SAURASHTRA UNIVERSITY

RAJKOT, GUJARAT

PERFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MS. RESHMA SARA GEORGE

FIRST YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING
YEAR 2023-2024

SHRI ANAND INSTITUTE OF NURSING

BEHIND SAINIK SOCIETY,
OPP. GHANTESHWAR PARK,
JAMANGAR ROAD, RAJKOT
 NAME OF THE
1. MS. RESHMA SARA GEORGE
CANDIDATE

ENROLLMENT
2. 22MD57PG00305
NO.

SHRI ANAND INSTITUTE OF NURSING

NAME OF THE BEHIND SAINIK SOCIETY, OPP.
3.
INSTITUTION GHANTESHWAR PARK, JAMNAGAR
ROAD, RAJKOT

COURSE OF
1ST YEAR MSc NURSING
4. THE STUDY
MEDICAL SURGICAL NURSING
AND SUBJECT

DATE OF
5. ADMISSION 28/01/2023
TO COURSE

“A STUDY TO EVALUATE THE

EFFECTIVENESS OF BUTEYKO
TITLE OF THE BREATHING EXERCISE ON LEVEL OF
6.
STUDY DYSPNOEA AMONG PATIENT WITH
OBSTRUCTIVE AIRWAY DISEASE IN
SELECTED HOSPITAL, AT RAJKOT”
BACKGROUND OF THE STUDY

The Buteyko method or Buteyko Breathing Technique is a form of complementary

or alternative physical therapy that proposes the use of breathing exercises primarily as
a treatment for asthma and other respiratory conditions.

Buteyko asserts that numerous medical conditions, including asthma, are caused or
exacerbated by chronically increased respiratory rate or hyperventilation. The method
aims to correct hyperventilation and encourage shallower, slower breathing. Treatments
include a series of reduced-breathing exercises that focus on nasal-breathing, breath-
holding and relaxation.

Advocates of the Buteyko method claim that it can alleviate symptoms and reliance on
medication for patients with asthma, chronic obstructive pulmonary disease (COPD),
and chronic hyperventilation. The medical community questions these claims, given
limited and inadequate evidence supporting the theory and efficacy of the method.

The Buteyko method was originally developed in the 1950s by physiologist Konstantin
Buteyko in Ukraine, then part of the Soviet Union. The first official study into the
effectiveness of the Buteyko Method on asthma was undertaken in 1968 at the
Leningrad Institute of Pulmonology. The second, held at the First Moscow Institute of
Pediatric Diseases in April 1980, eventually led to the head of the ministry of health to
issue an order (No 591) for the implementation of the Buteyko method in the treatment
of bronchial asthma. Later, this method was introduced to Australia, New Zealand,
Britain and the United States, where it has received increasing exposure. Anecdotal
reports of life-changing improvements attributed to the Buteyko method abound on the
Internet and in books.

The Buteyko method is one of a number of breathing retraining methods in use for
treating lung diseases, including conventional techniques such as physiotherapist-led
breathing exercises as well as alternative medicine techniques such as yoga.

In 2019, the popular Indonesian singer Andien posted images of herself, her husband
and their two-year-old son with tape over their mouths on social media. The pictures
prompted discussion and interest in the Buteyko method.

Breathing exercises and breathing retraining are often used in the management of
asthma. One specific form of breathing therapy, known as the Buteyko breathing
technique (BBT) has received considerable attention, but there is a paucity of rigorous
research evidence to support its recommendation for asthma patients. There are only
four published clinical trials and two conference abstracts evaluating BBT. Although
all have reported improvements in one or more outcome measures, results have not
been consistent. This article provides the background to the BBT, reviews the available
evidence for its use and examines the physiological hypothesis claimed to underpin it.
In common with other therapies, BBT is not a standardised treatment modality. The
BBT 'package' is complex, as it also includes advice and education about medication
use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly
inappropriate, to attempt to tease out a single mechanism. Buteyko's theory relating to
carbon dioxide levels and airway calibre is an attractive one, and has some basis in
evidence from experimental studies. However, it is not known whether altering
breathing patterns can raise carbon dioxide levels significantly, and there is currently
insufficient evidence to confirm that this is the mechanism behind any effect that BBT
may exert. Further research is necessary to establish unequivocally whether BBT is
effective, and if so, how it may work.

Asthma is a debilitating, chronic disease characterized by airway hyper‐responsiveness

and associated respiratory symptoms (Fauci 1998). Asthma is extremely common and
is one of the leading presenting complaints for patients in general practice in Australia
and the UK (Anderson 2007). It has been estimated that in the USA, asthma
management costs exceed $USA 12.7 billion per year (in 1998 dollars) (Weiss
2001). Symptomatic treatments provide short term relief from the symptoms of asthma
but do not prevent further episodes. A recent study of asthma patients (Shaw 2006)
reported that patients use a variety of alternative treatments for asthma which have
unknown or no efficacy including yoga, homeopathy (McCarney 1999), kinesiology,
massage therapy, osteopathy, acupuncture (McCarney 1999a) and breathing techniques
including Buteyko breathing techniques.

The Buteyko Breathing Method is a unique breathing therapy that uses breath control
and breath-holding exercises to treat a wide range of health conditions believed to be
connected to hyperventilation and low carbon dioxide. The therapy involves instructing
patients in controlled shallow breathing through the nose only, with breath-holding at
the end of the exhalation and resuming normal breathing calmly and gently. Aim: To
Study the immediate effect of Buteyko breathing technique on cardio-respiratory
parameters in young Adults Methodology: 80 subjects recruited for the study were
explained the entire procedure and subject were taught how to perform Buteyko
Breathing Technique (BBT). Baseline HR, BP, RPE and PFT were noted as pre-test
evaluation. Post-BBT for 12 min, evaluation was done for outcome measures like HR,
RPE, BP and PFT (PEFR, FEV1 and FEF 25-75). Results: When subject performed
five minute Buteyko at rest it was seen that HR increased and SBP decreased, the RPE
also increased significantly for both males and females and an increase in FEF 25-75
was also observed after five minute of BBT at rest, but it was significant only in
females. Conclusion: Buteyko Breathing technique used at rest has significant effect on
certain cardio-respiratory parameters in young adults like HR, SBP and RPE.
Asthma is one of the major medical challenges worldwide and the most common
chronic disease in childhood. Children with asthma are not only confronted with
potentially life-threatening exacerbations, but also with school absenteeism impairing
educational progress and further amplifying socioeconomic disparities. Moreover, they
are at increased risk of psychosocial problems resulting from the inability to participate
in age-appropriate activities important for the development of self-esteem and social
skills. Such disease-related impairments and a reduced quality of life can also adversely
impact the families.

Current approaches to management of asthma are based primarily on pharmacotherapy,

mainly with inhaled corticosteroids (ICS) and bronchodilators (beta-2 agonists).
However, some patients report an increasing interest in complementary therapies.
Parents in particular seek these options due to concerns about possible medication side
effects on their children. Breathing retraining is one of the most prominent
complementary approaches and consists of various techniques, such as the Papworth
method, Yoga (pranayama), capnometry-assisted respiratory training (CART), or slow
breathing and awareness training (SLOW). Breathing retraining focuses on the patient’s
breathing pattern as dysfunctional breathing, such as chronic hyperventilation, is
known to contribute to hypocapnia and related physical and mental problems, e.g.,
asthma and anxiety or panic disorders.

