A Study to Assess the Effectiveness of Balloon Therapy on Improving Breathing Capacity Among Patient with Chronic Obstructive Pulmonary Disease at Government Head Quarters Hospital, Cuddalore
P. Sathiyavathy1, D. Muthukumaran2, D. Moganaraman3, Pazhaniandavar4, Manishkumar4
1Principal, PKB College of Nursing, Puducherry, Tamil Nadu, India.
2Associate Professor, PKB College of Nursing, Puducherry, Tamil Nadu, India.
3Nursing tutor, PKB College of Nursing, Puducherry, Tamil Nadu, India.
4Final Year Students, PKB College of Nursing, Puducherry, Tamil Nadu, India.
*Corresponding Author E-mail: muthusep0909@gmail.com
ABSTRACT:
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airway, pulmonary parenchyma or both. The aim of the study is to assess the effectiveness of balloon therapy on patient affected with Chronic obstructive pulmonary disease. A quasi-experimental research approach was selected with pre test post test control group research design. Using the purposive sampling technique 60 patients with chronic obstructive pulmonary disease was selected at Government Headquarters hospital, Cuddalore. The demographic variable is collected using a structured questionnaire and the Observation technique, Modified Borg’s Dyspnea scale and Incentive spirometry was used to assess the respiratory rate, level of dyspnea and lung capacity respectively. 2-3 patients were selected daily and the total population was divided into experimental and control groups with 30 populations each. Along with the structured questionnaire and the Observation technique, Modified Borg’s Dyspnea scale and Incentive spirometry the ballon therapy was implemented using 90/90 Hemi Bridge with ball and balloon position for 10-15 minutes three times a day before meal for 5 Consecutive days which has been withdrawn for the control group. The post test was conducted on 7th day after the administration of the ballon therapy. The data were analyzed using descriptive and inferential statistics. The paired t test showed highly significant (t=8.32) for respiratory rate, level of dyspnea (t=9.45) and lung capacity (t=10.15). The change was statistically significant with a p-value of 0.001. This suggests the intervention was effective in improving respiratory rate. Hence hypothesis H1 is accepted. In experimental group, there was significant association found between the pre test respiratory rate and demographic variables in smoking habit (χ2=6.75) and in Control group there was significant association found between demographic variables and pre test in family history of COPD (χ2=4.39). Hence hypothesis 2 is accepted.
KEYWORDS: Chronic Obstructive Pulmonary Disease, Balloon therapy, Respiratory status, Dyspnea, Lung capacity, Quality of life.
INTRODUCTION:
Respiration is the mechanism whereby air flows between the atmosphere and the alveoli of the lungs. Normal respiratory rate for adult is about 20 breaths per minute which is controlled by respiratory pacemaker, medulla oblongata. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airway, pulmonary parenchyma or both. The airflow limitation or obstruction in COPD is not fully reversible most patients with COPD present with overlapping signs and symptoms of emphysema and chronic bronchitis. Smoke, atmosphere and industrial pollutants these are bronchial irritants and include cigarette smoke, dust, fumes and smoke from the industries and vehicles these occur as occupational hazards or as a part of atmospheric pollution in industrial cities these impair protective mucosal barrier and lead to hypertrophy and hyperplasia of mucous secreting glands.1
NEED FOR THE STUDY:
According to WHO Chronic obstructive pulmonary disease is the fourth leading cause of death globally causing 3.5 million deaths in 2021. It affects around 30 million people and results in about 64 million disability adjusted life years. The global prevalence of COPD was 10.3% in 2019 accounting for 391.9 million cases among people aged 30-79 most cases are in low income and middle-income countries accounting for 80.5%.2
According to national center for biotechnology information the prevalence of chronic obstructive pulmonary disease (COPD) in Tamil Nadu in 2023 is 22.1% with 39.2 % of men and 12.2 % of women experiencing COPD. The prevalence of COPD increases with age, sex, low BMI, illiteracy, smoking and inadequate ventilation.3
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of balloon therapy on improving breathing capacity among patient with chronic obstructive pulmonary disease at Government Head Quarters Hospital, Cuddalore.
OBJECTIVES:
1. To assess the respiratory rate, level of dyspnea and lung capacity among patients with chronic obstructive pulmonary disease.
2. To evaluate the effectiveness of balloon therapy among the patient with chronic obstructive pulmonary disease in experimental group.
3. To associate the level of balloon therapy among chronic obstructive pulmonary disease patient with the selected demographic variable among the control group and experimental group.
OPERATIONAL DEFINITION:
Effectiveness:
It refered as significant improvement of breathing capacity after giving balloon therapy. It is measured by spirometry a common test used to assess breathing capacity.
