CHAPTER I
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a chronic progressive respiratory
disease that leads to irreversible airway obstruction, with a high global prevalence of
about 20.9%, and it is responsible for the leading cause of death worldwide.
In 2016, COPD was the fifth leading cause of death in china with the prevalence ranging
from 2% to 21%.
In 2019, COPD was the third leading cause of deaths globally, contributing to 3.23
million deaths.
People with respiratory system disorder are very anxious and fearful that they may die.
Respiratory problems are wide spread ranges from minor inconvenience to more life
threatening process. Chronic respiratory problems affects many people often causing
them to make radical life styles.
NEED FOR THE STUDY:
One example of an evidence-based intervention is the use of care bundles. These are
simple tools used with the aim of reliably achieving delivery of clearly specified
elements of care.
Care bundles are sets of evidence- based interventions, elements of which are known to
optimise the clinical outcomes. A bundle is a structured way of improving the process of
care and thereby improving patient outcomes.
In 2015, nearly 3.2 million global deaths were reported due to COPD (5% of overall
deaths) globally in 2015,6309 million disability – adjusted life years (DALYs).
According to the 2017 GBD study, of all the chronic respiratory diseases, COPD
contributed 50% of all cases and 69% of years lived with disability.
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)
in 2017 [4,5]. COPD also imposes a significant burden owing to
high health care costs and impaired health-related quality of life
[6]. It is the leading cause of disability among chronic respiratory
diseases and was the second leading contributor of Disability
Adjusted Life Years (DALY) in 2016 [5]. In 2016, 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 [5]. COPD-related mortality has been reported to
be 39% from 2007-2017 [7]. Most of the existing data on COPD is
from high-income countries, but 90% of deaths occur in low and
middle-income countries [4]. Both India and China contributed to
33% of the world population and accounted for 66% of COPD
mortality [5,8].
The number of COPD cases in India was a staggering 55.3 million in
2016 and is the second common cause of deaths due to NCD [5].
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 [5]. 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% [9,10] whereas the
prevalence in Kerala was reported to be 6.19% among the general
population [11]. Evidence from a multi-centric study further
reported the prevalence of Chronic Bronchitis (CB) was 3.5% in
population above 35 years [12]. 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%
According to Australian institute of health and welfare: Prevalence of COPD
among people aged 45 and over, by sex and age group, 2017–18
Notes
COPD here refers to self-reported current and long-term bronchitis and/or
emphysema.
COPD occurs mostly in people aged 45 and over. While it is occasionally
reported in younger age groups, in those aged 45 and over there is more
certainty that the condition is COPD and not another respiratory condition.
For this reason only people aged 45 and over are included in this graph.
According to WHO in 2019 : Chronic obstructive pulmonary disease (COPD) is
the third leading cause of death worldwide, causing 3.23 million deaths in
2019.
Nearly 90% of COPD deaths in those under 70 years of age occur in low- and
middle-income countries (LMIC).
COPD kills more than 3 milllion people every year, making it the 4 th largest cause of
death in the world. According to world health organization (WHO) It has been estimated
that by the year 2030, COPD will become the third biggest cause of death.
According to American lung association: In 2020, 148,512 people died
from COPD, making it the sixth overall leading cause of death and the
fifth disease-related cause of death, behind heart disease, cancer,
COVID-19, accidents, and stroke.
In 2020, aroud 5.6 percent of adultsed 18 years and older in the united states had chronic
obstructive pulmonary disease (COPD).
STATEMENT OF THE PROBLEM
A study to assess the effectiveness of respiratory care bundle on improvement of
breathing pattern and lung volume capacity among patients with chronic
obstructive pulmonary disease
In selected hospital at karur
OBJECTIVES:
I. Assess the pre intervention level of breathing pattern and lung volume capacity among
patients with COPD in experimental and control group.
II. Compare the pre intervention and post intervention level of breathing pattern and lung
volume capacity among patients with COPD in experimental and control group.
