DOI Number: 10.5958/j.0973-5674.8.1.

021
Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1 105

Immediate effects of Active Cycle of Breathing Technique

and Conventional Chest Physiotherapy in Subjects with
Bronchiectasis - A Comparative Study
S Ram Anand1, D Anandhi2
1
Lecturer, Srinivas College of Physiotherapy & Research Centre, Mangalore, Karnataka, India, 2Associate Professor
SRM College of Physiotherapy& Research Centre, SRM University, Chennai,Tamil Nadu, India
ABSTRACT
Background: The prevalence of Bronchiectasis in India, is 10 fold increase in in persons with high
exposure to Arsenic caused skin lesions in West Bengal in 2005.The prevalence was higher among
women than men 71 vs 32/1, 00,000 and increased markedly with age 4/1, 00,000 for people aged 1834 years & 272/1, 00,000 for those aged 75.
Aim: The aim of the study is to compare the Immediate effects of Active Cycle of Breathing Technique
and Conventional Chest Physiotherapy in subjects with Bronchiectasis.
Methodology: StudyDesign-Experimental Design; Study Type-Comparative Study;Sample Size30Subjects; Sampling Method - Convenient Sampling;Sampling Specification - Group A-15 subjects
& Group B-15 subjects; Study Setting - Department of TUBERCULOSIS AND CHEST DISEASES,
SRM Medical college Hospital & Research centre, Kattankulathur. chennai. Tamilnadu, India. Study
Duration - 3 months.
Results: Comparing the values of Sputum volume between Group A and Group B, Group B showed
a significant difference than Group A. (P<0.05).
By comparing the values of Peak expiratory flow
rate within the Group A, it shows a significant difference between Pre-test and Post-test values
(P<0.05). By comparing the values of Peak expiratory flow rate within the Group B, it shows a
significant difference between Pre-test and Post-test values (P<0.05).By comparing the values of
Peak expiratory flow rate between the Group A and Group B, there was no significant difference
between Pre-test and Post-test values (P>0.05).
Conclusion: The results of this study thus concluded that subjects who underwent Conventional
Chest Physiotherapy showed good improvement in their Sputum clearance than subjects who
underwent Active Cycle of Breathing Technique and there was a good improvement between Pre
and Post Peak expiratory flow rate with both Conventional Chest Physiotherapy and Active Cycle of
Breathing Technique.Thus, this study will be useful for selection of intervention in subjects with
Bronchiectasis
Keywords: Active Cycle of Breathing Technique, Bronchiectasis, Peak Flow Meter, Chest Physiotherapy

INTRODUCTION
Bronchiectasis is mostly an acquired
bronchopulmonary disorder with abnormal thickening
of the bronchial wall and dilation of central and
medium sized bronchi, due to a viscous circle of
transmural infection and inflammation with mediator

21. Ram anand--105--112.pmd

105

release. It is idiopathic in about 50% of adults and 25%

of children (British Medical Journal; 2010)1. It causes
anomalous and irreversible dilatations of the bronchi,
caused by destruction of the elastic and muscular
layers of the bronchial wall, most frequently by
recurrent infection. Gradually, the pus-filled bronchial
sacs make gas exchange impossible, resulting in an

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106 Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1

infected, non-functioning lung segment. RENE

LANNAC made the first description of bronchiectasis
in 1819 (European Journal of Cardio-Thoracic Surgery;
2001)2.
Incidence & Prevalence
According to NATIONAL HEART, LUNG, BLOOD
INSTITUTE 1999; Death rate extrapolations for U.S.A.
for Bronchiectasis was 969 per year; 80 per month; 18
per week; 2 per day4.
According to STARSHIP CHILDRENS HEALTH
CLINICAL GUIDELINES-in 2000 a retrospective
review of children attending the Bronchiectasis clinic
found a crude prevalence rate 1:6000 in the Auckland
paediatric population. A prospective national study
reporting all new cases diagnosed (2001-2003) using
the Newzland paediatric surveillance unit gave an
incidence of 3.7/1, 00,000 children per year. This is 7
times higher than the only other comparable national
study from Finland. 80% of the children were Maori
or pacific peoples indicating a disproportionate
prevalence of Bronchiectasis at 1/1875 for pacific
peoples, 1/4244 for Maori and 1/24,900 for European
groups. In 2008 March, >160 children are reported in
STARSHIP BRONCHIECTASIS CLINIC statistics for
Bronchiectasis.In England 2002-2003; 39% of hospital
consultant episodes for Bronchiectasis were men and
61% were women4.

DISEASES,SRM Medical college Hospital &

Research centre,Kattankulathur-Chennai;Study
Duration 3 months.
Materials Used

Sputum produced during and following the

treatment was collected into the Mucus Extractor
and its volume measured in millilitres.

The Peak expiratory flow rate in liters/sec was

measured by using A mini-Wrights peak flow
meter.

