EFFECTS OF SHORT-TERM BREATHING EXERCISES ON CARDIO-RESPIRATORY RECOVERY IN PATIENTS WITH COVID-19: PRELIMINARY FINDINGS FROM BANGLADESH

M. Kader¹, V. Reddy², M.A. Hossain³

Background: Breathing exercises have been used in the physiotherapy management of patients with certain chronic lung conditions such as chronic obstructive pulmonary disease to increase the exchange of oxygen and strengthen the breathing. Coronavirus disease 2019 (COVID-19) attacks the lungs and can cause difficulty in breathing. Breathing exercises have been introduced as an effective treatment choice for COVID-19, but poor evidence exists about its role in the cardio-respiratory recovery among patients with COVID-19.

Purpose: To examine if adding supervised breathing exercises applied in a short period of time could improve cardio-respiratory outcomes among hospitalized patients with COVID-19.

Methods: This was a pre- and post test study with a matched control-group. The study selected laboratory-confirmed (by PCR test) hospital-admitted patients of COVID-19 in Bangladesh. The study-group consisted of 33 (67% men) patients (mean age 50.8 ±14.0 years) recruited from a private hospital. The control-group consisted of 25 patients matched for age, sex and baseline oxygen saturation level recruited from two another public hospitals. Both study-group and matched control-group received regular routine care (e.g., medication, oxygen therapy) for COVID-19. The study-group also received breathing exercises in form of breathing techniques in suitable positions and contained: breathing control, followed by diaphragmatic breathing (5-7 times), thoracic breathing (4-5 times deep breathing +5 sec hold of breath), huffing, coughing and active respiratory exercises (10-12 min).  For those with mild to moderate symptoms, each session was repeated in each 60 min (10-12 times/day), and those with severe symptoms, it was repeated in each 45-60 min (12-16 times/day). Each breathing exercise session was actively done by the patients themselves under the supervision of physiotherapists.
Outcome variables were some cardio-respiratory clinical symptoms, that is, oxygen saturation, respiratory rate and pulse rate, collected at baseline before the treatment session and at follow-up (3-5 days after the baseline assessment). Each treatment session was modified based on individual needs. Analysis of variance on repeated measures (between subjects) with Bonferroni post hoc adjustment was applied to compare the outcomes of two time points.

Results: Compared to the matched control-group, the study-group had more improvement in the mean values of oxygen saturation (96.0% (±2.3) vs 90.2%(±1.7), P<0.001), respiratory rate (21.74 ±2.2 vs 23.0 ±2.2) times/minute, P<0.001), and pulse rate (81.2 ±10.5 vs 92.8 ±10.2 beats/minute, P<0.001) after 3-5 days of breathing exercise sessions.

Conclusion(s): Our findings indicate that those who received breathing exercises (i.e., breathing techniques) even for short period had more favorable changes in certain cardio-respiratory clinical symptoms compared with their matched control counterparts without any breathing exercise. Further, randomized controlled trials are warranted to confirm the results. Studies are also needed to determine the long term effect of breathing exercises on the overall cardio-respiratory health after recovery from COVID-19.

Implications: Our findings provide guidance for the development of respiratory physiotherapy management to hospitalized patients with COVID-19. The results are of importance in maximizing cardio-respiratory recovery in patients with COVID-19.

Funding, acknowledgements: None

Keywords: breathing exercises, COVID-19, chest physiotherapy

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: Zainul Haque Sikder Women’s Medical College and Hospital, Dhaka, Bangladesh.

Committee: Ethical Board of Z H Sikder Women’s Medical College

Ethics number: SMCHRA001