Cahalin Lawrence P, Braga Malinda, Matsuo Yoshimi, Hernandez Edgar D
Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA.
J Cardiopulm Rehabil. 2002 Jan-Feb;22(1):7-21. doi: 10.1097/00008483-200201000-00002.
The evidence base for diaphragmatic breathing (DB) as an adjunctive treatment modality for persons with COPD is questionable. This article reviews the literature regarding the efficacy of DB in persons with chronic obstructive pulmonary disease (COPD), and reports on the beneficial and detrimental effects of DB in persons with COPD. Diaphragmatic breathing has been described as breathing predominantly with the diaphragm while minimizing the action of accessory muscles that may assist with inspiration. No single or combined patient characteristic has been identified consistently to help predict which person with COPD may benefit from DB. However, it has been suggested that persons with moderate to severe COPD and marked hyperinflation of the lungs without adequate diaphragmatic movement and increase in tidal volume during DB may be poor candidates for instruction in DB. Conversely, persons with COPD who have elevated respiratory rates, low tidal volumes that increase during DB, and abnormal arterial blood gases with adequate diaphragmatic movement may benefit from DB. Identification of an abdominal paradoxical breathing pattern and worsening dyspnea and fatigue during or after DB are criteria to modify or terminate DB. Persons with COPD demonstrating an abdominal paradox during DB may benefit from a more upright body position or trunk flexion. Several methods to examine diaphragmatic movement and the potential for success with DB will be discussed. Future research is needed to better identify which patients may benefit from DB.
作为慢性阻塞性肺疾病（COPD）患者辅助治疗方式的膈肌呼吸（DB）的证据基础存在疑问。本文回顾了关于DB对慢性阻塞性肺疾病（COPD）患者疗效的文献，并报告了DB对COPD患者的有益和有害影响。膈肌呼吸被描述为主要通过膈肌呼吸，同时尽量减少可能辅助吸气的辅助肌肉的活动。尚未一致确定单一或综合的患者特征来帮助预测哪些COPD患者可能从DB中获益。然而，有人提出，中重度COPD且肺部明显过度充气、DB期间膈肌运动不足且潮气量增加的患者可能不是DB指导的合适人选。相反，呼吸频率升高、DB期间潮气量增加且膈肌运动充分但动脉血气异常的COPD患者可能从DB中获益。识别腹部矛盾呼吸模式以及DB期间或之后呼吸困难和疲劳加重是修改或终止DB的标准。DB期间表现出腹部矛盾的COPD患者可能从更直立的体位或躯干屈曲中获益。将讨论几种检查膈肌运动和DB成功可能性的方法。需要未来的研究来更好地确定哪些患者可能从DB中获益。
