Effectiveness of Pranayama’s on Respiratory Health Status among Chronic Obstructive Pulmonary Disease (COPD) Patients Admitted in Pravara Rural Hospital, Loni (Bk)

Mr. Patel Mihir Kumar Maheshbhai¹, Mr. T. Sivabalan²*, Dr. Neesha Kiran Shinde³

¹Joitiba College of Nursing, Lalji Park, Bhandu - 384120, Gujarat, India

²Pravara Institute of Medical Sciences (DU), College of Nursing, Loni (Bk) - 413736. Maharashtra, India

³Pravara Institute of Medical Sciences (DU), College of Physiotherapy, Loni (Bk) - 413736. Maharashtra, India

Corresponding Author Email: sivavimal.guru@gmail.com

ABSTRACT:

Background: The respiratory diseases constitute a major problem of the world today. Every fifth death case is believed to be caused by a lung disease. The most frequent causes of death related to lung diseases are pneumonia, tuberculosis and COPD. These represent a substantial economic and social burden throughout the world.

Aims and objectives: A study was planned (1) to assess the level of respiratory health status, (2) to evaluate the effectiveness of Pranayama’s on respiratory health status among COPD patients and (3) to find association of respiratory health status with their socio demographic characteristics.

Material and Methods: Thirty COPD patients in the age group of above 30 years were studied. They were assessed for the level of respiratory health status on first day of admission followed by the implementation of Pranayama’s (Surya bhedana, Bhastrika and Nadi shodhana) for 30 days for every four hourly two times each. The post test was carried out after one month of intervention by using the Respiratory health status assessment Performa and computerized spirometry. The data were analyzed with descriptive and inferential statistics wherever required.

Results: Statistically significant improvement in the respiratory health status, pulmonary function and reduction of respiratory manifestations was found. There was significant association was found with age and the respiratory health status.

Conclusion: Study results indicate that the effect of Pranayama’s decrease the respiratory manifestations and improves the pulmonary function parameters. It is essential to raise the awareness on significance of Pranayama’s and seek behavioral change among COPD patients to improve the cardio pulmonary parameters.

Key words: Pranayama’s, Respiratory Health Status and Chronic Obstructive Pulmonary Disease

INTRODUCTION:

Chronic Obstructive Pulmonary Disease is major public health problem worldwide and is expanding throughout with high prevalence. Currently around 80 million people have moderate to severe disease and represents 5% of all death globally, and projected to increase by more than 30% in next 10 years; almost 90% of deaths occur in low and middle income countries [1].

The prevalence of COPD in India is 5% in males and 2.7% in females with the ratio of 1.6:1 (around 12 million cases). The incidence and prevalence is increasing as a result of urban ambient air pollution and indoor exposure concentrations of particulate air pollution[2]. It’s a preventable and treatable disease, as the symptoms progress, they can eventually become life threatening, and patients in the advanced stages are likely to die as a result of complete respiratory system failure [3].

The disease is associated with a significant symptom burden and poor quality of life. Patients experience poor physical functioning and live with distressing symptoms that require frequent hospital admission [4, 5]. There is a resurgence of interest in holistic systems of health care, mainly in prevention and management of non communicable and chronic diseases. Pranayama’s are considered as important part of modern medicine. The systematic reviews showed that the Pranayama’s significantly improves the lung function parameters, alters the cardiopulmonary responses and reduces the impact of disease on their lives [6].

Researchers demonstrated that the Pranayama’s, showed improvement of lung function parameters, improvement in the exercise tolerance, symptoms score, their usual activity and reduction on the impact of disease on their lives [7]. The yogic techniques including Pranayama’s are gaining importance and becoming increasingly acceptable to the scientific community. The number of patients with COPD is increasing. These patients need specific health care, including education in self care which has a positive effect on their physical and psychological well being. Health care professionals and care givers can facilitate and improve patient outcomes and services [8]. A study was therefore planned to assess the level of respiratory health status, and to evaluate the effectiveness of Pranayama’s on respiratory health status among COPD patients.