Another well-known breathing training program—the Buteyko Breathing Technique

(BBT)—was introduced in Russia in the 1950s by Dr Konstantin Buteyko. Buteyko
identified various dysfunctional breathing habits, such as mouth breathing and upper
chest breathing, as being among the major causes for chronic hyperventilation.
Consequentially, he introduced breathing exercises based on breath-holding maneuvers
and breath control to guide patients back to the normal nasal/diaphragmatic breathing
pattern, designed to reduce breathing volumes and restore metabolic balance.
The clinical utility of BBT has been explored in a number of studies in adult patients
with asthma. Overall, these studies have reported beneficial effects on asthma control
and quality of life as well as reductions in medication use, whereas pulmonary
function has remained largely unchanged. In children with asthma, evidence addressing
the value of BBT is limited. Enhancements in lung function and asthma control
following BBT intervention were reported by Elnaggar and Shendy who conducted an
RCT with three intervention groups comparing BBT, active cycle of breathing
technique (ACBT), and thoracic lymphatic pump technique (TLPT) in 54 children with
asthma (aged 8-14 years). Azab et al. observed similar levels of improvement in
pulmonary function and functional capacity (6-minute walk test) after 3 months of
training (3-day initial in-person training combined with daily home practice) when they
compared BBT to yoga in an RCT conducted with 40 individuals (aged 7-12 years)
having pediatric asthma. The respiratory outcome in 35 children with asthma (6-12
years) was enhanced upon completion of a short-term BBT intervention when
compared to that resulting from routine nursing care alone (n = 35 controls). McHugh
et al. published a case series on BBT in eight children, showing a reduction in beta-2
agonist and ICS use, but no lung function data were reported. Hepworth et al. recently
assessed the impact of breathing retraining, particularly BBT, on asthma symptoms and
dysfunctional breathing, as assessed with the Asthma Control Test and the Nijmegen
Questionnaire, in 169 children with asthma and found improved asthma control and
dysfunctional breathing in children on all levels of asthma treatment. In the present
study, we evaluated medication use, pulmonary function parameters and parents’
quality of life in an RCT designed to more fully evaluate potential benefits from adding
BBT to standard care in treating children with asthma.
In Buteyko’s view, because CO2 was so important, the body developed a set of
defensive mechanisms to maintain CO2, including constriction of airways and blood
vessels, and giving rise to diseases such as asthma and hypertension. According to his
theory, CO2 is a bronchodilator of the lung and low CO2 “hypocapnia” has exacerbated
multiple medical problems and developed as many as 150 symptoms and conditions.
Therefore, he believed that a small rise in the CO2 level has many beneficial results in
the body including relaxing smooth muscle, increasing oxygenation, switching on the
relaxing nervous system, and increasing the production of nitric oxide by the body.
Relaxation of the bronchi and bronchioles can improve ventilation and greatly decrease
airway spasms associated with asthma in the respiratory system.
Buteyko approach seeks to educate asthmatic patients to decrease airflow by teaching
them the best way to hold their breath at the functional residual capacity. The key
component of the Buteyko program is to minimize hyperventilation by periods of
controlled reduction of breathing, known as “slow breathing” and “reduced breathing,”
coupled with periods of breath keeping, known as “control pauses” and “extended
pauses”. The use of the diaphragm for breathing is often recommended, and the use of
accessory muscles for breathing is discouraged. They are sometimes accompanied in
Buteyko by physical activities to increase the CO2 build-up.
Advice and instruction on the effects of nasal breathing over oral breathing are also
used in the Buteyko technique. The nose not only warm, filter, and humidify the
inspired air, but also creates nitric oxide, which is a strong bronchodilator for asthma.
In order to encourage nasal breathing, Buteyko patients are encouraged to breathe
through the nose during the day and try to tap the mouth at night. The Buteyko
technique also proposes lifestyle changes beyond breathing, including diet, allergy
avoidance, and stress control. The Buteyko method’s four cardinal laws are as follows:
keeping the mouth closed, keeping the back straight, breathing gently and silently, and
eat only if hungry

NEED FOR THE STUDY

Chronic Obstructive Pulmonary Disease (COPD) is a “common preventable, and

treatable disease that is characterized by persistent respiratory symptoms and airflow
limitation due to abnormalities in the airway and (or) alveolar abnormalities usually
caused by significant exposure to noxious particles or gases”. According to the World
Health Organization (WHO), COPD is among the leading causes of deaths globally.
The WHO Global Alliance against Chronic Respiratory Diseases is committed towards
the common goal to reduce the global burden of respiratory diseases.
According to the WHO’s estimates, nearly 65 million people have moderate to severe
COPD that accounts for 5% of deaths (41.9 deaths per 100 000 individuals) globally
and COPD remained the most prevalent disease-specific chronic respiratory disease
(CRD). COPD also imposes a significant burden owing to high health care costs and
impaired health-related quality of life. It is the leading cause of disability among
chronic respiratory diseases and was the second leading contributor of Disability
Adjusted Life Years (DALY). In 2020, nearly 32% of global DALYs due to COPD
occurred in India and COPD is responsible for 75.6% of total DALYs among chronic
respiratory disease in India. COPD-related mortality has been reported to be 39%. Most
of the existing data on COPD is from high-income countries, but 90% of deaths occur
in low and middle-income countries. Both India and China contributed to 33% of the
world population and accounted for 66% of COPD mortality.
“Lung Health for All” is the key theme of World Lung Day 2022 (September 25). The
day aims to highlight the global burden of the major respiratory diseases and the impact
of coronavirus disease (COVID-19), with a focus on low- and middle-income countries
(LMIC). Key messages for the day are the importance of early detection and reduction
of inequalities. These align well with the objectives Global Initiative for Chronic
Obstructive Lung Disease (GOLD) of improving the diagnosis and management of
chronic obstructive pulmonary disease (COPD) around the world. COPD affects 1 in
10 of the adult global population and is one of the three commonest causes of death
worldwide (1). It is also a major cause of the global inequalities in health and is more
prevalent where such inequalities are more extreme.
In 2019 COPD killed 3.22 million people (2), and the number of deaths rose by 17.5%
between 2007 and 2017 (3). The main burden of mortality from COPD is seen in Latin
America, sub-Saharan Africa, India, China, and Southeast Asia. The Global Burden of
Disease study estimated that COPD affected 104.7 million men and 69.7 million
women globally in 2015 and that between 1990 and 2015 the prevalence of COPD had
increased by 44.2% (4); however, another analysis has estimated that COPD is much
more common and that 384 million people had COPD in 2010 (5). Until recently the
mean life expectancy of the population in many LMIC has been poor and survival to an
age when COPD would usually be diagnosed was uncommon, but improvements in life
expectancy in LMIC over the last 50 years, together with reductions in childhood
mortality, are likely to lead to a substantial increase in the prevalence of COPD in Latin
America, Africa, and Southeast Asia in future decades.
The number of COPD cases in India was a staggering 55.3 million and is the second
common cause of deaths due to NCD. Evidence from India suggested the COPD
prevalence increases with age and exponentially after 30 years of age. The estimated
prevalence of COPD ranged from 0.1% to 0.9% between the age group of 5 years to 29
years while the incidence ranged from 1.6% to 28.3% in population above 30 years of
age. The prevalence of COPD varies across different regions and states of India. While
the COPD prevalence in Bangalore was reported to be 4.36%, evidence from Delhi
reported a prevalence of 10% whereas the prevalence in Kerala was reported to be
6.19% among the general population. Evidence from a multi-centric study further
reported the prevalence of Chronic Bronchitis (CB) was 3.5% in population above 35
years. A systematic review revealed the gender-wise variation in prevalence, where
COPD rates in males ranged between 2% to 22% and that for females between 1.2 to
19%
WORLD WIDE:
In 2020, high income North America (3558.4), South Asia (3298.8), and Australasia
(3192.8) had the highest age standardized point prevalence’s for COPD (per 100 000),
whereas Andean Latin America (1382.6), high income Asia Pacific (1500.7), and
eastern sub-Saharan Africa (1503.5) had the lowest (table 1). Oceania (112.1), South
Asia (93.2), and East Asia (64.6) had the highest age standardized death rates from
COPD in 2020, with the lowest rates in high income Asia Pacific (8.2), eastern Europe
(15.0), and Andean Latin America (15.4) (table 1). In 2019, Oceania (2309.9), South
Asia (1915.9), and East Asia (1100.0) had the highest age standardized DALY rates
(per 100 000), whereas high income Asia Pacific (224.5), Andean Latin America
(281.9), and eastern Europe (381.5) had the lowest (table 1). Figures S1-S3 show the
age standardized point prevalence, death, and DALY rates of COPD, respectively, by
sex in 2020 for all regions in the Global Burden of Disease study.
The largest increases in the age standardized point prevalence of COPD, from 1990 to
2020, were found in North Africa and the Middle East (30.6%), Caribbean (29.2%),
and southern Latin America (19.8%), with the greatest decreases in eastern Europe
(−29.5%), East Asia (−27.1%), and high income Asia Pacific (−20.5%) (table 1). In the
same period, all regions showed a decrease in the age standardized death rates from
COPD, with the largest decreases in East Asia (−69.6%), eastern Europe (−55.8%), and
central Europe (−43.2%) (table 1). The age standardized DALY rates decreased in all
regions from 1990 to 2020, with the largest decreases in East Asia (−68.9%), Eastern
Europe (−50.8%), tropical Latin America (−36.2%), and central Europe (−34.6%)
(table 1). Figures S4-S6 show the percentage change, from 1990 to 2020, in age
standardized point prevalence, death, and DALY rates for COPD by sex, respectively.
The number of prevalent cases of COPD increased from 114.9 million in 1990 to 212.3
million in 2020. East Asia, South Asia, and western Europe had the highest numbers of
prevalent cases in 1990, and the same regions had the largest numbers in 2020 (table
S4). The number of deaths caused by COPD increased from 2.5 million in 1990 to 3.3
million in 2020, with East Asia, South Asia, and western Europe having the highest
numbers of deaths in 2020 (table S5). The number of DALYs due to COPD increased
from 59.2 million in 1990 to 74.4 million in 2019, with South Asia, East Asia, and high
income North America having the highest numbers of DALYs in 2020 (table S6).