III. To find the association between the pre intervention level of breathing pattern and lung
volume capacity among COPD patients with their selected demographic variables in
experimental and control group
HYPOTHESIS:
1. H1: there will be significant difference between the pre intervention and post
intervention level of breathing pattern and lung volume capacity among patients with
COPD in experimental group.
2. H2: there will be significant difference between post intervention level of breathing
pattern and lung volume capacity among patients with COPD in experimental and
control group.
3. H3: there will be significant association between the pre intervention level of breathing
pattern and lung volume capacity of patients with COPD with their selected demographic
variables in experimental and control group.
ASSUMPTION:
COPD patients will actively participate in this study
OPERATIONAL DEFINITION:
EFFECTIVENESS:
It refers to the improvement in level of breathing pattern and lung volume capacity
after respiratory care bundle among COPD patients.
RESPIRATORY CARE BUNDLE:
It includes:
oral care is the promotion of health, prevention and treatment of disease of the oral
mucosa, lips, teeth and gums.
Breathing exercise is the process of inhale deeply to a count of two, breathing in through
your nose with your mouth closed.
Nebulization turns liquid medicine into a mist that can be easily inhaled.
Posture is as the way in which we hold our bodies while standing, sitting, or lying down.
Incentive spirometer measures the volume of the air inhaled into the lungs during
inspiration.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
It refers to the patients who were diagnosed with mild and moderate symptoms of
COPD, and seeking medical treatment in selected hospital, karur.
BREATHING PATTERN:
It refers to the the level of breathing pattern among patients with copd assessed with
modified borg dyspnea scale and catogorized as no evidence of dyspnea, mild dyspnea,
moderate dyspnea and severe dyspnea.
LUNG VOLUME CAPACITY:
It refers to measure the level of lung volume capacity among patients with chronic
obstructive pulmonary disease assessed by using incentive spirometer and catogorized as
normal, mild , moderate, severe and very severe.
DELIMITATIONS:
The Study is limited to the patients with mild and moderate symptoms of COPD and not
having other disease condition.
Sample size is limited to 60
Patients aged between 31-70 years.
The data collection period is limited to 4 weeks.
CHAPTER – II
REVIEW OF LITERATURE
INTRODUCTION:
Review is a critical summary of research on a topic of interest, often prepared to put
the research problem in the correct perspective or as a basic for an implementation of project.
-
Polit and Beck
Review of literature is an essential component of the research process. It is a critical
examination of publications related to topic of interest. Review should be comprehensive and
elaborate. It helps to plan and conduct the study in a systematic and scientific manner.
For the present study, the related literature was reviewed and organized as following:
Literature related to chronic obstructive pulmonary disease
Literature related to Respiratory Care Bundle.
Literature related to effectiveness of Respiratory Care Bundle on breathing pattern
and lung volume capacity among patients with COPD
LITERATURE RELATED TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
Dr. Bireshwar Sinha (2017) An epidemiological profile of chronic obstructive
pulmonary disease: A community-based study was conducted in Delhi, among 1200 adults,
selected by systematic random sampling. Pretested questionnaire was used to interview all
subjects and screen for symptoms of COPD. Postbronchodilator spirometry was done to
confirm [Link] odds ratio (aOR) was calculated by multivariable analysis to
examine the association of risk factors with COPD. Receiver operating characteristic (ROC)
curve was developed to assess predictability. Results: The prevalence of COPD was 10.1%
(95% confidence interval [CI] 8.5, 11.9%). Tobacco smoking was the strongest risk factor
associated (aOR 9.48; 95% CI 4.22, 14.13) followed by environmental tobacco smoke (ETS),
occupational exposure, age, and biomass fuel. Each pack-year of smoking increased 15% risk
of COPD. Ex-smokers had 63% lesser risk compared to current smokers. Clinical allergy
seems to preclude COPD (aOR 0.06; 95% CI 0.02, 0.37). ROC analysis showed 94.38% of
the COPD variability can be assessed by this model (sensitivity 57.4%; positive predictive
value 93.3%). Only 48% patients were on treatment. Treatment continuation was impeded by
its cost.
