COPD and Dyspnea: Management of a Severely Affected Elderly Patient (Effect of Comprehensive Directed Breathing during Bi-level Exercises)

Abstract: This report is about an eleven year follow up of a 70-year-old man (185 cm tall, 98 kg of weight) with severe COPD diagnosed in 2006: He was given usual medical treatment, periodically, with bronchodilators, steroids and standard respiratory physiotherapy. Objective: To compare the effects of Traditional Diaphragmatic Breathing (TDB), and training exercises with those of the association of Comprehensive Directed Breathing (CDB) used at rest and during the 45 minute Bi-levels: Square Wave Endurance Exercise Test (SWEET) training on cycle ergometry, Two Step Stool (TSST) and walking. Design: The intervention for the two programs (TDB and CDB) included diaphragmatic breathing exercises, cycle ergometry, walk and bi-level stairs sessions for 90 minutes five days/wk. In addition our team taught and explained to the patient, the anatomical aspects, and the physiology of ventilation along with CDB. The CDB was taught with all the aspects of anatomy and physiology of ventilation; The patient observed his ventilatory dyssynchronism in a mirror; he was shown his ventilatory rhythm on a spirogram; diaphragmatic movement was demonstrated in an educational movie, and verbal feedback was used to correct respiratory asynchrony. Results: In the first (TDB) traditional treatment, all medical and physiotherapeutic interventions did not effectively improve his dyspnea neither his exercise tolerance. On the contrary, the second (CDB) treatment with SWEET-CDB showed significant improvements in endurance exercise capacity (6-MWT +30%; SWEET, kJ/kg +63%, p < 0.01; Ventilatory Anaerobic Threshold +76%; PWR +30%, in perception of dyspnea (Borg; VAT= - 91%; 120W -52%; PWR - 46%, p< 0.01), while (PEmax= +33%; PImax= +26%, MVV= +14%, E max= +31%, VT and O2 P all increased significantly (p < 0.01); in addition, overbreathing as well as RR, CO2, O2 and HR were reduced (p< 0.01). In summary: SWEET- CDB training proved effective because it significantly reduced both dyspnea at rest and during exercises. CDB reduced ventilatory asynchrony, overbreathing, breathing frequency, metabolism, and improved arterial blood gases and ventilatory efficiency.