Balloon Therapy:
In this study, it refers to simple exercise of blowing up of balloon, for 10-15 minutes in 90/90 bridge with ball and balloon position, which helps to maintain the Zone of apposition by inhaling slowly through the nose and exhale forcefully about through purse lip with a period of pause, until the size of balloon reaches diameter of 7inches, 3 times per day before the meal for 5 consecutive days.
Breathing Capacity:
It refers to the maximum amount of air the lungs can hold after a maximum inhalation.
Patients With Chronic Obstructive Pulmonary Disease:
In this study, it refers to patients who are diagnosed as chronic obstructive pulmonary disease.
Assumptions:
· The patients with chronic obstructive pulmonary disease may have dyspnea.
· The patients with chronic obstructive pulmonary disease may have decreased lung capacity.
· Balloon blowing exercise may have positive impact on respiratory status; thereby it may improve the quality of life.
· Balloon blowing exercise may slow down the exhalation phase of respiration which is helpful for decreasing shortness of breath.
· Respiratory rate, level of dyspnea and lung capacity of patients with chronic obstructive pulmonary disease will be influenced by selected demographic variables.
HYPOTHESIS:
H1: There is significant association between balloon therapies on improving breathing capacity among the patients with chronic obstructive pulmonary disease.
H2: There will be a significant association between pre-test score of Respiratory status among patients with chronic obstructive pulmonary Disease and their selected demographic variables and clinical variables in experimental and Control group.
Delimitations:
1. The study was delimited to patients who are all having chronic obstructive pulmonary disease.
2. The study was delimited to Government Head Quarters hospital Cuddalore.
3. The study was delimited to a data collection period of 2 weeks.
4. The study was delimited to 60 samples.
METHODOLOGY:
Research Approach:
Quantitative research approach was used for the present study.
Research Design:
The research design adopted for the study was Quasi experimental with pre test post test control group research design.
Research Variables:
Independent Variables: Balloon therapy.
Dependednt Variables: Respiratory rate, Level of dyspnea, Lung capacity.
Setting of The Study:
The study was conducted in Government headquarters hospital, Cuddalore.
Population:
The population of the study was patients admitted in Government general hospital, Cuddalore.
Sample:
The sample was patients who are admitted in the wards of a minimum of 5 days with the diagnosis of COPD, stage - I & II
Sample Size:
The sample size was 60 patients.
Sampling Techniques:
A non-probability purposive sampling technique was adopted for the study.
Sampling Criteria:
Inclusion Criteria:
· Admitted in wards for a minimum of 5 days
· Diagnosed with stage I and II COPD as defined by GOLD
· With dyspnea score ≤ 4
· Who knows to read and write Tamil, English
· Between the age of 35 - 75 years
Exclusion Criteria:
· Critically ill and diagnosed as COPD exacerbation
· Unable to follow the instructions. e.g. deaf and dumb, psychiatric patients and blind patients
· Cardiac co- morbid illness
· Not willing to participate
· Underwent lung surgery
· Who have oral lesions
Tools:
· A structured questionnaire on demographic variables
· Modified Borg’s dyspnea scale was used to measure
· Incentive spirometer was used to measure lung capacity
Data Collection Procedure:
After obtaining formal permission from the District Medical Officer, Government Headquarters Hospital, Cuddalore (August 2024), informed consent was obtained from all participants. A total of 60 patients diagnosed with COPD Stage I and II were selected using a non-probability purposive sampling technique, with 30 patients allocated to the experimental group and 30 to the control group. Pre-test assessment of respiratory rate, dyspnea level, and lung capacity was conducted on day one for both groups using observational technique, Modified Borg’s Dyspnea Scale, and incentive spirometry. The experimental group received balloon blowing exercise using a commercially available balloon in the 90/90 hemi-bridge position with ball and balloon, performed three times daily for 10–15 minutes over five consecutive days, while the control group received routine care only. Post-test assessment was carried out on the fifth day using the same tools for both groups.
RESULTS:
At baseline, there were no statistically significant differences between the experimental and control groups in respiratory rate (26.4±2.5 vs. 25.8±2.2; t = 0.68, p = 0.50), level of dyspnea (3.2±0.6 vs. 3.1±0.5; t = 0.47, p = 0.64), or lung capacity (720±88 vs. 735±90; t = −0.47, p = 0.64), indicating comparable baseline characteristics. Following the intervention, the experimental group demonstrated a significant reduction in respiratory rate (20.2±1.8) compared to the control group (25.5±2.0; t = −11.94, p<0.001) and a marked decrease in dyspnea level (1.1±0.4 vs. 3.0±0.6; t = −12.98, p<0.001). Additionally, lung capacity significantly improved in the experimental group (1060±92) compared to the control group (745±95; t = 14.74, p<0.001), demonstrating the effectiveness of the balloon blowing exercise in improving respiratory outcomes among patients with COPD.