Woldeamanuel, G.G.,(2019) A community based cross sectional study was
conducted from February 5 to May 20, 2019 in Abeshge district, Southern Ethiopia. A total of
734 adults aged at least 30 years were selected using multistage cluster sampling technique
and included in the study. All participants were interviewed about socio-demographic
characteristics, respiratory symptoms, smoking status and clinical characteristics. Moreover,
all participants underwent spirometry. We defined COPD as a post-bronchodilator
FEV1/FVC of less than 70%. Data were entered into Epi-data manager 4.4 and analyzed
using SPSS version 23. Descriptive statistics and binary logistic regression analysis were
used and p-value < 0.05 was considered as [Link] the 779 adults invited to participate,
734 adults (421 men and 313 women) were participated in this study. The mean (SD) age of
the participants was 39.15 (± 9.36) years, within the age range of 30–75 years. The
prevalence of COPD was 17.8% (95% confidence interval [CI], 15.1–20.6). Factors
significantly associated with COPD were age above 50 years (adjusted odds ratio [AOR] =
1.91, 95% CI [1.10, 3.30]), being smoker (AOR = 4.54, 95% CI [2.69, 7.66]), Exposed to
biomass smoke (AOR = 2.05, 95% CI [1.06, 3.95]) and poor ventilated kitchen (AOR = 4.12,
95% CI [2.67, 6.34]).
P. N. Kiran Kumar(2021) A prospective study was conducted To assess cases of
COPD in known population. Sixty- eight patients with COPD of both genders were enrolled
in present study. History of smoking, type of cooking fuel combustion, family history,
education level etc. was recorded. A thorough physical and clinical examination was
performed in all patients. Out of 68 COPD patients, male comprised 40 and female 28.
Education was primary in 44, secondary in 10 and graduation in 2. BMI was underweight in
38, overweight in 12 and normal in 18 cases. Family history was positive in 40 and fuel used
was LPG in 10, kerosene in 20 and wood in 38. A significant difference was observed (P<
0.05) Chronic obstructive pulmonary disease is becoming common nowadays. Though
underweight is one of the major cause but air pollution caused by combustion fuel cannot be
overlooked.
Olortegui-Rodriguez, J.J.,(2022) the study was conducted to evaluate the prevalence and
incidence of COPD in Latin America and the [Link] searched systematically in Web
of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed, and
Embase from 2010 to 2021. Studies assessing the prevalence and incidence of COPD
according to the GOLD classification were included. The overall prevalence of COPD was
calculated as a function of the general population using a random-effects model.20 studies
(19 cross-sectional and 1 cohort) met the inclusion criteria. The prevalence of COPD in the
general population older than 35 years was 8.9%. The prevalence in men was 13.7% and in
women 6.7%. The prevalence in smokers and ex-smokers was 24.3%. The incidence in the
general population of COPD according to one study was 3.4% at 9 years of follow-up.
LITERATURE RELATED TO RESPIRATORY CARE BUNDLE:
El-Koa, A.A., Eid, H.A., Abd Elrahman, S.R. et al. (2023) The study was
conducted to evaluate the value of IS on arterial blood gases, mMRC dyspnea scale,
spirometry, and diaphragmatic functions by ultrasound in patients hospitalized for COPD
exacerbation. Forty patients (37 males, 3 females) were admitted for COPD exacerbations
and divided randomly into 2 groups: Group1 (G1) =20 patients (mean age 60.7±5.99) used
incentive spirometry (IS) for 2 months with medical treatment. Group 2 as a control group
(G2) = 20 patients (mean age 60.3±6.44) were given medical treatment only. ABG,
spirometry, mMRC dyspnea scale, and diaphragmatic ultrasound functions were assessed on
admission and after 2 months of treatment in the groups. There were statistically significant
differences between G1 and G2 after 2 months regarding PaCO2, FEV1/FVC (p=0.001 and
0.042, respectively), and Lt diaphragmatic excursion and diaphragm thickness ratio. There
was a statistically significant increase in results of PaO2, PaCO2, FEV1/FVC, PEFR, and all
diaphragmatic findings in group I before and after 2 months of IS but no difference in FVC
and mMRC dyspnea scale.