IN INDIA:

In 2020, the national age standardized point prevalence of COPD ranged from 668.5 to
4299.5 cases per 100 000. Denmark (4299.5), Myanmar (3963.7), and Belgium
(3927.7) had the highest age standardized point prevalence’s of COPD, with Fiji
(668.5), Guam (1010.0), and Kiribati (1019.4) having the lowest estimates (fig 1 and
table S4). The national age standardized death rates for COPD in 2020 varied from 7.4
to 182.5 deaths per 100 000. The highest rates were seen in Nepal (182.5), Papua New
Guinea (145.0), and the Democratic People’s Republic of Korea (105.2), whereas the
lowest rates were found in Japan (7.4), Barbados (8.3), and Kuwait (8.3) (fig 2 and table
S5). In 2020, the national age standardized DALY rate of COPD ranged from 177.7 to
3318.4 patients per 100 000. The highest rates were seen in Nepal (3318.4), Papua New
Guinea (2902.7), and the Solomon Islands (2178.6) whereas the lowest rates were in
Barbados (177.7), Antigua and Barbuda (178.2), and Peru (189.6) (fig S7 and table S6).
The percentage change in the age standardized point prevalence, from 1990 to 2020,
differed noticeably between countries, with Egypt (62.0%), Georgia (54.9%), and
Nicaragua (51.6%) having the largest increases. In contrast, Turkmenistan (−47.9%),
Singapore (−47.3%), and Ukraine (−45.6%) had the largest decreases (table S4). Over
the same period, Nicaragua (68.5%), Norway (63.5%), and Sweden (36.9%) had the
largest increases in the age standardised death rate, whereas the largest decreases were
found in Singapore (−81.0%), China (−70.1%), and Turkmenistan (−69.9%) (table S5).
Nicaragua (44.3%), Cuba (38.6%), and Norway (38.5%) had the largest increases in
age standardised DALY rate of COPD from 1990 to 2019. In contrast, the greatest
decreases during the study period were found in Singapore (−73.8%), China (−69.5%),
and Turkmenistan (−65.1%) (table S6).
 Fig 1
Age standardized point prevalence of chronic obstructive pulmonary disease per 100 000
population in 2020, by country (generated from data available at https://ghdx.healthdata.org/gbd-
results-tool)
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Fig 2
Age standardized death rate of chronic obstructive pulmonary disease per 100 000 population in
2020, by country (generated from data available at https://ghdx.healthdata.org/gbd-results-tool)
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Global initiative for Chronic obstructive lung disease (GOLD) Science Committee was
established with an aim to review published research on COPD management and
prevention, and to evaluate the impact of research on recommendations on GOLD
documents. According to the GOLD criteria, spirometry is the gold standard diagnostic
measure for confirming COPD with FEV1/FVC values of <70%. However, the
pulmonary function test (PFT) is not routinely performed during outpatient consultation
leading to underestimating COPD cases especially during the early phases of the
disease. The data from low- and middle-income countries (LMIC) is underestimated
due to the scarcity in diagnosing the disease using spirometric measurements, thus
leading to under-reporting of COPD cases in LMICs. A study conducted in Italy
reported that only 56.2% of doctor-diagnosed COPD cases were confirmed via
spirometry assessment. This is alarming as it endangers misdiagnosis of COPD, under-
reporting of COPD which impedes early detection and treatment.
By 2030, Sustainable Development Goal 3.4 aims to reduce the premature mortality
caused by non-communicable diseases through prevention and treatment. Chronic
obstructive pulmonary disease is the second leading cause of mortality and disability-
adjusted life years in India. This review was conducted to estimate the prevalence of
COPD using systematic review and meta-analysis technique.
Search was conducted using six databases for studies on COPD among population
above 30 years in India between years 2000 to 2020. Cross-sectional and cohort studies
reporting prevalence of COPD and associated risk factors were included in the present
review. Screening and data extraction was done by two authors independently. Studies
were appraised for quality using the modified New Castle Ottawa scale and reporting
quality was assessed using STROBE guidelines.
Search returned 8973 records, from which 23 records fulfilled the eligibility criteria.
Overall, the prevalence of COPD among population aged 30 years and above in India
was 7%. Risk factors like active and passive smoking, biomass fuel exposure,
environmental tobacco smoke, occupational exposure to dust, indoor and outdoor
pollution, and increasing age were reported to have a significant association with COPD
among Indian population.
A national-level prevalence estimate for COPD in India is lacking. There is a dearth of
evidence on the burden of COPD in the recent past in Indian population above 30 years
along with the associated risk factors. The difference in the prevalence of COPD when
diagnosed with spirometry compared to other measures is crucial for the development
of guidelines. Studies reported difference between spirometry and non-spirometry
methods for COPD prevalence. A higher prevalence of COPD was consistent with
studies using spirometry method and under-estimation of COPD prevalence was
observed in non-spirometric studies. This also suggests positive internal consistency
with spirometry-based estimates. The reasons for not employing spirometry could be
attributed to lack of defined training cascade for diagnosis of COPD and limited
availability of spirometry equipment in health facilities. Therefore, the objectives of
this review are i) to estimate the prevalence of COPD among population above 30 years
in India, ii) compare the prevalence of COPD among population diagnosed through
spirometry and non-spirometry method and iii) to ascertain risk factors associated with
COPD among the Indian population aged above 30 years.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and
mortality across the globe. According to World Health Organization estimates, 65
million people have moderate to severe COPD. More than 3 million people died of
COPD in 2021 corresponding to 5% of all deaths globally and it is estimated to be the
third leading cause of death by 2030. Most of the information available on COPD
prevalence, morbidity and mortality comes from high-income countries. Even in those
countries, accurate epidemiologic data on COPD are difficult and expensive to collect.
However, it is known that low- and middle-income countries already shoulder much of
the burden of COPD with almost 90% of COPD deaths taking place in these countries.
In this issue of Lung India, the joint ICS/NCCP (I) consensus guidelines for the
diagnosis and management of COPD have been published to facilitate the Indian
practitioner in burden reduction, diagnosis and management of COPD.
Developing countries are changing fast. Socio-economic development,
industrialization, urbanization, changing age structure, and changing lifestyles have the
countries at a position where they are facing an ever-increasing burden of non-
