Effect of orthopneic position and pursed-lip breathing on dyspnea in patients with chronic obstructive pulmonary disease
https://doi.org/10.52235/lp.v7i1.695
Keywords:
dyspnea, orthopneic position, pursed-lip breathingAbstract
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation and dyspnea that significantly reduces patients’ functional capacity and quality of life. Non-pharmacological nursing interventions, including breathing techniques and therapeutic positioning, have increasingly been applied to improve respiratory function and alleviate dyspnea symptoms. However, evidence regarding the combined effectiveness of orthopneic positioning and pursed-lip breathing in clinical inpatient settings remains limited.
Objective: This study aimed to evaluate the effect of orthopneic position combined with pursed-lip breathing on dyspnea indicators, including respiratory rate, oxygen saturation, and peak expiratory flow, among patients with chronic obstructive pulmonary disease.
Methods: A pre-experimental one-group pretest–posttest design was conducted in the MDR Baji Ati ward, Labuang Baji General Hospital Makassar. Seventeen hospitalized adult COPD patients meeting inclusion criteria participated in the study. The intervention consisted of orthopneic positioning combined with pursed-lip breathing exercises administered for 20–30 minutes per session, at least three times weekly for four weeks. Outcome measures included respiratory rate, oxygen saturation, and peak expiratory flow assessed before and after the intervention. Data were analyzed using paired t-test with a significance level of 0.05.
Results: The intervention significantly reduced respiratory rate from 23.4 to 18.9 breaths per minute (p = 0.001), increased oxygen saturation from 89.6% to 96.4% (p = 0.001), and improved peak expiratory flow from 256 L/min to 367 L/min (p = 0.001). Large effect sizes across outcomes indicated substantial clinical improvement. No adverse events were reported during the intervention period.
Conclusion: The combined application of orthopneic positioning and pursed-lip breathing effectively improved respiratory parameters and reduced dyspnea among COPD patients. This evidence-based nursing intervention represents a safe, feasible, and clinically valuable strategy for respiratory symptom management in hospitalized patients with chronic obstructive pulmonary disease.
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References
Agustí, A., Beasley, R., Celli, B., et al. (2022). Global initiative for chronic obstructive lung disease report. GOLD Science Committee.
Agustí, A., Beasley, R., Celli, B., Hughes, R., Müllerová, H., Papi, A., Pavord, I. D., van den Berge, M., & Faner, R. (2022). Treatable traits in the NOVELTY study. Respirology, 27(11), 929–940. https://doi.org/10.1111/resp.14325
Ammous, O., Feki, W., Lotfi, T., Khamis, A. M., Gosselink, R., & Rebai, A. (2023). Inspiratory muscle training with or without pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 1, CD013778. https://doi.org/10.1002/14651858.CD013778.pub2
Anurak, A., & Chaow, C. (2026). Association Between Functional Status and Self-Care Behavior Among Adults at High Risk of Stroke : A Cross-Sectional Study. Journal of Community Nursing and Primary Care, 2(1), 15-20. https://doi.org/10.63202/jcnpc.v2i1.98
Ar-Razy, A. F. Z., & Rohmah, A. I. N. (2025). The combination of Slow Deep Breathing (SDB) and Progressive Muscle Relaxation (PMR) to reduce blood pressure in hypertension patients: A case study. Lentera Perawat, 6(4), 603–610. https://doi.org/10.52235/lp.v6i4.598
Bassanelli, S., Vasta, N., Bucchiarone, A., et al. (2022). Gamification for behavior change: A scientometric review. Acta Psychologica, 228, 103657. https://doi.org/10.1016/j.actpsy.2022.103657
Clímaco, D. C., Lustosa, T. C., Silva, M. V., Lins, O. L., Rodrigues, V. K., & Oliveira, L. A. (2022). Sleep quality in patients with chronic obstructive pulmonary disease: Correlation with disease severity and health status. Jornal Brasileiro de Pneumologia, 48(3), e20210340. https://doi.org/10.36416/1806-3756/e20210340
Cox, N. S., Dal Corso, S., Hansen, H., McDonald, C. F., Hill, C. J., Zanaboni, P., & Holland, A. E. (2021). Telerehabilitation for chronic respiratory disease. Cochrane Database of Systematic Reviews, 1, CD013040. https://doi.org/10.1002/14651858.CD013040.pub2
Global Initiative for Chronic Obstructive Lung Disease. (2024). Global strategy for prevention, diagnosis, and management of COPD: 2024 report. https://goldcopd.org/2024-gold-report/
GOLD. (2018). Asthma-COPD Overlap Phenotypes and Smoking :Comparative features of asthma in smoking or non-smoking patients with an incomplete reversibility of airway obstruction. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(2), 130–138. https://doi.org/10.1080/15412555.2017.1395834
GOLD. (2020). Global Initiative for Chronic Obstructive Lung Disease. Global Initiative for Chronic Obstructive Lung Disease, 141.