Inclusion Criteria

Diagnosed cases of Bronchiectasis by Chest

Physician (X-RAY, CT, PFT)

Age group 35 60 years

Both Males and Females

Subjects with expectorated sputum quantity of

10ml - > 150 ml/day

Subjects with stable Hemodynamics

Subjects under medications for Bronchiectasis

(antibiotics, bronchodilators, etc)

Exclusion Criteria

Pulmonary hypertension

Angina

Diabetes mellitus

Pulmonary embolism

Pneumothorax

Tuberculosis

Bronchial Asthma

Any chest trauma

Corpulmonale

Research Specification

Recent Abdominal surgery

Children

In India, it was the recent finding of a 10 fold

increase in Bronchiectasis prevalence in persons with
high exposure to Arsenic caused skin lesions in West
Bengal in 2005.The prevalence was higher among
women than men 71 vs 32/1, 00,000 and increased
markedly with age 4/1, 00,000 for people aged 18-34
years & 272/1, 00,000 for those aged 75 or over 4.
METHODOLOGY
The study aims to establish the Immediate effects
of Active Cycle of Breathing Technique and
Conventional Chest Physiotherapy in subjects with
Bronchiectasis.

Study Design Experimental Design;Study Type

Comparative Study;Sample Size 30
Subjects;Sampling Method Convenient
Sampling;Sampling Specification Group A-15
subjects & Group B-15 subjects;Study Setting
Department of TUBERCULOSIS AND CHEST

21. Ram anand--105--112.pmd

106

Testing Procedure
A comparative study was done on subjects with
Bronchiectasis to establish the Immediate effects of
Active Cycle of Breathing Technique and Conventional

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Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1 107

Chest Physiotherapy in subjects with Bronchiectasis.

After selecting the sample, test procedure was
explained to the subjects, a written consent was
collected from the subjects to participate in the study.
The time taken for discussion and for the
determination of the individuals pre-test
measurements allowed for a period of rest prior to
testing. The 30 subjects who fitted into the inclusion
criteria were randomized into 2 groups A &B.
Precautions
The subjects were asked to maintain the following
precautions

Avoid heavy meals within 2 hours of testing.

Wear comfortable clothing.

Pre&Post test measurements

Expectorated sputum in millilitres

Peak expiratory flow rate in litres/second

For both the groups, Peak expiratory flow rate was

measured using Pea expiratory flow meter.
For both the groups, expectorated sputum was
measured using Mucus Extractor.
Group A

Deep Breathing Exercises: Take 3 4 deep breaths

in, allowing the lower chest to expand. Try to ensure
neck and shoulders remain relaxed. At the end of the
breath in, hold the air in for 3 seconds .Let the air out
gently19.
Forced Expiration Technique/Huff: Huffs are
combined with breathing control and they were asked
to take a half breath in and blow air out steadily
through an open mouth. Follow this with breathing
control as secretion moves into larger airways. Take a
deep breath in and blow air out again through an open
mouth. A typical cycle consists of: Breathing control, 3
4 deep breaths, breathing control, forced expiration
technique/Huff. The total treatment session was 30
minutes19. The treatment sessions were performed
under supervision and at the same time of the day.
Group B
Conventional Chest Physiotherapy
All the 15 subjects in the Group B were allocated to
Conventional Chest Physiotherapy. The Conventional
Chest Physiotherapy consists of Postural drainage,
Percussion, Pressure-vibration, active bilateral
respiratory exercises. The total treatment session was
performed under supervision and at the same time of
the day. All usual medications are to be administrated
during the study days19, 31.
Statistical Analysis

Active Cycle of Breathing Technique

Subjects were made to sit with back support and
asked to maintain a good breathing pattern with
relaxed shoulders and neck and breathe in through
the nose and out through the mouth. Breathing out
should be slow, like sighing out. This minimizes any
wheezing 19.
Breathing Control: Rest one hand on abdomen,
keeping shoulders and upper chest relaxed and allow
their hand to rise gently as they breathe in. (If they
imagine air filling the abdomen like a balloon this may
help) Sigh out gently and ensure that the shoulders
remain relaxed. Over a few seconds, gradually increase
depth of breathing while maintaining relaxation.
Breathing control is an essential part of the cycle to
allow rest19.

21. Ram anand--105--112.pmd

107

The independent variables are Sputum & Peak

Expiratory Flow Rate. The Statistical Package Graph
Pad Prism was used for data analysis.
The statistical tools used in this study are pairedt
test and independentt test
Pairedt test
Pairedt test was used to find out the significant
difference in improvement between pre and post
treatment values between Group A and Group B for
Sputum & Peak expiratory flow rate.
Studentt test
The student independentt test is used to compare
the significant differences between group A and group
B for Peak expiratory flow rate.

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108 Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1

Data Analysis
Table 1. Comparison Between Group a and Group B Post-test Sputum Volume
Sputum

Group A

Post Treatment

Group B

Df

Mean

S.D

Mean

S.D

3.73

1.486

6.00

1.512

Calculated
Value

28

4.141

Table
value

P
Value

1.701

0.9503

There is significant difference between the post- test sputum volume between Group A and Group B (P< 0.05).

