The use of Pursed Lips Breathing in stable COPD : a systematic review of the

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessness levels; one RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB, those with moderate to severe COPD being most likely to benefit. Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit The use of Pursed Lips Breathing in stable COPD: a systematic review of the evidence Roberts S, Stern M, Schreuder FM, Watson T Address of the department or institute to which the work should be attributed: School of Health and Emergency Professions University of Hertfordshire Hatfield AL10 9AB UK Full postal address of each author: Ms S Roberts (corresponding author) Department of Physiotherapy The Whittington Hospital NHS Trust Magdala Avenue London N19 5NF UK [email protected] Tel: 020 7288 5489 Fax: 020 7 288 5661 Dr M Stern Department of Thoracic Medicine The Whittington Hospital NHS Trust Magdala Avenue London N19 5NF UK Mrs F. M. Schreuder School of Health and Emergency Professions University of Hertfordshire College Lane Hatfield AL10 9AB UK Prof T Watson School of Health and Emergency Professions University of Hertfordshire College Lane Hatfield AL10 9AB UK *Title page