Effectiveness of crocodile breathing versus prone position in patients with COVID-19: A pilot study

Introduction: Physiotherapy and medical management have shown to be beneficial in managing COVID-19 patients. Prone positioning was maximally used in managing these patients, which helped improve ventilation. Crocodile breathing emphasizes diaphragmatic recruitment, decreases accessory muscle use, and triggers the body's relaxation response. The study aims to see the immediate effect of crocodile breathing versus prone positioning in COVID-19. Methods: Thirty participants who passed the eligibility criteria were randomly assigned into two groups. Group A was asked to perform standard of care treatment followed by prone positioning, and after a washout period of a day, they were made to perform standard of care treatment followed by crocodile breathing. Group B performed crocodile breathing on Day 1 and prone positioning on the next day. Outcome measures pulse rate, respiratory rate, rate of perceived exertion, oxygen saturation, single-breath count (SBC), and chest expansion. The patient's feedback was recorded immediately within 1 min pre and post-treatment on both days. Results: Significant improvement was seen in physiological parameters (P < 0.0001), chest expansion (P < 0.0001), and SBC (P < 0.0001) in both groups. However, crocodile breathing was seen to be more effective than prone positioning on SBC (P < 0.0001), rate of perceived exertion (P = 0.000), and chest expansion (P < 0.0001). Twenty-six out of 30 (86%) participants reported crocodile breathing was a more comfortable and better position to relieve dyspnea. Conclusion: Crocodile breathing effectively manages COVID-19 and can be safely incorporated into physiotherapy management for patients with COVID-19.