communicable diseases (NCD). In India NCDs were estimated to have accounted for
53% of all deaths and 44% of disability-adjusted life-years (DALYs) lost in 2021. Of
this chronic respiratory disease accounted for 7% deaths and 3% DALYs lost India also
has had the ignominy of experiencing the “highest loss in potentially productive years
of life” worldwide in 2021. Crude estimates suggest there are 30 million COPD patients
in India. India contributes a significant and growing percentage of COPD mortality
which is estimated to be amongst the highest in the world; i.e. more than 64.7 estimated
age standardized death rate per 100,000 amongst both sexes. This would translate to
about 556,000 in case of India (>20%) out of a world total of 2,748,000 annually. Such
mammoth volumes of disease have the potential to overwhelm health systems and state
economies.
One has, however, to recognize that prevalence estimates in COPD are not totally
accurate. Several epidemiological studies have addressed the prevalence of COPD in
India, the limiting issue in these being the methodology adopted and the definitions
employed for diagnosis. Most of the studies have been unvalidated questionnaire based,
supplemented on occasion by measurement of peak flows. The reported prevalence
estimates have ranged from 2 to 22% in men and from 1.2 to 19% in women. The recent
‘Indian Study of Asthma, Respiratory Symptoms and Chronic Bronchitis’
(INSEARCH) study of 85,105 men and 84,470 women from 12 urban and 11 rural sites
reported the prevalence of chronic bronchitis to be 3.49% (4.29% in males and 2.7% in
females) in adults > 35 years. The national burden was thus estimated to be 14.84
million. However, since the study was questionnaire based and spirometry poorly
correlates with symptoms, this study might have missed asymptomatic individuals with
significant spiromteric abnormalities. Recently investigators from Pune conducted a
COPD prevalence study using post-bronchodilator spirometry in addition to the
questionnaire and reported a nearly 2-fold higher prevalence. In another collaborative
study with Burden of Lung Disease (BOLD) investigators using BOLD protocol, the
prevalence of Stage1 or higher COPD in participants > 40 years of age based in rural
Kashmir was found to be 19.3%. (Koul PA. personal communication). Thus
preliminary data emerging from the country is suggestive of higher true burden of
COPD than is currently believed.
Smoking is by far recognized to be the most important risk factor for development of
COPD. Smoking behaviors in India are also peculiar with a large number of people
using non-conventional form of tobacco in hookah, bidi, or chillum. Traditionally these
forms of tobacco have been believed to be innocuous because of a variety of reasons
like passage of smoke through water in case of hookah. Recent studies have, however,
dispelled these misperceptions. Lung cancer has been found to be nearly 6-times
common in hookah smokers compared to non-smokers, and Chillum smoking has been
demonstrated to result in much higher increase in end tidal carbon monoxide levels than
cigarette smoking, testifying to its injurious potential.
Exposure to biomass fuels like crop residues or woods or animal dung is also widely
prevalent in India. More than one-half of the world's households uses biomass fuels and
a significant proportion of this activity takes place in conditions where much of the
effluent is released into the indoor living area. This is more common in cold climates
and hilly terrains where cold temperatures force a heavier exposure in poorly ventilated
dwellings. Women, who do most of the cooking for households in rural villages, are
the most affected. Biomass fuels are now considered a major cause of the causation of
COPD and could be the single most common cause of COPD in the world. In India,
70% of the homes use biomass fuel for cooking and heating purposes in poorly
ventilated kitchens, and the amount of particulate matter pollution generated by the
burning of biomass fuel is extremely high. Ninety percent of rural households and 32%
of urban households cook their meals on a biomass stove with only 25% of the cooking
being done with cleaner gases. Exposure to biomass smoke thus becomes a major risk
factor for COPD in India. Mosquito coils used in homes to get rid of mosquitoes are
another source of exposure in Indian homes; burning of one mosquito coil in the night
capable of emitting particulate matter equivalent to those with around 100 cigarettes.
Chronic obstructive pulmonary disease (COPD) is currently the third leading cause of
death in the United States, and the number of deaths is increasing, especially among
women. Currently, more than 12 million people in the United States are diagnosed as
having COPD, but the true prevalence is estimated to be more than double this number.
The Third National Health and Nutrition Examination Survey (NHANES) examined
more than 14,000 adults from across the United States with a battery of tests that
included spirometry and respiratory symptom questionnaires and found that COPD was
undiagnosed in almost two-thirds of individuals with airflow obstruction. In the
NHANES, most of those with undiagnosed obstruction reported having chronic
respiratory symptoms and COPD-related physical impairment that negatively affected
their day-to-day lives. Although clinical trials such as the Lung Health Study
demonstrated that early diagnosis and aggressive interventions in COPD can improve
long-term outcomes, COPD is not diagnosed in most patients until they have long-
standing symptoms, experience complications such as pneumonia, or develop other
smoking-related conditions such as cardiovascular disease or cancer.
The age-standardized incidence rate (ASIR) and age-standardized prevalence rate
(ASPR) of chronic respiratory diseases (CRDs) (a, b) including chronic obstructive
pulmonary disease (COPD) (c), pneumoconiosis (d), asthma (e), and interstitial lung
disease and pulmonary sarcoidosis (f) for both sexes (males and females). ASIR, age-
standardized incidence rate; ASPR, age-standardized prevalence rate; COPD, chronic
obstructive pulmonary disease

IN GUJARAT:

A recent report from the Union health ministry has shockingly revealed that in Gujarat,
the number of patients of respiratory diseases grew by more than a lakh each year.
While there were a little over 10 lakh such patients in the state, that number neared 14
lakhs. Experts attribute the rapid acceleration in the number of respiratory disease
patients to increasing air pollution. According to the report, 10,41,042 cases were
registered in Gujarat, which increased to 12,49,351. The state registered 13,69,389
cases of patients suffering from respiratory diseases. This accounts for 3.84%
respiratory disease cases registered in India last year. Across India, in 2015, 3,56,50,451
cases of acute respiratory disease had been reported. The report of the Union health
ministry also stated that the state has recorded 41,461 cases of tuberculosis with 2,172
patients losing their lives.