MATERIAL AND METHODS:

The Quasi - experimental study, pre test post test design without control group approach were used. The present study was conducted in 30 COPD patients at medical wards of Pravara Rural Hospital, Loni (Bk). The patients who are above 30 years of age, able to follow and practice Pranayama’s and willing to participate were included in the study. However those who are acutely ill, not able to practice Pranayama’s, and unwilling to participate were excluded. Approval by ethical committee of Pravara Institute of Medical Sciences was obtained and the informed consent was obtained from the subjects. The subjects were selected by non probability; purposive sampling method. For the respiratory health status assessment, self prepared and pre tested respiratory health status assessment Performa was used which includes the sign and symptoms and categorized under inspection, palpation and auscultation areas. The presence of symptom indicates the score of one (1) and absent zero (0). The computerized spirometry was used to assess the pulmonary function parameters. The assessment was carried out by the researchers through physical examination with respiratory health status assessment Performa.

Pre test: was conducted on first day of admission in medical wards, followed by the intervention: Pranayama’s techniques training a). Surya bhedana – inhalation only with right nostril and exhalation via left nostril, b). Bhastrika – breath is forcefully drawn in and out through the nose in equal proposition and c). Nadi shodhana – the alternative nostrils breathing were imported; under supervision the patients were made to practice the Pranayama’s every four hourly two sessions each till they were discharged from the hospital; after, the patients were instructed to practice and maintain a dairy in home and they were supervised by the researchers once in a week through home visits. The duration of intervention was 30 days; the enrolled patients were brought to Medicine OPD after the one month of Pranayama’s practice while the post test: was carried out by using the respiratory health status assessment Performa and computerized spirometry. Two patients were dropped out from the study due to severity of disease. The collected data was organized and analyzed based on the objectives by using descriptive and inferential statistics.

RESULTS:

Findings related to socio demographic characteristics: Highest percentage (53.3%) of patients were >56 years of age, majority 73% were males, 53% had primary school education and 36% were illiterates, one third of patients (36%) were farmers, nearly half (47%) had monthly income of Rs. less than 5000, most (93%) were Hindus and highest percent (30%) received information on Pranayama’s through mass medias (Television/Radio).

Findings related to clinical characteristics: The highest percent (43%) had duration of illness less than one year, 43% had history of pollutant exposure, one third (33%) of patients had tobacco chewing habit followed by (30%) had smoking habits, and majority 66% followed the allopathic treatment.

Effectiveness of Pranayama’s on respiratory health status: The overall respiratory health status mean score was (10±2.2) which is 55.5% of the total score indicates COPD patients had moderate level impairment of respiratory health status whereas the post-test mean score was (6.26±3.5) which is 34.77% and the effectiveness was 20.78%. It interprets that the Pranayama’s significantly reduces the respiratory manifestations (t=4.62, p<0.05). (Table 1) However, the Pranayama’s had demonstrated more effectiveness on various areas of respiratory health status. (Table 2) The respiratory health status had significant association with socio demographic characteristics like age (χ²=4.61) at p<0.05 level.

Table 1: Effectiveness of Pranayama’s on various aspects of respiratory health status
Respiratory heath status aspects	Max. Score	Pre-test	Post-test					Mean difference (%)	‘t’ value
Respiratory heath status aspects	Max. Score	Mean	SD	Mean%	Mean	SD	Mean%	Mean difference (%)	‘t’ value
Inspection	11	5.63	1.5	51.2	3.57	2.3	19.8	31.35	3.9*
Palpation	3	1	0.9	33.3	0.27	0.5	8.7	24.67	1.4
Auscultation	4	3.37	0.6	84.3	2.42	1.2	60.5	23.75	2.5*
Overall	18	10	2.2	55.5	6.3	3.6	34.7	20.8	4.6*

Table value: 2.06, P<0.05, * Significant

Table 2: Effectiveness of Pranayama’s on various areas of respiratory health status
Respiratory health status	Pre-test (Y)		Post-test (X)		Effectiveness (E=Y-X)
Respiratory health status	No	%	No	%	Effectiveness (E=Y-X)
Dyspnea	18	60	04	13.3	46.7
Adventitious sound	30	100	19	63.3	36.7
Abnormal breathing pattern	25	83.3	14	46.7	36.6
Cough	30	100	20	66.7	33.3
Abnormal resonance	30	100	20	66.7	33.3
Restricted Air entry	14	46.7	05	16.7	30.0
Irregular Rhythm	11	36.7	03	10	26.7
Use of accessory muscles	20	66.7	13	43.3	23.4
Asymmetrical chest movement	07	23.3	02	6.7	16.6
Nasal flaring	14	46.7	10	33.3	13.4