Graph 1. A Comparison Between Post-test Sputum Volume In Group A And Group B

Mean

Total Number of Subjects

Table 2. Comparison Between Pre and Post Peak Expiratory Flow Rate Values in Group A
PEFR

Group A
mean

S.d

Pre

192

62.01

Post

210

63.74

Calculatedvalue

Tablevalue

Df

P Value

9.727

3.787

14

0.0001

PEFR- Peak Expiratory Flow Rate

There is significant difference between Pre and Post test values of Group A in Peak expiratory flow rate (P< 0.05).

Graph 2. Comparison Between Pre And Post Pefr In Group A

Mean

Total Number of Subjects

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Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1 109
Table 3. Comparison Between Pre and Post Peak Expiratory Flow Rate Values In Group B
PEFR

Group B
mean

Calculatedvalue

Tablevalue

Df

P Value

10.31

3.787

14

0.0001

S.d

Pre

192

43.9

Post

288

49.01

PEFR- Peak Expiratory Flow Rate

There is significant difference between Pre and Post test values of Group B in Peak expiratory flow rate (P< 0.05).

Graph 3. Comparison Between Pre And Post Pefr In Group B

Mean

Total Number of Subjects

Table 4. Comparison Of Post Test Values Of Peak Expiratory Flow Rate Between Group A and Group B
Sputum

Group A

Post Treatment

Group B

Mean

S.D

Mean

S.D

210.6

63.7

288

49.01

Df

Calculated
Value

28

0.834

Table
value

P
Value

1.701

0.410

PEFR- Peak Expiratory Flow Rate

There is no significant difference between the post-test Peak expiratory flow rate values between Group A and Group B (P > 0.05).

Graph 4. Comparison Between Group-A and Group-B Post PEFR

Mean

Total Number of Subjects

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110 Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1

RESULTS

DISCUSSION

The purpose of the study was to compare the

Immediate effects of Active Cycle of Breathing
Technique and Conventional Chest Physiotherapy in
subjects with Bronchiectasis.

The immediate effects of Active Cycle of

Breathing Technique and Conventional Chest
Physiotherapy shows significant improvement
between Pre and Post test values of Peak expiratory
flow rate and airway clearance. Comparing the Peak
expiratory flow rate values within the groups showed
a statistically significant difference and between the
groups does not show statistically significant
difference in Peak expiratory flow rate. This can be
probably because of the smaller sample size and
immediate measurements of the values.

From Tables 1, 2, 3 and 4 the following inferences

are made.

From Table 1: Group B (6.00) showed improved

sputum volume than Group A (3.73) with t-value
of (4.141) and P-value of (0.9503).

From Table 2: Peak expiratory flow rate values

improved in Group A between Pre test (192) and
Post-test (210) with t-value of (9.729) and P-value
(0.0001).

From Table 3: Peak expiratory flow rate values

improved in Group B between Pre test (192) and
Post-test (288) with t-value of (10.31) and P-value
(0.0001).

From Table 4: Peak expiratory flow rate values

between Group A (210.6) and Group B (288) with
t-value of (0.834) and P-value (0.410) does not show
significant difference in Post test Peak expiratory
flow rate.

Hence, by comparing the values of Sputum volume

between Group A and Group B, Group B showed a
significant difference than Group A. (P<0.05).
By comparing the values of Peak expiratory flow
rate within the Group A, it shows a significant
difference between Pre-test and Post-test values
(P<0.05).

The Peak expiratory flow rate values between the

groups may probably show significant difference when
measured after a long-term treatment and follow-up.
CONCLUSION
The results of this study thus concluded that
subjects who underwent Conventional Chest
Physiotherapy showed good improvement in their
Sputum clearance than subjects who underwent Active
Cycle of Breathing Technique and there was a good
improvement between Pre and Post Peak expiratory
flow rate with both Conventional Chest Physiotherapy
and Active Cycle of Breathing Technique.
Thus, this study will be useful for selection of
intervention in subjects with Bronchiectasis.
Limitations

The sample size is small.

Some of the subjects cannot perform the Breathing

Techniques properly.

By comparing the values of Peak expiratory flow

rate within the Group B, it shows a significant
difference between Pre-test and Post-test values
(P<0.05).

Further Recommendations

Large sample size including both male and female

subjects can be done.

Thus, from the above results the Null hypothesis

is rejected.

Quality of Life can be assessed.

The comfort, choice of the patient for the treatment

selection can be assessed.

Long-term effects can be studied.

Effects in severe cases of Bronchiectasis can be

studied.

By comparing the values of Peak expiratory flow

rate between the Group A and Group B, there was no
significant difference between Pre-test and Post-test
values (P>0.05).
Thus, from the above result the Alternate
hypothesis is rejected.

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Indian Journal of Physiotherapy & Occupational Therapy. January-March 2014, Vol. 8, No. 1 111

ACKNOWLEDGEMENT
Srm University, Department of Physiotherapy &
Rc,Department of Tuberculosis and Chest Diseases
&Rc, Srm Multi-speciality Hospital & Rc,
Kattankulathur, Kancheepuram. distChennai,Tamil
Nadu, India.
Conflict of Interest: None (There is No Objection to
Anyone For My Study).
Source of Funding: No Agency or Trust is Sponsered
for my Study.
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