According to experts increasing pollution and particulate matter in the atmosphere can
be held responsible for the rising incidence of respiratory diseases, which include
asthma, tuberculosis, silicosis and chronic obstructive pulmonary disease (COPD), a
type of obstructive lung disease. “Pollution and dust particles are the most common
factors that contribute in increasing respiratory diseases. Air pollution, mainly due to
industrial and untreated chemical effluent vapors in the air, is the most common reason
behind the rampant increase in respiratory problems." The study states that 12 cities of
Gujarat in which it was found that people living in urban areas, especially in slums, are
more susceptible to respiratory diseases. "In urban slums, lack of ventilation increases
cases of COPD and asthma. Children and elderly people are the biggest sufferers.

Non-communicable respiratory morbidities such as asthma and COPD are rapidly

rising to emerge as leading causes of mortality worldwide. Occupational lung diseases
form the majority of the work-related morbidity in India, mainly in the form of
occupational asthma and COPD followed by occupational cancers, cardiovascular
diseases, reproductive disorders, neurotoxicity, skin and psychological disorder.

Construction is one of the stable growing industries in the world including India. The
hazards in construction industry are 8 times riskier than those from any manufacturing
industry. It is one of the labor-intensive work and construction workers perform high
risk work for meager wages. Dusty tasks such as abrasive blasting, emptying bags of
cement, cutting wood and masonry expose workers to risk. Construction workers are
exposed to multiple risks at working and living places. They are exposed to physical,
chemical, biological, ergonomic hazards and environmental and psychosocial risks.

PROBLEM STATEMENT
A study to evaluate the effectiveness of Buteyko breathing exercise on level of
dyspnoea among patient with obstructive airway disease in selected hospital, at
Rajkot

OPERATIONAL DEFINITIONS
To evaluate: In this study, evaluate refers to find the level of respiratory outcomes
among patient with obstructive airway disease.

Effectiveness: In this study, it refers to improvement in respiratory outcome after

exposing to butekyo breathing exercise.

Buteyko breathing exercise: In this study, it is a form of complementary or alternative

physical therapy that proposes the use of breathing exercises primarily as a treatment
for asthma and other respiratory conditions

Dyspnoea: In this study, it is sudden shortness of breath, or breathing difficulty or

labored breathing.

Patient with obstructive airway disease: In this study, an individual awaiting or under
medical care and treatment for obstructive airway disease.

OBJECTIVES

1. To assess the pre-test and post-test level of dyspnoea among patient with
obstructive airway disease of experimental group in selected hospital, at Rajkot
2. To assess the pre-test and post-test level of dyspnoea among patient with
obstructive airway disease of control group in selected hospital, at Rajkot
3. To evaluate the effectiveness of Buteyko breathing exercise by comparing pre-
test and post-test on level of dyspnoea of experimental and control group among
patient with obstructive airway disease in selected hospital, at Rajkot.
4. To compare the post test score on level of dyspnoea between experimental and
control group among patient with obstructive airway disease in selected
hospital, at Rajkot.
5. To find out the association between selected demographic variables and post-
test level of dyspnoea among patient with obstructive airway disease in selected
hospital in selected hospital, at Rajkot.

HYPOTHESES

H1: There will be significant improvement in level of dyspnoea after butekyo breathing
exercise among patient with obstructive airway disease in experimental group.
H2: The mean post test score of level of dyspnoea of experimental group will be lower
than mean post test score of respiratory outcome of control group.

H3: There will be significant association between selected demographic variables and
post-test level of dyspnoea among patient with obstructive airway disease of
experimental and control group.

ASSUMPTIONS

• There may be increase in knowledge and practice of Butekyo breathing exercise

among patients with obstructive airway disease.
• There may be effectiveness of Buteyko breathing exercise on respiratory
outcomes among patient with obstructive airway disease.

DELIMITATIONS

• The study is delimited to patients with obstructive airway disease.

• The study is delimited to patients who are admitted in selected hospital.
• The study is delimited to the selected hospital, at Rajkot.
• The sample size is delimited to 40 patients.
• The study is delimited to patients who were present at the time of conducting
study.

REVIEW OF LITERATURE

i. A study to assess the effectiveness of buteyko breathing exercise

ii. A study to assess the effectiveness of buteyko breathing exercise on respiratory
outcomes
iii. A study to assess the effectiveness of buteyko breathing exercise on patient with
obstructive airway disease

A study to assess the effectiveness of buteyko breathing exercise:

Rachna. D. Arora, Visalakshi. H. Subramanian et.al., 2019, To Study the Effect of

Buteyko Breathing Technique in Patients with Obstructive Airway Disease. The
Buteyko Method, a breathing technique, has been found to be effective in individuals
with asthma and a range of other conditions. In the present study, an attempt was made
to compare the effect of Buteyko Breathing Technique in patients with obstructive
airway disease. Aim: To study the effect of Buteyko Breathing Technique in
Obstructive Airway Disease Objectives: To assess the pre and post changes on
outcome measures in control group & in experimental group respectively. To compare
the effect on outcome measures in both the groups. Methodology: The subjects were
screened to select 28 patients. The Control group received conventional Physiotherapy
and Experimental group received Conventional Physiotherapy with Buteyko breathing
technique. The treatment was given thrice a week for both the groups for 4 weeks. All
the outcome measures i.e. Single Breath Count Test (SBCT), Resting Respiratory Rate
(Resting RR) , Breath Holding Time (BHT), Percent Predicted Value of 6 Minute Walk
Distance (%PV of 6MWD) & Peak Expiratory Flow Rate (PEFR)were recorded at
baseline and post treatment in both the groups. Result: In control group, there was
statistically significant increase in SBCT (p=0.001), BHT (p=0.000), PEFR (p=0.000),
% PV 6MWD (P=0.006), reduction Resting RR (p=0.000) & Resting HR% (p=0.275).
In Experimental Group, there was a statistically significant increase in SBCT
(p=0.000), BHT (p=0.001), % PV 6MWD (p=0.001), PEFR (p=0.008), reduction
Resting RR (p=0.000) & Resting HR% (p=0.000). On comparing the differences
between both groups, statistically significant increase was found in BHT (p= 0.002),
SBCT (p= 0.014), % PV 6MWD (p=0.097), PEFR (p=0.098) & significant reduction
was found in Resting HR% (p=0.000) & Resting RR (p=0.005). Buteyko Breathing was
effective in improving breathing control, breath holding and reducing the work of
breathing in subjects with Obstructive Airway disease.

