Regional contributions of the ribcage and abdomen before and after a six week pulmonary rehabilitation programme

Abstract

Background: Pulmonary Rehabilitation (PR) has been repeatedly shown to improve a number of patient centred outcomes, however the literature examining any impact on lung mechanics is limited, despite the fact that many PR programmes include interventions to alter breathing pattern. Aim: To compare the regional contributions of the ribcage (RC) and abdomen (AB) before and after a six week PR programme in patients with chronic respiratory disease during different breathing and speech tasks. Method: Twenty patients (mean age 69.7±8.81) with COPD (n=14) and Bronchiectasis (n=6) were recruited from the respiratory outpatients department in a UK NHS hospital. Breathing patterns were recorded non-invasively using Respiratory Inductive Plethysmography (RIP) on the first and last day of PR during four tasks (quiet breathing, reading, spontaneous speech and counting), where four breathing parameters were extracted; contribution of the RC and AB during inspiration (%RCInsp; %ABInsp) and expiration (%RCExp; %ABExp). Results: On average, the percentage contribution of the RC during inspiration and expiration was found to increase, while AB contributions were found to decrease following a six week PR programme. These changes were statistically significant for the %RCExp (t=-6.79, t=-2.28, p=0.04) and %ABExp (t=6.64, p=0.04) during the quiet breathing task. Conclusion: These preliminary findings suggest that the contributions of the lower RC and AB wall during tidal breathing alter following a six week PR programme in patients with chronic respiratory disease. Future trials with control groups are needed to confirm whether PR has any impact on lung mechanics.