Chronic obstructive lung disease

Table of contents

COPD is common worldwide contributes to major disablement every bit good as economic and societal load. More than 30 million Americans have COPD. Deaths from COPD numbered 118,774 in 2001. It remain 4th taking cause of decease in united provinces. Over the past 20 old ages their decease rate has increased about three creases.

20.1 Per 100,000 in 1980.

56.7 Per 100,000 in 2000.

COPD likely highest in England when comparison to the remainder of Europe, particularly in the major Centres of industry. Approximately 5 % of population in Sweden have jobs caused from COPD disease. 35000 sweds is annually placed into infirmary for intervention for heavy external respiration job caused by COPD. In Sweden approximately 2000 individual died of COPD disease annually.


Physiotherapy is frequently required to assist clear secernment and cut down work of external respiration, including non invasive airing to forestall cannulation. Physiotherapy must therefore include educating the patient and household about Restoration and care of exercising tolerance and self direction. Physiotherapy is hence best provided in the signifier of pneumonic rehabilitation. To live over any bronchospasm and ease the remotion of secernments. To better the form of external respiration, take a breathing control and control of dyspnea. To learn local relaxation, better position and aid still fright and anxiousness. To increase the cognition of the patient about lung status and control of the symptoms. Improve exercising tolerance and guarantee a long term committedness to exercisings. To cut down the perceptual experience of shortness of breath. To better the functional capacity. To cut down the degree of anxiousness for physical activity.

Chest wall musculuss stretching techniques increases critical capacity and scope of gesture. Keeping respiratory musculus map of critical importance for the respiratory system. The stretching of musculus fibers promotes consecutive addition in the figure of sarcomeres. Increase the volume of the splanchnic mass, inappropriate position, respiratory disease, and musculus failing and aging. Muscle stretching technique addition flexibleness and hurts. Prevent the musculus from responding sufficient extremum tenseness, which evolves to muscle failing, abjuration.

Need for the study

Although intercessions to change by reversal failing in peripheral musculuss, are in common usage, secondary postural malformations can happen in response to hyper rising prices and increased work of take a breathing in COPD patients. Postural alterations can include elevated, protracted or abducted shoulder blade with medially rotated humerus and crookback spinal malformations. Since, hyper rising prices of the thorax, topographic points pectoralis major musculus in a sawed-off place it increases the opposition of chest wall to spread out, farther increasing the work of external respiration.

The intent of this survey was aimed at stretching the shortened pectoral muscle major musculuss utilizing the clasp relax PNF technique and integrating pectoral mobility exercises to change by reversal the alterations in the chest wall following COPD.


There is no important difference in the dyspnea degree and shoulder horizontal extension following hold relax technique and pectoral mobility exercisings.

There is important difference in the dyspnea degree and shoulder horizontal extensions following clasp relax technique and pectoral mobility exercisings.

Kimm ( 1987 )

Respiratory musculuss stretching better airing and tissue oxygenation improves the activity of day-to-day life and quality of life.

Kahisaki et al. , ( 1999 )

The elongation of the respiratory musculuss might better pectoral enlargement and lessening dyspnea in COPD patients.

Hamer A, Mahler A, Daubensperh.1967

Respiratory musculus stretching may heighten respiratory musculus map and cut down dyspnea in diagnostic patients with mild COPD.

Levso, Honvoh F 1982,

Stretching exercisings are a good 1 for the COPD patients and showed to be better the quality of life of patients.

Magadle R, Mc Connel AX, Beckerman M,

Inspiratory musculus preparation provides extra benefits to patients undergoing pneumonic rehabilitation plan.

Moore AJ, StubbingsA, 2006,

Concluded that COPD consequences non merely alteration in musculus fiber type distribution, but in a structural alteration in the titin molecule in all musculus fibre type with in the stop.

M.Estenne, PA Gevenois, W Kinner

In many patients with chronic failing of the respiratory muscles the cut down the lung distensability does non look to be caused by microatelectasis, it might be related to changes in snap of the lung tissues.

Hideko minoguchi, Hirotaka Tanaka

Respiratory musculus stretch may hold clinically important benefits, which may be slightly different from the benefit of inspiratory musculus preparation, in patients with COPD.

M.Jeffy mador, MD, Omar Deniz MD

The endurance of the respiratory musculuss can be improved by specific developing beyond that achieved by endurance developing entirely in patients with COPD.

Eleine Paulin, Antonio ternando Bruneto 2003.

Our consequences suggest that exercises aimed that pectoral enlargement better thoracic enlargement, quality of life bombers maximum exercising capacity, every bit good as cut down dyspnea and depression in COPD patients.

PJ Wijkstra, EM tenvergart R, new wave Altena

This survey is first show the rehabilitation at place for three months followed by one time monthly physical therapy Sessionss improve quality of life over 18 months ; the alteration in quality of life was non associated with a alteration in exercising tolerance.

Havver A, Mahler DA 1989

Target inspiratory musculus stretching may heighten respiratory musculus map and cut down dyspnea in diagnostic patients with COPD.

Camargo CA, Clarks Kenney PA.

Additions slow critical capacity significantly correlated with dyspnoea betterment among exigency section patients with COPD.

Montaldo et al. , 2000

The greater pectoral enlargement might better the length tenseness ratio of the respiratory muscles diminish the sensory nerve stimulation for cardinal respiratory control and cut down dyspnea.