Joel Patric Lal, et.al., 2018, To Assess the Effectiveness of Buteyko Breathing
Technique on Respiratory Pattern among 3 to 12 Years Children with Respiratory
Diseases. This study was carried out to reduce the episodes respiratory attacks and to
manage respiratory emergencies by the use of non-pharmacological interventions like
Buteyko breathing technique among the children of 3 to 12 years of age group those
who are suffering from different types of respiratory diseases, this study will also
improve the level of understanding of children as well as of the family members to
manage these condition initially at home so that the anxiety level of the parents will be
reduced, along with reduction in mortality and morbidity rate of this age group children.
Jinsabin, et.al., 2018, A Comparative study on Effectiveness of Buteyko Breathing
Technique and Active Cycle of Breathing Technique in the Management of Dyspnoea
among Asthma Patients. Asthma is a chronic inflammatory condition of the airways
that is characterised by an increased responsiveness of the airway smooth muscle to
various stimuli. It is manifested by widespread narrowing of the airways that reverses
either spontaneously or as a result of treatment (Peter Lange, 1998). Asthma is
associated with airway hyper responsiveness that leads to recurrent episodes of
wheezing, breathlessness, chest tightness and coughing particularly at night or in the
early morning. These symptoms are usually associated with widespread but variable
airflow limitation that is atleast partly reversible either spontaneously or with treatment.
The inflammation also causes an associated increase in airway responsiveness to a
variety of stimuli (NIH). There is a considerable global variation in the prevalence rates
of asthma, with the highest rates reported in America, Australia and the United
Kingdom. Much lower rates are reported in prevalence studies from Africa and Asia.
OBJECTIVE OF THE STUDY: 1. To determine the effectiveness of Buteyko breathing
technique in the management of level of dyspnoea among patients with asthma. 2. To
determine the effectiveness of in the management of Active cycle of breathing Exercise
level of dyspnoea among patients with asthma. 3. To systematically the effectiveness
of Buteyko breathing technique and Active cycle of breathing Exercise in the
management of level of dyspnoea among the patients with asthma. DESIGN: This study
is a pre test and pos test experimental design comparative in nature.
PARTICIPATIONS: Twenty subject were selected treated with course buteyko
breathing and active cycle of breathing technique. MATERIALS AND METHODS:
Thirty both gender subjects who has been diagnosed as asthma with mean age 20-40
years were taken as subjects in the study. Parameter Modified Borg’s dyspnoea scale
and Peak expiratory flow rate noted prior to and following 6 session of intervention.
All subjects were randomly divided in two group A and B with ten subject in each group
GROUP A underwent Buteyko breathing .GROUP B underwent treatment of active
cycle of breathing technique. OUTCOME MEASURE: The outcome was measured by
using Modified Borg’s dyspnoea scale and Peak expiratory flow rate. RESULT: There
was significant improvement in reduction of dyspnoea and improve breathing pattern.
CONCLUSION: Buteyko breathing technique is found to be effective in reduction
dyspnoea and to improve breathing pattern.
Yosreah Mohamed, Sabah Elderiny and Dr. Lobna Ibrahim, et.al., 2019, The
Effect of Buteyko Breathing Technique among Patients with Bronchial Asthma.
Asthma is a serious global health problem and there is still lack of awareness regarding
Buteyko Breathing Technique to achieve more control over it. Aim: this study aimed
to assess the effect of practicing Buteyko breathing technique on asthma
symptoms among patients with bronchial asthma. Hypothesis: It was hypothesized that
practicing Buteyko Breathing Technique will have significant effect on reducing the
severity of asthma symptoms among study group of patients with bronchial asthma
and will improve their ability to control asthma. Design: A Quasi-experimental research
design was used in this study Setting: This study was conducted in Chest Medicine
Ward and clinic at Ain Shams University Hospital. Subjects: A purposive sample of
100 patients with bronchial asthma, 50 were assigned in experimental group and 50
patients in control group. Tools: Three tools were utilized; the first tool used to collect
patients' clinical data, the second tool control. Results: The symptoms severity, which
need for treatment were reduced, also control of bronchial asthma were improved in the
study group post implementation of the Buteyko Breathing Technique. Conclusion:
There is a positive effect for practicing Buteyko Breathing exercise on reducing asthma
Recommendations: Further research studies are needed to study new modalities to
reduce asthma symptoms.
Dr. Raghavendran, Gunjan Singh, et.al.,2022, A Study to Assess the Knowledge
Regarding Buteyko Breathing Technique among Asthma Patients of the Creative
Commons Attribution License. Asthma is an incurable disease of inflammation of the
airways. In affected patients, inflammation causes recurrent episodes of shortness of
breath, shortness of breath, chest tightness and coughing, especially at night or very
early in the morning. The objectives of the study were to test information on Buteyko's
respiratory system. The Quantitative test method was adopted in the current study. 60
patients with Bronchial asthma who experienced an inclusive procedure were selected
for a simplified procedure. The study was conducted at Medanta Hospital, Lucknow.
Data were collected using information questionnaires to assess information on
breathing exercises among OPD asthmatic patients. These study results show that out
of 60 samples 10 (16.6%) had sufficient information and 16 (26.7%) had limited
information and 34 (56.7%) had sufficient information. The study found that the
majority of respondents who participated in the study had insufficient knowledge about
breathing exercises; very few participants are experienced enough.
Priyalatha G, Geetha C and Dr. Renuka K, et.al., 2018, Effectiveness of buteyko
breathing exercise (BBE) on respiratory outcome among children with bronchial
asthma admitted in paediatric unit. Chronic respiratory disease especially childhood
Bronchial asthma rate in India is increasing significantly compared with rates in other
countries. According to report by American Academy of Allergy Asthma &
Immunology (AAAAI), In world- wide, asthma accounts for nearly 500,000
hospitalizations per year and it is third ranking cause of hospitalization among children
under 15 years old. Respiratory rehabilitation is an effective method in improving the
respiratory functions and reducing the episodes of asthma attacks. Buteyko Breathing
Exercise (BBE) was brought into practice in Russia by Dr. Konstantin Buteyko and is
based on the belief that asthma is caused by hyperventilation and hypocapnea. Buteyko
exercise (BBE) is a breathing exercise that describes a series of breathing retraining as
a management for Bronchial asthma as well as other respiratory conditions. Buteyko
Breathing Exercise (BBE) is a set of shallow breathing exercises that helps to control
symptoms of asthma. The Buteyko Breathing Exercise (BBE) helps to reduce hyper-
inflation through nasal breathing known as “slow breathing” or reduced breathing and
helps in reducing the symptoms of Bronchial asthma. Aim: This study was aimed to
assess the the effectiveness of Buteyko Breathing Exercise (BBE) on respiratory
outcome among children with Bronchial asthma admitted in Paediatric Unit of
MGMCRI, Puducherry. Methodology: Quasi experimental non-equivalent control
group pre-test post-test design and 70 children with Bronchial asthma were selected
using purposive sampling technique was adopted for this study. Results: The study
results show that Buteyko Breathing Exercise (BBE) was effective in reduction of
Bronchial asthma symptoms assessed by Modified Becker’s Score and in improving
oxygen saturation, Peak Expiratory Flow Rate, Breath Holding Time (BHT).
Zahra Mohammed Hassan, Nermine Riad, et.al., 2012, Effect of Buteyko breathing
technique on patients with bronchial asthma. A new dawn is emerging by recognizing
that correct breathing volume is fundamental to maintaining good health, the new
beginning is based on the life’s work of Russian scientist professor Konstantin Buteyko.
The Buteyko breathing technique method as suggested by Professor Buteyko helps to
decrease the number and severity of attacks as well as the dosage of medication. As a
result of this therapy, the indicators of acid-alkali balance and lung
ventilation improved. The aim of this study was to assess the effect of Buteyko
breathing technique on patients with bronchial asthma. Forty patients with bronchial
asthma participated in this study, their age ranged between 30 and 50 years. They were
divided into two equal groups, group (A) received Buteyko breathing technique (BBT),
and the medications prescribed by the physician, while group, (B) did not perform any
physical therapy program just their medications prescribed by the physician. The
program continued for 6 weeks (2 sessions per week except the 1st week was 4 sessions
per week). Peak expiratory flow rates (PEFR), Control pause test and asthma daily
symptoms (asthma control questionnaire) were measured at the beginning and after
the treatment program for both groups. The results of this study revealed a significant
decrease in asthma daily symptoms, a significant improvement in PEFR, and Control
pause test in group (A), while there was insignificant change in group (B). It can be
concluded that BBT produce a significant improvement for patients with bronchial
asthma as regard daily symptoms, PEFR and Control pause test.

