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Critically Appraised Topics

Introduction to The Effectiveness of Physiotherapy in Patients with Asthma

The connexion between asthma and anxiety is quite well-established. Both in anxiety attacks and asthma, signs, such as breathing difficulties, are very common. Breathing retraining has known to help relieve the effects of asthma and severe anxiety and subsequent improvements in the quality of life of an asthmatic. There is no compelling evidence, however, that a chest Physiotherapy (CPT) program, primarily the method of respiratory additional training, significantly reduces the anxiety symptoms and enhance the control of asthma. It is a chronic airway inflammatory condition in which several multiple physiological structure groups play important roles (Connett & Thomas, 2018). This inflammation induces repeated bouts of wheezing, breathlessness, and coughing in susceptible persons. The awareness that psychological influences affect the onset and progression of asthma is rising. Besides, a substantial association exists between asthma and negative feelings, especially depression and anxiety. Anxiety, with a prevalence measured at up to 20 percent of the population, is a very prevalent condition. Anxiety has had an impact on the quality of life metrics. Among the various anxiety and depression are mood disorders and agoraphobia. Agoraphobia is the extreme apprehension of finding oneself in busy environments where it can be impossible to avoid sight (Lack et al., 2020).

PICO Question

A clinical problem identified in Asthma patient whether the breathing exercises reduce the anxiety during hospitalization. Where the population(P) is asthma patient, intervention (I) is breathing exercise, comparator (C) is no exercise, and outcomes (O) is reduced anxiety.

Prisma

Author (year)

Source of evidence

Study design

Levels of evidence

Key findings

or outcomes

Evaristo et al., 2014

Studies

Forty-eight asthmatic patients will be spontaneously categorized into either breathing exercises (BG) or aerobic (AG) for optimized medical care. Twice a week, patients undergo breathing or aerobic activity for 3 months, with a total of 24 sessions of 40 minutes each. All participants then completed an instructional curriculum consisting of 2 training classes before interference. The following criteria will be measured before and after treatments: behavioral regulation (main result), the standard of living related to fitness, levels of psychological distress, physical exercise in everyday life, and optimal exercise ability (secondary result).

Level 2

In addition to pharmacological therapy, aerobic and breathing activities have been considered essential as alternative treatments, especially for patients with managed or partly regulated asthma, since they enhance anxiety control.

Bruurs et al., 2013

Syntheses

In asthma patients, a study was carried out on the terms of breathing exercises (BE), physical training (PhT), inspiratory muscle strengthening (IMT), and airway clearing (AC).

Level 1

BE increase the basic quality of life of the condition, decrease symptoms, hyperventilation, depression or anxiety, lower respiratory rate, and use of medication. Physical therapy can boost QoL, cardiorespiratory health, inspiratory strength, and decrease the use of drugs and effects.

Sankar, J., & Das, R. R. (2018)

Studies

An updating literature review was performed and appropriate literature on the role of breathing exercises or yoga and/or pranayama in asthma treatment was retrieved which also gave relief to anxiety in some patients.

Level 1

These strategies mostly change the breathing rhythm to decrease hyperventilation, resulting in CO2 level stabilization, bronchospasm reduction, and shortness of breath. They can change behavior, minimize fear, increase biochemical parameters, and increase respiratory muscle capacity, which will potentially benefit asthmatic patients.

 

Studies

Asthmatic patients were allocated to a category with chest physiotherapy which included a three-month respiratory retraining program held once a week or a matched monitoring group which included a program with Gentle Contact.

Level 2

For panic disorder and agoraphobia, all classes had high scores, which restricted their quality of life. The Breathing Retraining Community program increased asthma behavioral regulation, reduced stress attacks and agoraphobia, lowered patient ratings, and increased their quality of life on the Sheehan Anxiety Scale.

Tehrany et al., 2018

Studies

The results of physiotherapy BR on a 57-year-old female with a 10-year history of asthma are explored in this review. Before and after a physiotherapy BR program, data was gathered.

Level 4

The levels of anxiety-depression have now declined to 'normal' scales. With longer pulmonary cycles and slower breathing rate, the expiratory period of the patient improved.

Thomas M. (2009)

Syntheses

A randomized clinical study was performed compared to respiratory preparation with asthma education and management of anxiety disorders in asthmatic patients.

Level 3

Both groups reported comparable increases in asthma quality-of-life assessment results in one month just after treatment, but there was a substantial gap between the groups in terms of breathing therapy at six months. At six months, and there was a large change in depression and anxiety levels in favor of breathing instruction.

The best study was by Laurino et al., the purpose of this research was to determine the degree of anxiety and the standard of living in a community of asthma patients who have had panic attacks before. The authors have also shown that a breathing physiotherapy program (breathing retraining) can improve conditions of anxiety disorder, contributing to improvements in asthmatics' health-related standard of life. A systematic review suggested that there could be some theoretical advantages of chest physiotherapy. Two independent randomized clinical trials of asthma patients found that chest physiotherapy and relaxation greatly increased the quality of life associated with wellbeing and reported substantial improvements in symptoms of asthma. This reports also call for further research to show the importance of asthma retraining for breathing. These new principles of asthma management can, according to the evidence, help decrease hospitalizations and emergency department admissions, maximize commitment to care, and improve the quality of life of patients (Laurino et al., 2012).

