Effect of stretching respiratory accessory muscles in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is considered as a systemicdisease affecting lungs as well as many other organs [12]. Their manifestations lead to skeletal muscle dysfunction mainly affects leguscles as Muscle fatigue is more predominant than dyspnea in some patients with COPD [19]. The severity of COPD progresses to restriction of upper limb usage, as hyperinflation of chest places pectoralis major muscle in shortened position and secondary postural deformities develop such as elevated shoulder girdle, protracted and abducted scapulae with medially rotated humerus, increased tightness and stiffness of accessory muscles of respiration, increased work of breathing [12]. The purpose of this study was to enhance chest expansion and facilitate the normal respiratory pattern of breathing, as the patients with COPD more commonly use accessory muscles for breathing which becomes tightened. The study was conducted for a period of 4-week which uses simple exercises and is cost-effective. The results showed significant improvement in Group A which consists of respiratory accessory muscles stretching with co-ordinated breathing exercise in COPD patients over Group B, which consists only of conventional therapy. Lanza Fde et al. demonstrated that chest wall mobility is associated with the lung volume. It shows that greater the respiratory muscle strength increases the lung volume, greater the expansion of both the upper and lower rib cage enhancing the chest wall mobility during inspiration [13]. Results of this study show that stretching enhances the chest expansion by lengthening the accessory respiratory muscles. This study has used exercise regiment which consists of stretching respiratory accessory muscles with coordinated breathing exercise in COPD patients. Once the patient gets accustomed to the exercise in the hospital it requires no equipment at all, is easy to perform, thus making pulmonary rehabilitation cost-effective, which is well suitable for Indian population. The active method of treatment included in this study appears to be safe and effective in chronic respiratory patients. However, this study has provided evidence that hold and relax stretching techniques can improve the restrictive component of COPD and improve chest wall mobility by increasing chest expansion, reduced dyspnea level and increase exercise tolerance level by improving 6 minutes walk distance in patients with COPD in the short-term.