Rachna. D.(2019) The study was conducted to assess the effectiveness of Buteyko
Breathing Technique in patients with obstructive airway [Link] subjects were screened
to select 28 patients. The Control group receivedconventional Physiotherapy and
Experimental group received Conventional Physiotherapy withButeyko breathing technique.
The treatment was given thrice a week for both the groups for 4 [Link] 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
of6MWD) & 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) & RestingHR% (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).Conclusion: Buteyko
Breathing was effective in improving breathing control, breath holding and reducing the work
of breathing in subjects with Obstructive Airway disease
Karthika,k (2017): A Quasi experimental study was conducted to evaluate the
effectiveness of deep breathing exercise among chronic obstructive pulmonary disease
patients. In this study quasi experimental, non randomized control group pre test-post test
design was adopted. The study include 60 samples patients who were selected by purposive
sampling technique . Modified Borg scale was used to evaluate the dyspnea. Experimental
group received intervention of deep breathing exercise for 25 minutes twice a day for without
treatment. Findings of the pre test level of breathing pattern in control group on 2 subjects
(6.7%) had moderate level of breathing difficulty and 5 subjects(16.7%) had severe level of
breathing difficulty . And the post test level of breathing difficulty in control group , 2
subjects (6.7%) had somewhat severe level of breathing difficulty and10subjects (33.3%) had
slight level of breath difficulty. Whereas in experimental group, the pre test level of breathing
pattern 11 subjects (36.7%) had maximum level of breathing difficulty and 2 subjects (6.7%)
had moderate level of breathing difficulty and the post test level of breathing difficulty, 12
subjects (40%) had very very slight level of breath difficulty, and 10(33.3%) had slight
breathing difficulty, level of breathing in the experimental group. The calculated ‘t’ values in
the control group were 2.07which are not significant. It is concluded that there was no
significant differences between the pre and post test level of breathing pattern among chronic
obstructive pulmonary disease patients The calculated ’t’ value in the experimental group
were 2.64was statistically significant at p<0.05 level which clearly shows that there was a
significant reduce in the level of breathing pattern among patients among chronic obstructive
pulmonary disease after giving breathing exercise. Hence H1 is accepted. The obtained ‘t’
values for level of pain between the control and experimental group is 4.51which were highly
significant at p<0.05 level.
LITERATURE RELATED TO EFFECTIVENESS OF RESPIRATORY CARE
BUNDLE ON BREATHING PATTERN AND LUNG VOLUME CAPACITY AMONG
PATIENTS WITH COPD
Hollingworth W, (2019) study was conducted the effectiveness of implementing
standardised packages of care called ‘care bundles’ on COPD readmission, emergency
department (ED) attendance, mortality, costs and process of [Link] is a mixed-methods,
controlled before-and-after study with nested case studies. 31 acute hospitals in England and
Wales which introduced COPD care bundles (implementation sites) or provided usual care
(comparator sites) were recruited and provided monthly aggregate data. 14 sites provided
additional individual patient data. Participants were adults admitted with an acute
exacerbation of COPD. There was no evidence that care bundles reduced 28-day COPD
readmission rates: OR=1.02 (95% CI 0.83 to 1.26). However, the rate of ED attendance was
reduced in implementation sites over and above that in comparator sites (implementation:
IRR=0.63 (95% CI 0.56 to 0.71); comparator: IRR=1.12 (95% CI 1.02 to 1.24); group–time
interaction p<0.001). At implementation sites, delivery of all bundle elements was higher but
was only achieved in 2.2% (admissions bundle) and 7.6% (discharge bundle) of cases. There
was no evidence of cost-effectiveness. Staff viewed bundles positively, believing they help
standardise practice and facilitate communication between clinicians. However, they lacked
skills in change management, leading to inconsistent implementation.
