Efficacy of Breathing Techniques anEfficacy of Breathing Techniques and Positioning Strategies on Dyspnea and Nocturnal Symptoms in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Reviewd Positioning Strategies on Dyspnea and Nocturnal Symptoms in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review
DOI:
https://doi.org/10.37287/ijghr.v8i2.951Keywords:
breathing exercise, breathing technique, chronic obstructive, COPD, dyspnea, nocturnal symptoms, patient positioning, pulmonary disease, sleep wake disorders, standard of careAbstract
Chronic Obstructive Pulmonary Disease (COPD) is a major global health burden and is projected by the World Health Organization (WHO) to become the third leading cause of mortality by 2030. This trend highlights the urgent need for multidisciplinary healthcare management to maintain patient stability and improve outcomes. Objective to evaluate the effectiveness of non-pharmacological breathing exercise techniques and patient positioning strategies in reducing dyspnea, enhancing lung function, improving nocturnal symptoms, and supporting overall quality of life in individuals with COPD. This systematic review followed PRISMA 2020 guidelines. Literature searches were conducted in PubMed, Scopus, ProQuest, EBSCO, SAGE Journals, ScienceDirect, and ClinicalKey using MeSH terms, keywords, and Boolean operators. The search strategy used combinations of the following main keywords: COPD, breathing exercise, breathing technique, positioning, pulmonary rehabilitation, dyspnea, nocturnal symptoms, sleep disturbances. Inclusion criteria were Randomized Controlled Trials (RCTs), adult participants (≥19 years) and publication years 2020–2025. A total of 2,695 articles were identified. After screening, removal of duplicates, and full-text assessment, 14 studies met the inclusion criteria. Analysis of the 14 included studies demonstrated that a variety of non-pharmacological breathing techniques particularly when combined with optimal patient positioning, pulmonary rehabilitation, supportive devices, complementary therapies, and virtual-reality–based interventions consistently improved lung function, functional capacity, dyspnea, and health-related quality of life in patients with COPD. None of the included studies reported adverse effects related to the interventions. Breathing exercise techniques and therapeutic positioning are effective non-pharmacological strategies for managing COPD symptoms.
References
Cazorla, S., Busegnies, Y., D'Ans, P., Héritier, M., & Poncin, W. (2023). Breathing Control Exercises Delivered in a Group Setting for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Healthcare (Switzerland) , 11 (6). https://doi.org/10.3390/healthcare11060877
Ceyhan, Y., & Tekinsoy Kartin, P. (2022). The effects of breathing exercises and inhaler training in patients with COPD on the severity of dyspnea and life quality: a randomized controlled trial. Trials , 23 (1). https://doi.org/10.1186/s13063-022-06603-3
Farooq, V., Tariq, M.I., Fawad, M., Malik, S., Nadeem, S., & Sheraz, S. (2024). Effects of resistive expiratory muscle training on lung function in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Khyber Medical University Journal , 16 (2), 110–116. https://doi.org/10.35845/kmuj.2024.23027
GOLD. (2025). Pocket-Guide-2025-v1.2-FINAL-covered-13Dec2024_WMV . 1–42. www.goldcopd.org
Ministry of Health of the Republic of Indonesia. (2019). Ministry of Health of the Republic of Indonesia No. HK.01.07/MENKES/687/2019 concerning National Guidelines for Medical Services for the Management of COPD .