A study to assess the effectiveness of buteyko breathing exercise on respiratory

outcomes:

Esra Elwan Hassan, Fawzia Abusaad, et.al., 2022, Effect of the Buteyko breathing
technique on asthma severity control among school age children. Asthma is a complex
condition that can impair not only the child’s physical growth but also his optimal
functional capacity and performance. Buteyko breathing technique is an exercise
designed to regulate the breathing process. This study aimed to evaluate the effect of
the Buteyko breathing technique on asthma severity control among school-age children.
In Egypt, this technique was applied through five studies, four among adult patients and
only one among children. In Mansoura University, only one study conducted among
adult patients and no studies conducted among children. Therefore, to fulfill this gap of
knowledge, it was necessary to study the effect of this technique on asthma severity
control among school age children. The mean childhood asthma control pretest was
significantly improved in the posttest with high mean percent change of posttest than
pretest (p = 0.0001), which was clinically and statically high significant. There was a
statistical significant increase in the mean of peak expiratory flow rate and control pause
test at the fourth week than the first one (p = 0.0001), with a high significant mean
percent of change. There was a significant decrease in the heart rate over the 4 weeks
of follow-up with high mean percent changes at fourth week than the first one
(p = 0.003).
Miss Gunjan Singh, Dr Raghavendran M, et.al., 2019, A Study to Assess the
Knowledge Regarding Buteyko Breathing Technique among Asthma Patients of the
Creative Commons Attribution License Asthma is an incurable disease of
inflammation of the airways. In affected patients, inflammation causes recurrent
episodes of shortness of breath, shortness of breath, chest tightness and coughing,
especially at night or very early in the morning. The objectives of the study were to test
information on Buteyko's respiratory system. The Quantitative test method was adopted
in the current study. 60 patients with Bronchial asthma who experienced an inclusive
procedure were selected for a simplified procedure. The study was conducted at
Medanta Hospital, Lucknow. Data were collected using information questionnaires to
assess information on breathing exercises among OPD asthmatic patients. These study
results show that out of 60 samples 10 (16.6%) had sufficient information and 16
(26.7%) had limited information and 34 (56.7%) had sufficient information. The study
found that the majority of respondents who participated in the study had insufficient
knowledge about breathing exercises; very few participants are experienced enough.
Yosreah Mohamed, Sabah Elderiny, et,al., 2019, Asthma is a serious global health
problem and there is still lack of awareness regarding Buteyko Breathing Technique to
achieve more control over it. A Quasi-experimental research design was used in this
study. Setting: This study was conducted in Chest Medicine Ward and clinic at
Ain Shams University Hospital. A purposive sample of 100 patients with bronchial
asthma, 50 were assigned in experimental group and 50 patients in control group. Tools:
Three tools were utilized; the first tool used to collect patients' clinical data, the
second tool used to assess bronchial asthma symptoms’ severity and the third tool used
to assess level of asthma control. The symptoms severity, which need for treatment
were reduced, also control of bronchial asthma were improved in the study group post
implementation of the Buteyko Breathing Technique. Conclusion: There is a positive
effect for practicing Buteyko Breathing exercise on reducing asthma

A study to assess the effectiveness of buteyko breathing exercise on patient with

obstructive airway disease:

Ms. Jaculine Jemima, et.al., 2019, Effectiveness of Buteyko Breathing Exercise on

Respiratory Outcomes among patients with Obstructive Airway Disease. As of 2015,
235–330 million people worldwide are affected by Obstructive Airway Disease, and
approximately 250,000–345,000 people die per year from the disease. Although there
is no permanent cure for OAD, the disorder can be managed by various complementary
and alternative therapies. The study was conducted to assess the effectiveness of
Buteyko Breathing Exercise on Respiratory Outcomes. True Experimental, Pre test Post
test Control Group Research Design and Simple Random Sampling technique was
adopted. Buteyko Breathing Exercise was demonstrated two times a day for a week for
the interventional group alone, and the post test was conducted for both the groups on
the seventh day using Modified ACT, CAT and PEFR. The result revealed that the
Buteyko Breathing Exercise was significantly effective on Respiratory Outcomes
among patients with OAD. The pre test mean and standard deviation of interventional
group for Modified ACT was 9.03±1.87, CAT was 32.83±3.29, and PEFR was
47.63±21.12, whereas post test mean and standard deviation of Modified ACT was
21.07±1.5, CAT was 13.83±3.78 and PEFR was 67.40±15.40, whereas the calculated
‘t’value for Modified ACT,CAT and PEFR was 29.71,17.38 and 5.62 respectively and
given table value was 2.04, and it states that the provision of Buteyko Breathing
Exercise was effective for the patients with Obstructive Airway Diseases.

Rachna. D. Arora, Visalakshi. H. Subramanian, et.al.,2019, To Study the Effect of

Buteyko Breathing Technique in Patients with Obstructive Airway Disease. The
Buteyko Method, a breathing technique, has been found to be effective in individuals
with asthma and a range of other conditions. In the present study, an attempt was made
to compare the effect of Buteyko Breathing Technique in patients with obstructive
airway disease. To study the effect of Buteyko Breathing Technique in Obstructive
Airway Disease. To assess the pre and post changes on outcome measures in control
group & in experimental group respectively. To compare the effect on outcome
measures in both the groups. The subjects were screened to select 28 patients. The
Control group received conventional Physiotherapy and Experimental group received
Conventional Physiotherapy with Buteyko breathing technique. The treatment was
given thrice a week for both the groups for 4 weeks. All the outcome measures i.e.
Single Breath Count Test (SBCT), Resting Respiratory Rate (Resting RR) , Breath
Holding Time (BHT), Percent Predicted Value of 6 Minute Walk Distance (%PV of
6MWD) & Peak Expiratory Flow Rate (PEFR)were recorded at baseline and post
treatment in both the groups. In control group, there was statistically significant
increase in SBCT (p=0.001), BHT (p=0.000), PEFR (p=0.000), % PV 6MWD
(P=0.006), reduction Resting RR (p=0.000) & Resting HR% (p=0.275). In
Experimental Group, there was a statistically significant increase in SBCT (p=0.000),
BHT (p=0.001), % PV 6MWD (p=0.001), PEFR (p=0.008), reduction Resting RR
(p=0.000) & Resting HR% (p=0.000). On comparing the differences between both
groups, statistically significant increase was found in BHT (p= 0.002), SBCT (p=
0.014), % PV 6MWD (p=0.097), PEFR (p=0.098) & significant reduction was found
in Resting HR% (p=0.000) & Resting RR (p=0.005). Buteyko Breathing was effective
in improving breathing control, breath holding and reducing the work of breathing in
subjects with Obstructive Airway disease.