Aby Thankachan, (2018) A Quasi Experimental study wasconducted to Evaluate the
Effectiveness of Respiratory Care Bundle on Dyspnea among Patients with Bronchial asthma.
Quasi Experimental, pre test, post test control group design. Population: Patients with
bronchial asthma. Sample size: 60 patients with bronchial asthma, 30 in experimental group
and 30 in control group. Non Probability – Purposive Sampling Technique. Setting:
Muthumeenakshi Multi Specialty Hospital and Team Specialty Hospital, Pudukkottai. Tool:
Demographic variables and Modified Borg‟s Dyspnea Scale. Data collection: The period of
data collection was 6 weeks. Respiratory care bundle which includes oral care, deep
breathing exercises and incentive spirometry was given to the patients with bronchial asthma
for 3 days. The pre test and post test level of dyspnea was assessed with Modified Borg’s
Dyspnea scale. Data analysis: Descriptive Statistics (Frequency, Percentage, Mean, Standard
Deviation), and Inferential statistics (paired “t” test, unpaired “t” test, and chi – square) were
used. MAJOR FINDINGS OF THE STUDY: 1. Experimental group of patients with
bronchial asthma had experienced mild and moderate level of dyspnea when compared with
control group. 2. There was a significant reduction in the level of dyspnea between
experimental and control group. So that the administration of Respiratory care bundle was
found to reduce the level of dyspnea among patients with bronchial asthma. 3. There was a
significant association between the level of dyspnea among patients with bronchial asthma
with the selected demographic variables in experimental group. CONCLUSION: 1.
Respiratory care bundle reduces the severity of dyspnea in patients with bronchial asthma. 2.
Respiratory care bundle was found to be easy to administer and very affordable for patients
with bronchial asthma.
J Bindu1,(2015) The objective of the study was to assess the effectiveness of
respiratory care bundle on dyspnea among Patients with respiratory problems. A quasi
experimental study was conducted on patients with respiratory problems (n=60) at MMIMSR
& Hospital, were divided into two groups experimental and control group. The data was
collected by Modified Borg Dyspnea Scale. There was statistically significant difference
between the two groups in terms of dyspnea score (p=0.01) after administration of respiratory
care bundle. Respiratory Care Bundle is an effective therapy to reduce dyspnea.
J Bindu, Kumari Vinay, N Sembian
ABSTRACT
The objective of the study was to assess the effectiveness of respiratory care bundle on the pulmonary function test measurement
and Respiratory distress parameters among patients with respiratory problems. A Quasi experimental study was conducted on
patients with respiratory problems (n=60) at MMIMSR and Hospital, who were divided into two groups; experimental and control
group. The data was collected by peak flow meter, respiratory distress parameters performa and semantic differential scale
regarding patient satisfaction. There was no significant difference between the two groups in terms of level of PEFR (p=0.17) after
administration of respiratory care bundle. There was no significant difference between the two groups in terms of respiratory rate
(p=0.43), accessary muscle use (p=0.55), grunting at end of expiration (p=0.44) and nasal flaring (p=0.76) except restlessness
(p=0.00*). Respiratory Care Bundle is not an effective therapy to improve pulmonary function test measurement and to reduce
respiratory distress parameters.
CHAPTER III
RESEARCHMETHODOLOGY:
The methodology of research indicate the general
pattern of organizing,
the procedure for gathering valid and reliable data
for the problem under
investigation
- Polit and Beck
This chapter describes the methodology followed to
evaluate the
effectiveness of Respiratory care bundle on
dyspnea among patients with
bronchial asthma.
This phase of the study included research
approach, design, the setting
population, sample size, sampling technique,
inclusive, exclusive criteria for
selection variable, description of tools, validity and
reliability of tool, data
collection and plan for data analysis.
RESEARCH APPROACH
Research approach is a systematic, controlled,
empirical, and critical
investigation of natural phenomenon guided by
theory and hypothesis about the
presumed relations among such phenomenon.
A Quantitative approach was adopted by the
researcher to evaluate the
effectiveness of Respiratory care bundle on
dyspnea among patients with
bronchial asthma.