Holland, A. E., Cox, N. S., Houchen-Wolloff, L., et al. (2021). Defining modern pulmonary rehabilitation: An official American Thoracic Society workshop report. Annals of the American Thoracic Society, 18, e12–e29. https://doi.org/10.1513/AnnalsATS.202102-146ST
Huang, H., Da, J., Watson, R., et al. (2024). Development and validation of an evidence-based home pursed-lip breathing protocol for improving health outcomes in patients with chronic obstructive pulmonary disease. International Journal of Older People Nursing, 19, e12627. https://doi.org/10.1111/opn.12627
Huang, H., Huang, M., Chen, Q., et al. (2023). Effects of serious games for patients with chronic obstructive pulmonary disease: A systematic literature review. JMIR Serious Games, 11, e46358. https://doi.org/10.2196/46358
Kim, J., & Castelli, D. M. (2021). Effects of gamification on behavioral change in education: A meta-analysis. International Journal of Environmental Research and Public Health, 18(7), 3550. https://doi.org/10.3390/ijerph18073550
KK, I. F. J. (2024). Effect of Diaphragmatic Breathing Exercise on Respiratory Rate and Oxygen Saturation in patients with Bronchial Asthma. Indonesian Journal of Health Services, 1(1), 18-24. https://doi.org/10.63202/ijhs.v1i1.5
KK, I. F. J., Auliana, H., Damayanti, A. D., Putri, A., Susanti, M., Hidayati, T., … Herliza, S. (2025). Application of Active Cycle Breathing Technique (ACBT) Exercises on Hemodynamic Status in Pulmonary Tuberculosis Patients With Respiratory Problems : A Case Study. Lentera Perawat, 6(2), 227–233. https://doi.org/10.52235/lp.v6i2.450
Marlina, S., Epin, E., KK, I. F. J., Yunianti, F., Jamal, J., & Diana, D. (2025). Nursing management of ineffective airway clearance through effective cough technique in chronic obstructive pulmonary disease: A case study. Lentera Perawat, 6(4), 750–758. https://doi.org/10.52235/lp.v6i4.629
Meghji, J., Mortimer, K., Agustí, A., Allwood, B. W., Asher, I., Bateman, E. D., et al. (2021). Improving lung health in low- and middle-income countries: From challenges to solutions. The Lancet, 397(10277), 928–940. https://doi.org/10.1016/S0140-6736(21)00458-X
Riaz, H., Amjad, A., Mustafa, N., et al. (2024). Impact of diaphragmatic breathing with pursed-lip breathing versus pursed-lip breathing alone on dyspnea and exercise capacity among COPD patients. International Journal of Health Research, 2, 488–495. https://doi.org/10.71000/m66c1140
Şahin, H., Naz, İ., Karadeniz, G., Süneçlı, O., Polat, G., & Ediboğlu, O. (2023). Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes. Jornal Brasileiro de Pneumologia, 49(1), e20220107. https://doi.org/10.36416/1806-3756/e20220107
WHO. (2019). Assessment of National Capacity For Noncommunicable disease prevention and control. The report of a global survey.
WHO. (2021). Chronic Obstructive disease (COPD). Who-Searo.
Winda Agustina, & Yudi Budianto. (2025). Management of Hyperthermia with the Application of Tepid Water Sponge in Pediatric Patients with Hyperthermia. Indonesian Journal of Health Services, 1(3), 60-65. https://doi.org/10.63202/ijhs.v1i3.14
Yun, R., Bai, Y., Lu, Y., Wu, X., & Lee, S. D. (2021). How breathing exercises influence respiratory muscles and quality of life among patients with COPD: A systematic review and meta-analysis. Canadian Respiratory Journal, 2021, 1904231. https://doi.org/10.1155/2021/1904231
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