CHAPTER - II

REVIEW OF LITERATURE
Review of literature is systematic identification, critical analysis and reporting of existing
information on the topic of material for the study. The review of literature is a key step in
research process excessive review of literature relevant to research was alone to collect
maximum information for laying foundation of this study. The purpose of the review of
literature is to gain maximum relevant information and perform the study in a scientific m
Review of literature is systematic identification, critical analysis and reporting of existing
information on the topic of material for the study.

Section I: Literature related to asthma

Pratik (2022) To assess the knowledge regarding bronchial asthma among adults. To associate
the knowledge score with demographical variables. A quantitative research approach using
non-experimental descriptive research design was adopted for the study using non-probability
purposive sampling technique 100 adults was selected from urban areas of Pune city. Modified
questionnaire was used to collect the data during October 2018 to November 2018 to obtain
the knowledge level. Results: findings of the study shows that 52.00% of samples were had
average knowledge regarding bronchial asthma, 45.00% of sample had good knowledge,
whereas only 3.00% of sample had poor knowledge category. Also there was an association
between the knowledge and occupation regarding bronchial asthma as the P value was 0.003
which is less than 0.05. And also there was an association between the income and the
knowledge regarding bronchial asthma as the P value was 0.012 which is less than 0.05.

Mohammad (2022) explore the characteristics of knowledge and practice of physicians

towards asthma in Saudi Arabia. Overall, participants' knowledge was moderate. The average
percentage of physicians who reported practicing asthma management based on recommended
guidelines 63.7%. Younger age (30-34 years) and having a work experience of (6-10 years)
were significant predictors of being adherent to asthma practices guidelines (OR: 1.96 (95%
CI: 1.21-3.17) (p=0.006) and OR: 1.67 (95% CI 1.05-2.67) (p=0.031), receptively).

Kaur (2022) study aimed to evaluate the asthma knowledge among patients with Bronchial
asthma. Study was conducted to assess the effectiveness of structured asthma educational
program on self care management of Bronchial asthma. Experimental Pre test-post test control
group design was chosen. From the patients with confirmed diagnosis of asthma, sample were
selected to experimental (n=100) and control (n=50) groups. The Pre-test means between
experimental (19.9) and control (18.82) groups were not much significant. There is a significant
improvement within the pre test (mean 19.930; S.D 8.84)) and Post test scores in the
experimental group (mean 42.31/S.D 3.449). The post test means between experimental
(42.31) and control groups (21.28) supports the significant enhancement in the knowledge of
the experimental group after asthma education. Asthma education is an important means to
equip patients with knowledge and skills required to manage the condition effectively.
Adequate knowledge may further motivate patients towards behavior modification and long
term

Section II: Literature related to effectiveness of breathing exercises on asthma patient

Thayla A (2022) To evaluate the evidence for the efficacy of breathing exercises in the
management of people with asthma. included nine new studies (1910 participants) in this
update, resulting in a total of 22 studies involving 2880 participants in the review. Fourteen
studies used Yoga as the intervention, four studies involved breathing retraining, one the
Buteyko method, one the Buteyko method and pranayama, one the Papworth method and one
deep diaphragmatic breathing. The studies were different from one another in terms of type of
breathing exercise performed, number of participants enrolled, number of sessions completed,
period of follow-up, outcomes reported and statistical presentation of data. Asthma severity in
participants from the included studies ranged from mild to moderate, and the samples consisted
solely of outpatients. Twenty studies compared breathing exercise with inactive control, and
two with asthma education control groups. Meta-analysis was possible for the primary outcome
quality of life and the secondary outcomes asthma symptoms, hyperventilation symptoms, and
some lung function variables. Assessment of risk of bias was impaired by incomplete reporting
of methodological aspects of most of the included studies. We did not include adverse effects
as an outcome in the review. Breathing exercises versus inactive control For quality of life,
measured by the Asthma Quality of Life Questionnaire (AQLQ), meta-analysis showed
improvement favouring the breathing exercises group at three months (MD 0.42, 95% CI 0.17
to 0.68; 4 studies, 974 participants; moderate-certainty evidence), and at six months the OR
was 1.34 for the proportion of people with at least 0.5 unit improvement in AQLQ, (95% CI
0.97 to 1.86; 1 study, 655 participants). For asthma symptoms, measured by the Asthma Control
Questionnaire (ACQ), meta-analysis at up to three months was inconclusive, MD of -0.15 units
(95% CI -2.32 to 2.02; 1 study, 115 participants; low-certainty evidence), and was similar over
six months (MD -0.08 units, 95% CI -0.22 to 0.07; 1 study, 449 participants). For
hyperventilation symptoms, measured by the Nijmegen Questionnaire (from four to six
months), meta-analysis showed less symptoms with breathing exercises (MD -3.22, 95% CI -
6.31 to -0.13; 2 studies, 118 participants; moderate-certainty evidence), but this was not shown
at six months (MD 0.63, 95% CI -0.90 to 2.17; 2 studies, 521 participants). Meta-analyses for
forced expiratory volume in 1 second (FEV1) measured at up to three months was inconclusive,
MD -0.10 L, (95% CI -0.32 to 0.12; 4 studies, 252 participants; very low-certainty evidence).
However, for FEV1 % of predicted, an improvement was observed in favour of the breathing
exercise group (MD 6.88%, 95% CI 5.03 to 8.73; five studies, 618 participants). Breathing
exercises versus asthma education For quality of life, one study measuring AQLQ was
inconclusive up to three months (MD 0.04, 95% CI -0.26 to 0.34; 1 study, 183 participants).
When assessed from four to six months, the results favoured breathing exercises (MD 0.38,
95% CI 0.08 to 0.68; 1 study, 183 participants). Hyperventilation symptoms measured by the
Nijmegen Questionnaire were inconclusive up to three months (MD -1.24, 95% CI -3.23 to
0.75; 1 study, 183 participants), but favoured breathing exercises from four to six months (MD
-3.16, 95% CI -5.35 to -0.97; 1 study, 183 participants).