RESEARCH DESIGN
Research design is a blue print to conduct a study
which involves the
description of research approach, study setting, sampling size, sampling
technique, tools and methods of data collection and analysis to answer
specific
research questions or for testing research hypothesis.
Quasi - experimental, pre test, post test control group design was adopted
for this study.
E O1 X O2
C O1 O2
E - Experimental group
C - Control group
O1 –Assessment of Pretest level of dyspnea in the experimental group and
control group
O2 –Assessment of Posttest level of dyspnea in the experimental group and
control group
X - Respiratory care bundle Evaluative approach.
RESEARCH DESIGN:
Pre test, post test with control group design.
STUDY SETTINGS:
The study will be conducted in selected hospital at Karur.
SAMPLING TECHNIQUE:
convenience sampling technique.
SAMPLE SIZE:
30- experimental group
30- control group
SAMPLING CRITERIA:
INCLUSION CRITERIA:
Patients who are:
suffering from COPD with mild and moderate symptoms
Agreed to participate in the study.
between 31-70 years of age.
Available at the time of data collection
EXCLUSION CRITERIA:
Patients with mental illness.
Patients who has Severe and very severe form of bronchial asthma on admitted in
ICU/ER.
Patients who are having other disease condition.
INDEPENDENT VARIABLE:
Respiratory care bundle
DEPENDENT VARIABLES:
Level of breathing pattern and lung volume capacity among patients with COPD.
DEVELOPMENT OF RESEARCH TOOL:
DATA COLLECTION TOOL:
The tool consist of four parts:
SECTION I : Demographic variables
SECTION II : Clinical variables
SECTION III : Modified Borg’s Breathlessness Scale
SECTION IV : incentive spirometry value
SECTION : I
It consists of demographic data like age, sex, marital status, religion, educational
status, occupation,place of work, type of residence, family income per month, duration of
illness, family history of respiratory diseases, smoking habits,place of work and previous
exposure to the incidental education regarding breathing exercises
Structured interview tool to seek the information about chronic obstructive
disease.
Dear participants, you are requested to give your response to all questions. The
information will be treated as confidential.
DEMOGRAPHIC VARIABLES:
1. Age in years
a) 31 - 40 years ( )
b) 41 - 50 years ( )
c) 51 - 60 years ( )
d) 61 - 70 years ( )
2. Gender
a) Male ( )
b) Female ( )
3. Marital status
a) Married ( )
b) Unmarried ( )
c) Separated ( )
d) Widower ( )
4. Religion
a) Hindu ( )
b) Christian ( )
c) Muslim ( )
d) Others ( )
5. Educational status
a) No formal education ( )
b) Primary education ( )
c) High school and higher secondary ( )
d) Graduate / post graduate ( )
6. Living area
a) Rural area ( )
b) Urban area ( )
c) Semi rural ( )
d) Semi urban ( )
7. Occupation
a) Unemployed ( )
b) Self - employed ( )
c) Private employee ( )
d) Government employee ( )
8. Working environment
a) Farmer ( )
b) Textile area ( )
c) Industrial area ( )
d) None ( )
9. Family income per month
a) Less than Rs 5000 ( )
b) Rs 5001 - Rs 10000 ( )
c) Rs 10001 - Rs 25000 ( )
d) More than Rs 25000 ( )
10. Duration of illness
a) 12 months - 23 months ( )
b) 24 months - 36 months ( )
c) 37 months - 48 months ( )
d) More than 48 months ( )
11. Family history of respiratory diseases
a) Maternal ( )
b) Paternal ( )
c) Nill parity ( )
12. Smoling habits
a) Non smoker ( )
b) Occasionally smokes ( )
c) Chain smoker ( )
d) Passive smoker ( )
SECTION : III
This section deals with assessment of patients breathing pattern by using Modified
Borg’s Scale.
