A study to assess the effectiveness of breathing exercises on selected pulmonary parameters on patients with chronic obstructive pulmonary disease at selected hospitals Chennai

Themost frequent chronic lung disease characterized by increased resistivity to air low as a result of airway obstruction. A study to assess the effectiveness of breathing exercises on selected pulmonary parameters on patients with chronic obstructive pulmonary disease. To assess the pulmonary function before administering breathing exercises, to assess the pulmonary function after administering breathing exercises. The research design used in this study was quasi-experimental, two groups before and after design. Nonprobability convenient sampling technique was followed to allow the samples to an experimental and control group. The tool contains 3 parts part Ademographic variables, part B-measurement of pulmonary parameters and part C-self-instructional module on breathing exercises. The practicing of breathing exercise was found to be effective in improving the pulmonary parameters. Younger age patients gained more breathing hold time after practicing breathing exercise. Non-smokers gained more chest expansion and PEFR after practicing breathing exercise. The results of the study were concluded that selected breathing exercises (Pursed lip and Diaphragmatic Breathing Exercise) given to the COPD patients was effective to improve in their pulmonary parameters.

A The most frequent chronic lung disease characterized by increased resistivity to air low as a result of airway obstruction. A study to assess the effectiveness of breathing exercises on selected pulmonary parameters on patients with chronic obstructive pulmonary disease. To assess the pulmonary function before administering breathing exercises, to assess the pulmonary function after administering breathing exercises. The research design used in this study was quasi-experimental, two groups before and after design. Nonprobability convenient sampling technique was followed to allow the samples to an experimental and control group. The tool contains 3 parts part Ademographic variables, part B-measurement of pulmonary parameters and part C-self-instructional module on breathing exercises. The practicing of breathing exercise was found to be effective in improving the pulmonary parameters. Younger age patients gained more breathing hold time after practicing breathing exercise. Non-smokers gained more chest expansion and PEFR after practicing breathing exercise. The results of the study were concluded that selected breathing exercises (Pursed lip and Diaphragmatic Breathing Exercise) given to the COPD patients was effective to improve in their pulmonary parameters.

INTRODUCTION
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality throughout the world. Currently, it is the 3 rd leading cause of death all over the world (Raherison and Girodet, 2009). According to WHO new estimates for 2030, COPD is predicted to become the third leading cause of death. "Much of the increase in COPD is associated with expected increases in tobacco use and the exposure to smoke from the combustion of solid fuels indoors, for heating and cooking", says Medical of icer Dr Cruz, for the Chronic Respiratory Diseases group in WHO. "Usage of Tobacco is highly widespread in many countries, mainly in low-and middle-income countries (WHO, 2008). Diaphragmatic breathing encourages patients to use their abdominal wall when breathing to reduce chest wall motion. Whereas it signi icantly improved dyspnea after four weeks of training in another study. There was also an increase in the functional capacity of 34.7 m (95% CI, 4.1 to 65.3) as measured by a sixminute walk test and improvement in the quality of life as measured by the St. George's respiratory questionnaire (mean difference = -10.5 points; 95%  (Holland et al., 2012). (Jindal, 2006) said that in India, there were 2.65% of people got affected by COPD. It is higher when correlating to the Asian Paci ic Countries, likewise in China (2.57%), in Japan (2.12%). In a large, multi centric study from India, the population prevalence of COPD was 4.1% of 35295 subjects with a male to female ratio of 1.56:1. (Efremidis et al., 2005) concluded that exercise capacity was predicted from measurements of resting pulmonary function parameters with excel-lent accuracy in the COPD patient. The nurse as a health team member, has the responsibility of educating the patients about the breathing exercises and their effectiveness in pulmonary care. Regular breathing exercise can have both physiological and psychological bene its and help the patients to have a better quality of life. Hence the investigator is motivated to do a study to know the effectiveness of breathing exercise on chronic obstructive pulmonary disease.  for the control groups by using the non-probability convenient sampling technique, on a selection of the study subject, self-introduction was given, the objective of the study was explained, and arranged privacy to the patients and their written consent was obtained. The investigator maintained a good interpersonal relationship with the patient throughout the study. The demographic data were collected by interview method. Pre-assessment of pulmonary parameter obtained for clients in both experimental and control groups followed by breathing exercises were given only for the clients in the experimental group. On 8 th day, post-test was conducted for both groups. Self-instructional module on breathing exercises was given to the control group. The data collected from the subjects were compiled and analyzed by using descriptive and inferential statistical methods. Table 1 shows percentage and frequency distribution of demographic variables with the respect of age 2(15%) of patients belonged to the age group of 20-30 years and 7(35%) patients belong to 65-79  years. Sex majority 11(55%) of them are male and 9(45%) of the female. Religion the maximum number of 13(65%) of the Hindus and 5 (25%) them Christian, marital status 13(65%) married to 2(10%) are single/unmarried, education 9 (45%) had primary middle school 2(10%) are graduate, occupation 6(30%) government/private and 4(20%) unemployed/business, income 11(55%) had an income of above 3000 and 2(10%) had an income of between 1000 to 3000, Regarding domicile 12(60%) belongs to urban and 8(40%) belongs to rural. Differences between experiment and control were tested using Pearson's Chi-square test (P<0.05) and both the groups were homogeneous. Table 2 report that pretest measurements of the lungs response to the breathing exercises of the experimental and control group patients with chronic obstructive pulmonary disease. In all the four pulmonary parameters measurements, it showed that the mean measurement value in both the groups is equal which is con irmed using independent student t-test (P>0.05). Table 3 concluded that in all the four pulmonary parameter measurements, it showed that mean measurement value of the experimental group is more than the control group using student independent t-test, it was observed that there is the signi icant statistical difference observed between the control group, experimental groups. Experimental group pulmonary parameters have improved following breathing exercises.