Table 1 Mean, Standard deviations, Mean difference and unpaired ’t’ test values on respiratory status in between experimental group and control group.
|
Group |
Variable |
Experimental Mean±SD |
Control Mean ± SD |
Mean Difference |
Unpaired t-test |
df |
p- value |
|
Pretest |
Respiratory Rate |
26.4 ± 2.5 |
25.8 ±2.2 |
0.6 |
0.68 |
58 |
0.50 |
|
Pretest |
Level of Dyspnea |
3.2 ± 0.6 |
3.1 ± 0.5 |
0.1 |
0.47 |
58 |
0.64 |
|
Pretest |
Lung Capacity |
720 ± 88 |
735 ± 90 |
-15 |
-0.47 |
58 |
0.64 |
|
Posttest |
Respiratory Rate |
20.2 ± 1.8 |
25.5 ± 2.0 |
-5.3 |
-11.94 |
58 |
<0.001 |
|
Posttest |
Level of Dyspnea |
1.1 ± 0.4 |
3.0 ± 0.6 |
-1.9 |
-12.98 |
58 |
<0.001 |
|
Posttest |
Lung Capacity |
1060 ± 92 |
745 ± 95 |
315 |
14.74 |
58 |
<0.001 |
In the experimental group, no significant association was found between demographic variables and pre-test respiratory rate, as all p-values were greater than 0.05, indicating that age, gender, education, and other demographic factors did not influence baseline respiratory rate; most participants had a respiratory rate between 25–30bpm. Similarly, in the control group, there was no statistically significant association between demographic variables and pre-test respiratory rate (p > 0.05), despite a higher proportion of participants aged 55–65 years falling within the 25–30bpm range. However, in the experimental group, a significant association was observed between pre-test lung capacity and selected demographic and clinical variables, including age (χ² = 32.1), gender (χ² = 27.9), BMI (χ² = 31.6), family history of COPD (χ² = 28.7), history of smoking (χ² = 25.2), and regular exercise practices (χ² = 29.6), while no association was found with education, occupation, comorbid illness, or area of work; therefore, hypothesis H2 was accepted for the associated variables and rejected for the remaining variables in the experimental group.
DISCUSSION:
The first objective was to assess the respiratory rate, level of dyspnea, and lung capacity among patients with chronic obstructive pulmonary disease. In the experimental group, most patients had a respiratory rate of 25–30 breaths per minute, mild to moderate dyspnea, and lung capacity between 600 and 900cc/min during the pre-test. After the intervention, the majority showed improvement with reduced respiratory rate (20–25 breaths per minute), very mild dyspnea, and increased lung capacity, with many reaching 1200cc/min. In the control group, there were no noticeable changes in respiratory rate, dyspnea level, or lung capacity between the pre-test and post-test.
The second objective was to evaluate the effectiveness of balloon blowing exercise on respiratory status among patients with chronic obstructive pulmonary disease. In the experimental group, the mean respiratory rate reduced significantly from 26.4±2.5 in the pre-test to 20.2±1.8 in the post-test. The mean dyspnea score also decreased from 3.2±0.6 to 1.1±0.4, while lung capacity improved from 7.20±8.8 to 10.60±9.2. These changes were statistically significant (p<0.001), showing that balloon blowing exercise was effective. No significant improvement was observed in the control group.
The third objective was to find the association between pre-test respiratory status and selected demographic variables. There was no significant association between pre-test respiratory rate and demographic variables in both groups. However, in the experimental group, lung capacity showed a significant association with age, gender, BMI, family history of COPD, smoking history, and regular exercise practices, while no association was found with education, occupation, comorbid illness, or area of work.
CONCLUSION:
The balloon therapy was effective in proving the respiratory status of patients with COPD. There was significant association found between respiratory statuses of patients with COPD. There was significant association found between respiratory rate and age, gender, occupational status, area of working, comorbid illness, and regular exercise in Experimental group.
IMPLICATION:
The findings of the study have practical application in the field of nursing. The implication of the study could be discussed in four areas namely: Nursing practice, Nursing administration, Nursing education and Nursing research.
CONFLICT OF INTEREST:
The authors have declared that no competing interests exist.
REFERENCE:
1. Brunner and Suddharth’s (2011) textbook of Medical Surgical Nursing, Philadelphia: Lippincott Publication (1th edition)
2. World Health Organization. Chronic Obstructive Pulmonary Disease (COPD). Geneva: World Health Organization; 2023.
3. National Center for Biotechnology Information. Prevalence and risk factors of chronic obstructive pulmonary disease in Tamil Nadu, India. Bethesda (MD): National Library of Medicine; 2023
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Received on 02.03.2026 Revised on 28.03.2026 Accepted on 21.04.2026 Published on 05.05.2026 Available online from May 09, 2026 A and V Pub Int. J. of Nursing and Med. Res. 2026; 5(2):63-66. DOI: 10.52711/ijnmr.2026.14 ©A and V Publications All right reserved
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