A Study to Compare the Immediate Effects of Inverse Ratio Breathing and Diaphragmatic Breathing on Pulmonary Functions and Thoracic Expansion in Patients with Chronic Obstructive Pulmonary Disease

Background: COPD leads to airway obstruction, hyperinflation, mechanical disadvantage of respiratory muscles which places accessory muscles in shortened position, leading to increase resistance to chest wall expansion, this causes decrease in pulmonary function. Breathing exercises assist by decreasing dyspnea. Diaphragmatic breathing aims to improve chest wall motion and distribution of ventilation. In Inverse ratio breathing, the ra­tio of I:E becomes 2:1. This study aims to compare the immediate effects of diaphragmatic and inverse ratio breathing in patients with COPD. Method: Study was conducted on 60 patients having COPD. Subjects were randomly selected to perform diaphragmatic or inverse ratio breathing first on day 1, and other technique on day 2. Diaphragmatic breathing was performed for total duration of 5 minutes within 10 minute interval at 6-8 breathes/minute. Washout period of one day was given. Next day, subject was asked to perform inverse ratio breathing using visual video feedback (inspiration for 4 seconds and expiration for 2 seconds) for 10 minutes. Outcome measures: Pulmonary functions (FVC, FEV1, FEV1/FVC, MVV) and thoracic expansion at 2nd, 4th, 6th intercostal space Results: Result showed significant improvement for FVC, FEV1 and MVV, but FEV1/FVC shows no significant difference after diaphragmatic breathing. There was no significant difference for pulmonary functions after inverse ratio breathing. Results showed no significant difference for thoracic expansion after either of two breathing techniques. Conclusion: Diaphragmatic breathing showed significant improvement in pulmonary functions, however no improvement was observed in thoracic expansion. Inverse ratio breathing showed no improvement in pulmonary functions or thoracic expansion. Key words: COPD, diaphragmatic breathing, inverse ratio breathing, pulmonary functions, thoracic expansion