Breathing

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Chapter 35 Breathing

35.1 Breathing Strategies

INCENTIVE RESPIRATORY SPIROMETRY

OVERVIEW.

Incentive respiratory spirometry involves a technique of taking slow deep breaths for a sustained maximal inspiration (fully inflate lungs) using a medical device that provides visual feedback. It is used to prevent or treat atelectasis after surgery and to treat restrictive lung defects associated with dysfunctional diaphragm or quadriplegia.¹

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Four sources cited a total of nine concerns for incentive spirometry. Concerns ranged from one to four per source, with the American Association of Respiratory Care (AARC)¹ and a physician citing the largest number and a physical therapist citing the fewest. The largest proportion of concerns were device-related, such as how the device is used. The most frequently cited concerns were patients who either had a limited vital capacity or were uncooperative.

F00-F99 MENTAL AND BEHAVIORAL DISORDERS

J00-J99 DISEASES OF THE RESPIRATORY SYSTEM

R00-R99 SYMPTOMS, SIGNS INVOLVING

Medical Device

PROCEDURAL CONCERNS

BREATHING EXERCISES

Procedural issues related to inspiration, expiration, and deep breathing during breathing exercises as noted below.

PROCEDURAL CONCERNS

Pursed-Lip Breathing

Pursed lip breathing is a method of controlling respiration by exhaling through pursed lips (e.g., the lips gathered into a wrinkle or pucker). The technique is thought to increase airway pressure and keep bronchioles open so that gas exchange and breathing improves.⁵

PROCEDURAL CONCERNS

1 AARC. Clinical practice guideline, incentive spirometry. Respir Care. 1991;36:1404-1405.

2 Peruzzi WT, Smith B. Bronchial hygiene therapy. Crit Care Clin. 1995;11(1):79-96.

3 Pullen RLJr. Clinical do’s and don’ts: Teaching bedside incentive spirometry. Nursing. 2003;33(8):24.

4 Kisner C, Colby LA. Therapeutic exercise: foundations and techniques, ed 3. Philadelphia: F.A. Davis, 1996.

5 McConnell EA. Teaching pursed-lip breathing. Nursing. 1999;29(9):18.

35.2 Coughing (Cough Therapy)

OVERVIEW.

A cough (reflex) is the expulsion of air from the lungs, performed in a noisy, sudden manner.¹ The sequence involves a brief inspiration, glottis closure, an expiratory muscle contraction (i.e., abdominals), increased pressures within the thorax and abdomen, the opening of the epiglottis, and the expulsion of air and sometimes foreign matter and sputum. It is used to clear secretions from the main bronchi and trachea.²

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Five sources cited a total of 14 concerns for cough (therapy). Sources cited anywhere from one to seven concerns. The largest proportion of concerns were procedural (e.g., hand placements for assisted coughs) and circulatory. Many concerns related to the Valsalva maneuver that accompanies a cough, which can stress the vascular system (ICP, eye surgery, aneurysm) or musculoskeletal system (spinal instability, back pain). One source mentioned the concern for spreading airborne infection (i.e., TB). The most frequently cited concerns were coughing in persons with a history of aneurysm.

PROCEDURAL CONCERNS

1 Dorland’s illustrated medical dictionary. ed 24. Philadelphia: W.B. Saunders; 1965.

2 Thomson A, Skinner A, Piercy J. Tidy’s physiotherapy, ed 12. Oxford: Butterworth-Heinemann, 1991.

3 AARC. Clinical practice guideline, direct cough. Respir Care. 1993;38:495-499.

4 Pauls JA, Reed KL. Quick reference to physical therapy, ed 2. Austin (TX): Pro-Ed, 2004.

5 Obuchowska I, Mariak Z, Stankiewicz A. Massive suprachoroidal hemorrhage during cataract surgery, case report (in Polish—from abstract). Klin Oczna. 2002;104(5-6):406-410.

6 Kisner C, Colby LA. Therapeutic exercise: foundations and techniques, ed 3. Philadelphia: F.A. Davis, 1996.

7 Musnick D, Hall C. Red flags: potentially serious symptoms and signs in exercising patients. In: Hall CM, Brody LT, editors. Therapeutic exercise: moving toward function. Philadelphia: Lippincott Williams & Wilkins, 2005.

8 Imle PC. Physical therapy and respiratory care for the patient with acute spinal cord injury. Phys Ther Health Care. 1987;1:45.

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