R. Maheshwari (2022) study was to see how the Buteyko breathing technique helps to reduce
breathing difficulty in patients with bronchial asthma at Saveetha medical college and hospital.
The study used a quasi-experimental pre-test and post-test research design a total of 30 samples
was chosen with care. The moderate Aaldrete score was used to examine the respiratory
physiological parameters on a regular basis. The results reveal that there is a significant
association of selected demographic variables with the post test respiratory parameters
among patients with bronchial asthma using descriptive and Interferential statistical
approaches. It is also shown statistically significant association with the post test level of
respiratory status among patients with bronchial asthma at p<0.05 level. The other
demographic variables had not shown a statistically significant association with the post test
level of respiratory status among patients with bronchial asthma. The study revealed that
showed a significant improvement in the level of improvement in the respiratory parameters
following the administration of Buteyko breathing technique was effective in improving the
respiratory parameters and home management of bronchial asthma.

Shijie (2022) study aimed to compare the effects of different types of exercise on pulmonary
function in adult patients with asthma using Network Meta-analysis A total of 28 randomized
controlled trials with 2,155 patients with asthma were finally included. The results of Network
Meta-analysis showed that compared with control group, breathing training (BT)、aerobic
training (AT)、relaxation training (RT)、yoga training (YG) and breathing combined with
aerobic training (BT + AT) improved Forced Expiratory Volume in the first second (FEV1)
levels; AT、BT、YG and BT + AT improved the level of Forced Vital Capacity (FVC); BT、
AT、RT、YG and BT + AT improved Peak Expiratory Flow (PEF); BT、AT、and YG
improved Forced Expiratory Volume in the first second/Forced Vital Capacity
(FEV1/FVC).The results of SUCRA probability ranking showed that RT had the most
significant effect on improving the FEV1[SMD = 1.13,95%CI(0.83,1.43), p<0.001] levels,
BT + AT had the most significant effect on improving the FVC[SMD =
0.71,95%CI(0.47,0.95), p<0.001] level; YG had the most significant effect on improving the
PEF[SMD = 0.79,95%CI(0.55,1.02), p<0.001] level.

Ki Jong (2022) present study investigated the effects of an intervention program to enhance
the pulmonary function and muscle activity of elderly smokers. Participants were randomly
assigned to one of two experimental groups or a control (CG) group. The experimental groups
performed exercises three times per week for six weeks, whereas the CG performed no
exercises. One of the experimental groups performed a Feedback Breathing Exercise (FBE) for
15 minutes, and the other repeated three sets of Balloon-Blowing Exercises (BBE) with
sufficient rest of more than one minute between sets. In the experimental groups, FVC,
FEV1/FVC, PEF and muscle activity of the rectus abdominis significantly improved after four
weeks, but no significant differences were observed in FEV1 or VC after six weeks.
CONCEPTUAL FRAME WORK

The conceptual frame work of the present study was developed by the investigator is based on
Nola benders health promotion model (1997)that is mostly applicable while dealing with improve the
breathing pattern and promoting deep breathing exercise

Major concept

A. Person

Man has the ability to express human health potential and has the capacity for reflective self awareness
,including the assessment of his own competencies The important of a individual’s unique personal
factors or characteristics and experiences will depend on the target behavior for health promotion

B. Health

 Health promotion is defined as client behavior towards developing well being and actualization
human health potential

 Health protection is client behavior geared towards preventing illness detecting it early or maintaining
function

C. Nursing

 The trend towards health promotion has created the opportunity for nurse to strengthen the
professions influences on health information disseminate information that promotes an educated public
and assist individuals and communities to change long –standing health behavior

D. Environment

 Individuals are more apt to perform behavior if they are comfortable with the environment versus
feeling alienated environment that are consider safe as well as facilitate health promotion behavior

Key concept

Individual characteristics and experiences

 Prior related behavior

 Most of the person have breathing problem and less know about the deep breathing exercise
and to treat for chronic obstructive pulmonary disease
 Personal factors
People have inadequate experience about deep breathing exercise
Behavior specific cognitions and affect

 Perceived benefits of action

 In this study the effectiveness of deep breathing exercise among chronic obstructive pulmonary
disease to improve breathing pattern

 Perceived barriers to action

 Perceived self -efficacy

 Activity –related affect
 Interpersonal influences
 Situational influences In this study the interpersonal and situational influences act as a
perceived barrier to action.

Behavior outcomes

 Commitment to a plan of action

 Immediate competing demands and preferences
 Health –promoting behavior After deep breathing exercise, most of the person adequate
information and effectiveness deep breathing exercise which indicated health promoting
behaviour
 Perceived
Health
Cognitive Perceived benefit
perceptual promotion
status
factor service

DEMOGRAPHIC POST TEST EXPERIMENTAL

VARIABLES Experimental
Administration Assess the GROUP
group
Age, sex , religion, of deep effectiveness
educational status deep Positive
breathing
occupational place
breathing response To
of residence, exercise among
exercise improve the
smoking, habit , asthma
duration of illness among breathing
patients
Asthma pattern among
PRE TEST
patient asthma
Assess the
breathing pattern
patients
among asthma
patient

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