmonary disease (COPD). Subjects. Thirty subjects with stable, moderately severe COPD participated. Methods. Oxygen consumption (O₂) and respiratory rate (RR) during spontaneous breathing at rest (SB) were recorded for 10 minutes. Subjects then performed 3 breathing exercises in random order, with a rest between exercises: diaphragmatic breathing (DB), pursed-lip breathing (PLB), and a combination of DB and PLB (CB). Oxygen consumption and RR were measured. Results. Mean O₂ (±SD) was lower during the breathing exercises (165.8±22.3 mL O₂/min for DB, 164.8±20.9 mL O₂/min for PLB, and 167.7±20.7 mL O₂/min for CB) compared with SB (174.5±25.2 mL O₂/min). Correspondingly, mean RR (±SD) was higher during SB (17.3±4.23 breaths/min), followed by DB (15.0±4.32 breaths/min), PLB (12.8±3.53 breaths/min), and CB (11.2±2.7 breaths/min). Discussion and Conclusion. Given that patients do not spontaneously adopt the breathing pattern with the least O₂ and the lowest RR, the results suggest that determinants of the breathing pattern other than metabolic demand warrant being a primary focus in patients with COPD.

Key Words: Breathing exercises • Chronic obstructive pulmonary disease • Diaphragmatic breathing • Oxygen cost • Pursed-lip breathing

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