Kizmaz, E., Telli Atalay, O., Çetin, N., & Uğurlu, E. (2024). Virtual reality for COPD exacerbation: A randomized controlled trial. Respiratory Medicine , 230 . https://doi.org/10.1016/j.rmed.2024.107696
Liu, W., Liu, X.M., Huang, Y.L., Yu, P.M., Zhang, Tai Chi as a complementary exercise for pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized controlled trial. Complementary Therapies in Medicine , 78 . https://doi.org/10.1016/j.ctim.2023.102977
Mohammed, M., Hassan, S., Aziz, A.A., Mohamed, M.F., & El Nahas, N. (2023). Efficacy of threshold inspiratory muscle trainer versus diaphragmatic plus pursed lip breathing in occupational COPD. Beni-Suef University Journal of Basic and Applied Sciences , 12 (1). https://doi.org/10.1186/s43088-023-00409-1
Mok, Y., Foong, JW, Wong, HS, Soh, A., Tan, SH, Tan, PC, Choo, BP, & Wong, KKH (2023). High flow nasal oxygen versus usual care in improving pulmonary rehabilitation outcomes of chronic obstructive pulmonary disease patients after an exacerbation - a pilot randomized controlled trial. Proceedings of Singapore Healthcare , 32 . https://doi.org/10.1177/20101058231204705
Neşe, A., & Samancioǧlu Baǧlama, S. (2022). The Effect of Progressive Muscle Relaxation and Deep Breathing Exercises on Dyspnea and Fatigue Symptoms of COPD Patients: A Randomized Controlled Study. Holistic Nursing Practice , 36 (4), E18–E26. https://doi.org/10.1097/HNP.0000000000000531
Özer, Z., Bahçecioğlu Turan, G., & Aksoy, M. (2021). The effects of yoga on dyspnea, sleep and fatigue in chronic respiratory diseases. Complementary Therapies in Clinical Practice , 43 . https://doi.org/10.1016/j.ctcp.2021.101306
PDPI (Indonesian Lung Doctors Association). (2023). COPD: Guidelines for Diagnosis & Management in Indonesia .
Rahmi, R., Irawati, D., & Waluyo, A. (2023). Breathing Techniques for Dyspnea in COPD Patients. Journal of Telenursing (JOTING) , 5 (1), 708–719. https://doi.org/10.31539/joting.v5i1.5501
Sevasta, K., Agius, T. P., & Sciriha, A. (2024). Muscle Energy Techniques in patients with COPD: a randomized controlled trial. European Journal of Physiotherapy , 26 (2), 78–86. https://doi.org/10.1080/21679169.2023.2192766
Shen, MD, Guo, LR, Li, YW, Gao, RT, Sui, X., Du, Z., Xu, LQ, Shi, HY, Ni, YY, Zhang, Role of the active cycle of breathing technique combined with phonophoresis for the treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a preliminary randomized controlled trial. Trials , 22 (1). https://doi.org/10.1186/s13063-021-05184-x
Song, F., Ding, K., Sun, W., Huang, Q., Jiang, R., Xiang, H., & Sun, M. (2025). Effects of 12 weeks of Head-Down Strong Abdominal Breathing Training on Gait and Cognitive Function in Patients with Chronic Obstructive Pulmonary Disease. International Journal of COPD , 20 , 1347–1359. https://doi.org/10.2147/COPD.S514766
Tsiligianni, I., & Kocks, J. W. H. (2020). Daytime symptoms of chronic obstructive pulmonary disease: a systematic review. In npj Primary Care Respiratory Medicine (Vol. 30, Issue 1). Nature Research. https://doi.org/10.1038/s41533-020-0163-5
WHO South-East Asia. (2025). Development of health education in South-East Asia . World Health Organization, Regional Office for South-East Asia.
Wu, J., Meng, W., Zeng, H., Ma, Y., & Chen, Y. (2023). Relationship between nighttime symptoms and clinical features in COPD patients: A cross-sectional multicenter study in China. Heart and Lung , 62 , 168–174. https://doi.org/10.1016/j.hrtlng.2023.07.008
Yuldasheva, G. , & Azkhodjaeva, R. (2022). View of Modern Trends in the Development of Healthcare . https://doi.org/DOI:10.31557/APJEC.2022.5.S1.57
Zare, F., Karimyar Jahromi, M., Rahmanian, Z., &phaseleh Jahromi, M. (2025). Comparing effects of breathing exercises alone and combined with breathing-stretching exercises on respiratory indices, disease severity and exercise capacity in COPD. Scientific Reports, 15 (1). https://doi.org/10.1038/s41598-025-89664-z
Zeng, Y., Wu, Q., Chen, Y., & Cai, S. (2024). Early Comprehensive Pulmonary Rehabilitation For Hospitalized Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Journal of Rehabilitation Medicine, 56. https://doi.org/10.2340/jrm.v56.39953
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