Findings interpretation
Tables 4 and 5 shows that signi icant association exposure to pollution, Habit of smoking and pulmonary parameters among the experimental group. Exposure to pollution and pulmonary parameters after breathing exercises. Among the four pulmonary parameters, only Peak expiratory low rate is signi icantly associated with exposure to pollution. Inhabit of smoking PEFR and chest expansion are signi icantly associated with the habit of smoking. Tested using one-way Anova F test (p<0.05). Before administering breathing exercises.
In this study, the result revealed there is no statistically signi icant difference observed between control and experimental group and after administering breathing exercises post test response was in experimental group investigator found that there was a signi icant improvement in the mean difference scores between the pre and post test in all four pulmonary parameters. In association, exposure to pollution and the habit of smoking signi icantly associate with pulmonary parameters. It was clear that these two respiratory muscle exercises improve pulmonary function. This research reviews the litera-ture regarding the ef icacy of Diaphragmatic Breathing in persons with chronic obstructive pulmonary disease and reports on the bene icial and detrimental effects of DB in persons with COPD. Diaphragmatic breathing has been described as breathing predominantly with the diaphragm while minimizing the action of accessory muscles that may assist with inspiration (Cahalin et al., 2002).
Dr Helen Shaji John Cecily concluded After undergoing breathing exercises, the level of dyspnea was signi icantly reduced (P<0.001) and there was a signi icant improvement in the Quality Of Life (QOL) and pulmonary function parameters such as FEV1 (Forced Expiratory Volume), FVC (Forced Vital Capacity), FEV1/ FVC ratio and PEFR (Peak Expiratory Flow Rate). The result concluded speci ic breathing exercise (Pursed lip and Diaphragmatic breathing exercise) increase the pulmonary parameters, muscles strength and improve exercise tolerance are signi icant at (P<0.05) (Cecily et al., 2013).

CONCLUSIONS
The results of the study concluded that Pursed lip and Diaphragmatic Breathing Exercise given to the patients with the chronic obstructive pulmonary disease was effective to improve in their pulmonary parameters. Therefore, the investigator felt that more importance should be given to the selected breathing exercises; it can be given as unmedicated measures to enhance reduction of periodic exacerbations of a patient with chronic obstructive pulmonary disease.