Aerobic and respiratory techniques have been found to help asthmatic patients, although there is little evidence to compare the success of both therapies. Airway hyperresponsiveness and flow of air blockage are associated with symptoms of inflammation, leading to reoccurring episodes of breathlessness, wheezing, chest stiffness, and coughing. Both of the conditions improve the standard of life and emotional well-being of the individual and limit the physical activity of everyday living. Besides, there are elevated levels of stress and anxiety in asthmatic patients, which are correlated with an increased rate of exacerbations and serious asthma diagnoses. The pulmonary respiratory pattern, which contributes to rapid breathing, repeated sighing and prevalent thoracic breathing, may be changed by these psychosocial conditions. Besides, to maximize the living standard and expiratory peak flow levels, breathing techniques have been shown. The degree of anxiety and stress, asthma attacks, the use of relaxation medicine, exacerbation outbreaks, and airway hyperresponsiveness are often decreased by controlled breathing.

This report reviews the latest proof of the efficacy of respiratory exercise services for people with asthma as adjuvant therapy for pharmacological strategies. Addressed are the styles of breathing training programs used, it is believed that after sufficient pharmacological care, patients with asthma tend to cause complications and quality-of-life decline. Even with tailored pharmacotherapy, most patients in clinical trials will reach high levels of control, inadequate control is normal in "real-life" practice, through over-reliance on relief bronchodilator treatment and continuing symptom and impairment in quality of life. To improve asthma regulation, many patients are engaged in non-pharmacological therapies, especially breathing regulation exercises, but the clinical evidence has indeed been insufficient until recently. The position of breathing techniques has been problematic, partially because exaggerated, farfetched statements of efficacy have also been made by some opponents (Porsbjerg & Menzies‐Gow, 2017).

Anxiety, with a prevalence measured at up to 20 percent of the population, is a very prevalent condition. Anxiety has had an impact on the quality of life metrics. Among the various anxiety and depression are panic disorder and agoraphobia. Breathing retraining has known to help relieve the effects of asthma and severe depression and subsequent improvements in the quality of life of an asthmatic. The quality of life examines the well-being of a person, complements conventional health and treatment interventions, and examines the greater effect of asthma on physical, emotional, and social life. To control the effects of anxiety and airway congestion, a breathing retraining regimen led to a statistically meaningful result, with increases in peak flow rate (Stoodley et al., 2019). Breathing retraining facilitates biomechanical reorganization and increases muscle control, leading to a substantial increase in peak flow independent of airway obstruction enhancement.

But for those with serious asthma, breathing is something that many people overlook. Medicines such as inhaled corticosteroids and beta-agonists loosen up the airways and make you breathe better. Asthma reduces the breathing passages to the point that it can be difficult to catch the breath. However, for those patients with serious asthma, these medications may not be adequate to manage the symptoms. Patients may choose to consider breathing exercises if they are looking for ways to supplement their opioid therapy. Until lately, physicians did not prescribe asthma breathing techniques, mainly because there was inadequate proof to suggest that they function. Nevertheless, more recent literature shows that these techniques will help enhance performance and the standard of living. Breathing exercises may also have benefit as an add-on procedure to medicine and other conventional asthma therapies, based on recent research.

References for The Effectiveness of Physiotherapy in Patients with Asthma

Bruurs, M. L., Van Der Giessen, L. J., & Moed, H. (2013). the Effectiveness of Physiotherapy in Patients with Asthma: A Systematic Review of The Literature. Respiratory Medicine107(4), 483-494.

Connett, G. J., & Thomas, M. (2018). Dysfunctional breathing in children and adults with asthma. Frontiers in Pediatrics6, 406.

Evaristo, K. B., Saccomani, M. G., Martins, M. A., Cukier, A., Stelmach, R., Rodrigues, M. R., & Carvalho, C. R. (2014). Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial. BMC Pulmonary Medicine14(1), 160.

Lack, S., Brown, R., & Kinser, P. A. (2020). An integrative review of yoga and mindfulness-based approaches for children and adolescents with asthma. Journal of Pediatric Nursing52, 76-81.

Laurino, R. A., Barnabé, V., Saraiva-Romanholo, B. M., Stelmach, R., Cukier, A., & Nunes, M. (2012). Respiratory rehabilitation: A physiotherapy approach to the control of asthma symptoms and anxiety. Clinics (Sao Paulo, Brazil)67(11), 1291–1297. https://doi.org/10.6061/clinics/2012(11)12

Porsbjerg, C., & Menzies‐Gow, A. (2017). Co‐morbidities in severe asthma: Clinical impact and management. Respirology22(4), 651-661.

Sankar, J., & Das, R. R. (2018). Asthma–a disease of how we breathe: the role of breathing exercises and pranayam. The Indian Journal of Pediatrics85(10), 905-910.

Stoodley, I., Williams, L., Thompson, C., Scott, H., & Wood, L. (2019). Evidence for lifestyle interventions in asthma. Breathe15(2), e50-e61.

Tehrany, R., BScPT, DeVos, R., & Bruton, A. (2018). Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report. Physiotherapy Theory and Practice34(4), 329–335. https://doi.org/10.1080/09593985.2017.1400139

Thomas M. (2009). Are breathing exercises an effective strategy for people with asthma?. Nursing Times105(10), 22–27.

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