Teddoro montemayor et al. , 2006

Suggested that a simple place based plan of exercising preparation achieved betterment is exercise tolerance, station attempt dyspnea, and quality of life in COPD patients.

Mario grassi MD, marica pecis 2009

A disease oriented place attention plan is effectual in cut downing mortality in COPD patients.

Manuel gimenz, Pedro vergara 2000

A maximally intense stretching exercising plan can be created for most COPD patients that can significantly better respiratory musculus strength and endurance.

Denna swart out-corbeil R.N, Davison A.M 2006

Physical exercising is designed to better respiratory efficiency promote, enlargement of lung and, chest, beef up the respiratory musculus and assist the patient breath more freely and to acquire more O into the organic structure.

American physiological society 2006

The physical exercising improves respiratory take a breathing capacity by increasing chest wall enlargement and forced expiratory lung volume, bole mobility improves the chest wall map and relieves dyspneas.

Putt MT, Watson M, seale H,

The clasp and loosen up techniques produce short term benefits in patients with COPD.

Study design

A individual group pre test- station trial experimental survey design.

Department of pulmonology,

K.G.Hospital, Coimbatore-18.

Study was conducted for a period of three months ( 12 hebdomads ) .

Simple random sampling.

A sum of 15 patients diagnosed with mild COPD by the clinical doctor go toing the outpatient Department of Pulmonology of K.G.Hospital were selected indiscriminately for the survey.

Inclusive standards

  • Patients classified as holding mild COPD by the doctors were taken for the survey.
  • Ability to execute exercisings.
  • Both sexes.
  • Patient in age group between 35-45 old ages.

Exclusive standards

  • Patients with any associated jobs of COPD
  • Recent acute aggravation of disease
  • Conditionss that contraindicate the application of clasp and loosen up techniques.
  • Secondary musculoskeletal upsets.
  • Recent breaks or hurt to the ribs, collarbone or upper limb.
  • Perennial subluxation or disruption of either shoulder.
  • Inability to execute isometric contraction.
  • Connective tissue upset
  • Ischemic bosom diseases
  • Uncontrolled hyper tenseness
  • Moderate to severe osteoporosis
  • Extra conditions curtailing chest enlargement ( e.g. Obesity, terrible scoliosis, ancylosing spondylitis )
  • Systemic disease musculuss and articulations ( e.g. Rheumatoid arthritis )
  • Extremist mastectomy with remotion of the pectoral muscle major musculus.
  • Recent thorax or abdominal surgery.


Hold and loosen up technique

Thoracic mobility exercisings

Dependent variables:

  • Shoulder horizontal extension
  • Rate of perceived effort


  • Goniometer
  • Borg ‘s graduated table


Before the intervention all the topics were explained about the survey process and intervention to be applied. They were asked to inform if they had any uncomfortableness during the class of intervention. The patients were explained and show about the clasp relax technique and pectoral mobility exercisings which they had to execute.

The pre trial shoulder horizontal extension and rate perceived effort steps were taken, after which the group was asked to execute hold relax technique and pectoral mobility exercising for a continuance of 6 hebdomads, after which shoulder horizontal extension and dyspnea was assessed utilizing Goniometer and Borg ‘s graduated table severally.

At the terminal of the 12th hebdomad the degree of dyspnea was found to be decreased with an addition in shoulder horizontal extension motion.

The above tabular array II shows the analysis of pre trial and station trial values. The mated t-test value is ( 10.2 ) which is greater than the tabulated t-value ( =2.145 ) at 5 % degree of significance.

This shows that there is a important difference between the values.


Purpose of this survey was to bespeak that a hold relax technique specifically to the pectoral muscle major musculus is capable of increasing the result steps which are shoulder horizontal extension scope of gesture ( there by a little addition in critical capacity ) and cut down dyspnea in COPD patients.

Previous surveies have found that a hold relax technique in normal topics can bring forth statically important increased hemodynamic viz. , systolic and diastolic blood force per unit area, as rate of perceived effort, respiratory rate, SaO2 were non adversely affected in any topics after intercession, this implies that the intervention is a safe method of intervention in chronic respiratory patients.

The active method of intervention included in this survey appears to be safe and effectual in chronic respiratory patients.

As adaptative shortening and stiffness around the upper limb musculus quadrant addition chest wall opposition and work of take a breathing. A method of change by reversaling these alterations of import to include a direction program for these patients. ( Arch phys med rehabilitation, vol 89, June 2008 ) .

15 topics with COPD were indiscriminately selected as a individual group who underwent hold relax technique of the pectoral muscle major and pectoral mobility exercisings, following 12 hebdomads of survey continuance and there was a important betterment of the result steps shoulder horizontal extension ( t 16.6 ) and dyspnea ( t 10.2 ) .


This survey shows as important betterment in the dyspnea degree ( t=10.2 ) and shoulder horizontal extension ( t=16.6 ) in patients with mild COPD following hold relax technique and pectoral mobility exercisings.

This provides considerable grounds that hold relax technique can better the restrictive constituent of COPD, Extensibility of the pectoral muscle major musculus and perchance get the better of some of the postural alterations of COPD.


Restriction of this survey is that FEV1, FVC were non measured in order to bespeak the badness of COPD in each topics.

Demographic information was non taken into the survey.


Further survey should be done to learn more about how to change by reversal the secondary soft tissue effects of chronic respiratory disease.

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