The use of Pursed Lips Breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessness levels; one RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB, those with moderate to severe COPD being most likely to benefit. Conclusion: High quality studies are required to identify PLB responders from nonresponders and to determine whether short-term effects translate into clinically significant benefit.