[Link] CHARACTERISTICS RESPIRATORY RATE
1. Normal 16 - 22 breaths / mt
2. Mild 23 - 29 breaths / mt
3. Moderate 30 -36 breaths / mt
4. Severe 37 - 43 breaths / mt
5. Very severe 44 - 50 breaths / mt
SECTION : IV
This section deals with assessment of lung volume capacity through incentive spirometer
[Link] LEVEL OF RESPIRATORY STATUS VALUE
1. Norml 1101 - 1200 ml/L
2. Mild 901 -1100 ml/L
3. Moderate 601 - 900 ml/L
4. Sever 301 - 600 ml/L
5. Very severe 0 - 300 ml/L
PILOT STUDY:
Pilot study will be conducted for a period of 1 week. After obtaining written
permission from the head of the institution and the participants prior to the study, the pilot
study will be conducted for 6 patients {3 samples in experimental group and 3 samples in
control group} with chronic obstructive pulmonary disease in selected hospital at Karur. The
samples will be selected by convenience sampling technique. The level of breathing pattern
and lung volume capacity will be assessed by using modified borg’s breathlessness scale and
incentive spirometry among patients with COPD. The respiratory care bundle will be given 3
times a day for about 5 days. Then post test will be conducted after 5 days. The feasibility
and practicability of the tool will be assessed. The data collection will be amenable to
statistical analysis and thus the study will be found to be feasible.
DATA COLLECTION PROCESS:
The data will be collected among chronic obstructive pulmonary disease patients
those who are willing to participate in this study in selected hospital at karur. Written
permission will be obtained from the authorities concerned. The period of data collection
procedure will be four weeks. The purposes of the study will be explained to the patients with
mild and moderate symptoms of chronic obstructive pulmonary disease patients in selected
hospital at karur. Pre test will be conducted by using Modified Borg’s Breathlessness Scale to
assess the breathing pattern and lung volume capacity by using incentive spirometry among
chronic obstructive pulmonary disease patients. Raspiratory care bundle will be given to all
the samples for 30 minutes. Post test will be conducted after 7 days and 15 th day to assess the
effectiveness of respiratory care bundle among patients with mild and moderate symptoms of
chronic obstructive pulmonary disease.
PLAN FOR DATA ANALYSIS:
DESCRIPTIVE STASTISTICS:Demographic variables will be analyzed using
frequency distribution, Mean and Standard deviation.
INFERENTIAL STATISTICS:
i) Post intervention score between the groups will be analyzed using independent “t” test.
RESPIRATORY CARE BUNDLE:
Respiratory care bundle respiratory care bundle comprises oral care, deep breathing
exercises, nebulization, positions, and incentive spirometry which will reduce the level of
dyspnoea among patients with bronchial asthma and it can be utilized as a non-
pharmacological management in respiratory rehabilitation.
Gargling and rinsing mouth with salt water provide a range of health benefits
including maintenance of the natural pH level, clears mucus and relieves nasal congestion,
treats dry cough, prevents upper respiratory tract infection, and cleanses mouth.
Breathing exercises aim to control the symptoms of asthma and can be performed as
the Buteyko breathing technique, deep diaphragmatic breathing or any other similar
intervention that manipulates the breathing pattern. The training of breathing usually focuses
on tidal and minute volume and encourages relaxation, exercise at home, the modification of
breathing pattern, nasal breathing, holding of breath, lower rib cage and abdominal breathing.
Body posture has long been identified as a very important factor having an impact on
lung volumes. The effective patient positioning may be associated with marked improvement
in PaO2 and plays an important role in the conservative management of pulmonary
dysfunction by reducing the effect of shunt or dead space, some positions may deteriorate
V/Q matching.
Incentive spirometers gently exercise the lungs and aid in keeping the lungs as healthy
as possible. The device helps retrain lungs how to take slow and deep breaths. Incentive
spirometer helps to increase lung capacity and improves patients‟ ability to breathe. There are
several benefits of incentive spirometry benefits. Using incentive spirometer exercises lungs,
measures how well lungs fill with air and helps keep tiny air sacs (alveoli) inflated. Keeping
alveoli inflated and working properly to help the lungs for exchange of oxygen and carbon
dioxide more effectively by individuals.