Somrat Lertmaharit, Chathipat Kruapanich, et.al., 2019, Effects of Breathing

Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review
and Meta-Analysis To update evidence on the effects of breathing exercises (BEs) on
ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive
pulmonary disease (COPD) patients. Randomized controlled trials investigating the
effects of BEs in COPD patients published through May 2018, were retrieved from five
electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect).
Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s
tool, and the Grading of Recommendation Assessment, Development, and Evaluation
(GRADE) approach, respectively. Nineteen studies (n=745), were included. Quality of
evidence, was low to moderate. When compared to the control groups, respiratory rate
significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory
feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined
BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory
time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly
improved inspiratory capacity (p<0.001), and singing significantly improved the
physical component of QoL, than did the control groups (p<0.001). All BEs did not
significantly improve dyspnea, compared to the controls (p>0.05).

Prasanna K. B., Sowmiya K. R, et.al., 2019, Asthma is a chronic inflammatory disease

of the airways and is on the increasing trend owing to air pollution and urbanization.
The use of alternative ways of treatment that are as efficacious as the standard treatment
is the need of the hour. This study was conducted to study the effects of Buteyko
breathing exercise on the newly diagnosed asthmatic patients. Materials and Methods:
Totally, 100 newly diagnosed asthmatic patients attending Tagore Medical college out-
patient department were randomly allocated into the interventional and the control
group for a period of 2 months. The former were taught Buteyko breathing exercise
while the control group was on standard asthma treatment. The effects were assessed
using a pretested close ended Asthma Control Questionnaire and Pulmonary Function
Tests. The results were given in mean with a standard deviation. Chi-square test was
done to compare the results between the two groups and P < 0.05 is taken as significant.
The analysis was done by SPSS software version 13. Results: Among the 100
participants, majority of the participants were in the age group of 31-40 years. It was
observed that there was an overall subjective improvement of asthma symptoms among
the interventional group at the end of 2 months (which was statistically significant)
when compared to the control group. Also, there was an improvement in the pulmonary
function in terms of peak expiratory flow rate in both the groups. Conclusions: The
results of this study support the effectiveness of Buteyko breathing exercise over the
standard treatment in the newly diagnosed asthmatic patients.

METHODOLOGY

RESEARCH APPROACH

Quantitative research approach

RESEARCH DESIGN

Quasi-Experimental design; Time series design, with control group

VARIABLES

Independent variable: Butekyo breathing exercise

Dependent variable: Level of dyspnoea

SETTING

The study was conducted in selected hospital

POPULTION
Accessible population: Patient with obstructive airway disease

Target population: Patient with respiratory disorder in selected hospital

SAMPLE

Sample size: 40

CRITERIA FOR SAMPLE SELECTION

Inclusion criteria for sample selection

1. Patients admitted with obstructive airway disease

2. Patients who were available at the time of study

3. Patients who were willing to participate in the study

Exclusion criteria for sampling

1. Patients who were not available at the time of study

2. Patients who were not willing to participate

SAMPLING TECHNIQUE

The research study was conducted by non-probability purposive sampling technique.

DEVELOPMENT OF TOOL

Section-A: Demographic variables

Section-B: Modified Borg’s dyspnoea scale.

DESCRIPTION OF TOOL

Section-A: Contains demographic variables which include the characteristics of the

patient such as age, gender, educational qualification, smoking, secondary cause,
asthma, previous knowledge, source of information.

Section-B: Contains the Modified Borg’s dyspnoea scale (MBS) is a 0 to 10 rated

numerical score used to measure dyspnoea, to assess the respiratory outcome.
 SR. NO. GRADE SEVERITY OF DYSPNOEA
1 0 No breathlessness at all
2 0.5 Very- very slight (just noticeable)
3 1 Very slight
4 2 Slight breathlessness
5 3 Moderate
6 4 Somewhat severe
7 5-6 Severe breathlessness
8 7-8 Very severe breathlessness
9 9 Very- very severe breathlessness
10 10 Maximal

DESCRIPTION OF INTERVENTION

The pre-test dyspnoea leve of the patient will be assessed by using the Modified Borg’s
dyspnoea scale (MBS) and the post-test score will be noticed. Pre-test scores obtained
from the control and experimental group. As a part of intervention Butekyo breathing
exercise will be provided to experimental group of patients with obstructive airway
disease for 5 days. After finishing Butekyo breathing exercise again level of respiratory
outcome will be assessed of both experimental and control group by using Modified
Borg’s dyspnoea scale (MBS) to collect the post-test score.

VALIDITY

The tool prepared for the data collection will be validated by the subject and medical
experts. Opinion will be taken from 6 nursing experts and 1 medical officer for the
validation.

PILOT STUDY

10% of population is taken for the pilot study. A written permission will be obtained
from the concerned authority of the selected hospital. Informed consent will be taken
from the subjects. Level of respiratory outcome will be assessed by the using of
Modified Borg’s dyspnoea scale (MBS) and the pre-test scores will be noticed. As a
part of intervention, Butekyo breathing exercise will be provided to patients with
obstructive airway disease for 5 days. After finishing Butekyo breathing exercise again
the level of respiratory outcome will be assessed by using Modified Borg’s dyspnoea
scale (MBS) to assess the post-test score. Pre-test will be conducted by using Modified
Borg’s dyspnoea scale (MBS). The interventional programme will be conducted on the
same day. Post-test will be carried out for the next 4 days for evaluating the
effectiveness of Butekyo breathing exercise on obstructive airway disease.

DATA COLLECTION PROCEDURE

As a part of data collection procedure, written permission will be obtained from the
concerned authority of the hospital. Informed consent will be taken from the subjects.
Data collection will be done in two sections; data regarding socio-demographic
variables and Modified Borg’s dyspnoea scale. Then the data will be collected
regarding the level of respiratory outcome and the pre-test score will be assessed of the
control and experimental group. respiratory outcome will be assessed by using the tool.
Then again Modified Borg’s dyspnoea scale will be used to assess the post-test level of
respiratory outcome of both experimental and control group and data will be recorded.

DATA ANALYSIS

Descriptive statistics: Collected data will be analysed by descriptive statistics such as

mean, standard deviation, frequencies and percentage.

Inferential statistics: The effectiveness of Butekyo breathing exercise will be analysed

by anova-test among the obstructive airway disease patients. The association between
selected demographic variables and post-test level of respiratory outcomes among
patient with obstructive airway disease will be analysed by using the chi-square. The
comparison of the post test score on level of respiratory outcome between experimental
and control group will be analysed by independent t- test.

PROTECTION OF HUMAN RIGHTS

In this study all the subjects as a human being will be protected.

ETHICAL CLEARANCE

In this study all the subjects as a human being will be protected. Ethical consideration
will be considered for the purpose of the study to assess the effectiveness of Buteyko
breathing exercise on level of respiratory outcomes among patient with obstructive
airway disease in selected hospital, at Rajkot.
 SIGNATURE OF THE MS. RESHMA GEORGE
CANDIDATE M.Sc. NURSING 1ST YEAR
1. SAION, RAJKOT.

2. REMARKS OF THE GUIDE

MR. SUNEESH P.M

GUIDE NAME AND ASSISSTANT PROFESSOR
3. MSN DEPARTMENT
DESIGNATION
SAION, RAJKOT

4. GUIDE SIGNATURE

5. CO-GUIDE NAME

6. CO-GUIDE SIGNATURE

HEAD OF THE MR. SUNEESH P.M

ASSISSTANT PROFESSOR
7. DEPARTMENT AND MSN DEPARTMENT
SIGNATURE SAION, RAJKOT

8. REMARKS OF PRINCIPAL

SIGNATURE OF THE
9.
PRINCIPAL
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