Effectiveness of Pranayama’s on pulmonary function parameters:

The post test pulmonary function parameters scores of COPD patient’s shows that the 30 days of Pranayama’s practice has significantly improved the pulmonary function parameters like Force Expiratory Volume (FEV) (t=2.3) and FEV1/FVC% (t=2.5) at P<0.05 level, which interprets that the performing Pranayama’s produce significant changes in pulmonary functions of COPD patients. However the other parameters like Tidal Volume (TV), Inspiratory Reserve Volume (IRV), Expiratory Reserve Volume (ERV), Force Vital Capacity (FVC) and Oxygen Saturation (Spo2) had no significant improvement.

DISCUSSION:

The chronic non-communicable diseases are assuming increased importance among the adult population in both developed and developing countries. The impact of chronic diseases on the lives of people is serious when measured in terms of loss of life, disablement, family hardship and poverty and economic loss of the country [9].

The study findings revealed that majority of COPD patients has advanced age which is supported by Vilkman S, Keistinen T, Tuuponen T and Kivela SL in a study among COPD patients on disease severity and symptoms. The results showed that COPD is usually diagnosed between the ages of 50 and 60 years [10] and most (73.33%) of patients under study were males. It is consistent with study carried out by Zhong N and Wang C that the prevalence of COPD was significantly higher in men than in women [11].

Results showed that significant percent of patients has exposure to pollutant and smoking habits which is congruent with a study carried out by Jindal SK that interaction between host factors and exposure to environmental pollutants (tobacco smoke, occupational dust and fume) and socio economic status was important risk factors for COPD and other respiratory Problems [12].

Pranayama is the conscious, deliberate regulation of breath replacing unconscious patterns of breathing. It is considered as very important part in modern medicine. Many physicians now recommend yoga to patients at risk for heart disease and respiratory diseases; can produce different physiological responses [13].

In our study pranayama’s showed significant improvement in the respiratory health status and pulmonary functions. Pomidori L, Campigotto, Amatya TM, Bernadi L and Cogo A has studied effects of pranayama’s on COPD patients and observed that the pranayama’s significantly improves the respiratory health status and pulmonary parameters like tidal volume, inspiratory reserve volume, respiratory rate and oxygen saturation [14].

The 30 days of pranayamas practice produced significant improvement in the pulmonary parameters like Force Expiratory Volume (FEV), Force Vital Capacity, FEV1/FVC% and Oxygen Saturation. Study of Ahmed QR, Sau SK and Kar SK indicated that performing pranayamas produce significant changes in FVC, FEV1 and PEFR on COPD patients [15].

The results of this study provide the important implications for understanding the impact of COPD on patient’s health status and quality of life. The findings of this study support the multidimensional notion of the treatment strategy and emphasize the role of complementary therapies in patient care.

CONCLUSION:

The findings demonstrated that COPD patients are affected in many dimensions of their health. The result of study indicates that the practice of pranayama’s actively improves respiratory health status and the pulmonary function. The regular practice of pranayama’s can improve the efficacy of respiratory muscles, reduce the severity of respiratory symptoms and prevents pulmonary complication. It is emphasized that education/training on pranayama’s is essential for the COPD patients and caregivers/family members would thereby improve their awareness and skill in performing the pranayama’s which leads to state of well being. A multi focus treatment and rehabilitation is a need of hour for chronic diseases patients; thereby the health care professionals focus measures to improve the quality of life and prevention of respiratory consequences.

ACKNOWLEDGEMENT:

The authors express our sincere thanks to the Pravara Institute of Medical Sciences (DU), the Medical Superintendent, HOD of Medicine of Pravara Rural Hospital, Loni (Bk) and the Principal, College of Physiotherapy and the COPD patients for their kind cooperation and support.

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Received on 03.01.2013 Modified on 20.01.2013

Asian J. Nur. Edu. & Research 3(1): Jan.-March 2013; Page 33-36