Respiratory muscle stretch gymnastics (RMSG) and pursed lip breathing exercise (PLB) on increasing forced expiratory volume 1 (FEV1) on patients of chronic obstructive pulmonary disease
Corresponding Author(s) : Bima Aminul Karim
bimaprepito@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 8 No. 3 (2020): 2020 Volume - 8 Issue-3
Abstract
Background
Methods
Result
Conclusion
Lung's inability to carry out its function due to the stiffness of the respiratory muscles that can cause a decrease in Forced Expiratory Volume 1 (FEV1). Respiratory Muscle Stretch Gymnastics (RMSG) and Pursed Lip Breathing Exercise (PLB) can help improve lung function in patients with Chronic Obstructive Pulmonary Disease (COPD). Objective
This study aims to determine the effectiveness of Respiratory Muscle Stretch Gymnastics (RMSG) and Pursed Lip Breathing Exercise (PLB) on the increase in Forced Expiratory Volume 1 (FEV1).
Methods
This research quasi experimental with design was pretest and posttest control group design. Retrieval of data in the Magelang region public health center involving 32 respondents selected through techniques non-probability sampling with method consecutive sampling which is divided into 2 groups. The combination of respiratory muscle structure gymnastic and pursed lips breathing exercise was given to the intervention group, while the control group was only given treatment pursed lip breathing exercise without respiratory muscle stretch gymnastic.
Result
Independent test showed a significant difference with p value 0.014 (<0.05) means that the intervention group is better at increasing Forced Expiratory Volume 1 (FEV1) than the control group with the difference in the intervention group 0.54 higher than the control group 0.16.
Conclusion
Giving a combination of respiratory muscle stretch gymnastic and pursed lips breathing exercise for 4 days with 5 measurements is very effective in increasing Forced Expiratory Volume 1 (FEV1) in patients with Chronic Obstructive Pulmonary Disease (COPD).
Keywords
Respiratory Muscle Stretch Gymnastics (RMSG)
Pursed Lip Breathing Exercise (PLB)
Forced Expiratory Volume 1 (FEV1)
Chronic Obstructive Pulmonary Disease (COPD)
1.
Bima Aminul Karim. Respiratory muscle stretch gymnastics (RMSG) and pursed lip breathing exercise (PLB) on increasing forced expiratory volume 1 (FEV1) on patients of chronic obstructive pulmonary disease . Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 24 [cited 2025 Oct. 11];8(3):547-5. Available from: https://ijamscr.com/ijamscr/article/view/893
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References
-
[1]. GOLD. Global Strategy For The Diagnosis, Management, and Prevention Of Chronic Obstructive Pulmonary Disease. USA: GOLD; 2017.
[2]. WHO. Chronic obstructive pulmonary disease (COPD) USA: World Health Organization (WHO); cited 2019, 2017. Available from: https://www.who.int/respiratory/copd/en/.
[3]. Rhee CK, Chau NQ, Yunus F, Matsunaga K, Perng DW, APSR CAot. Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology. Respirology. 2019.
[4]. RI K. Riset Kesehatan Dasar, Riskesdas. In: RI K, editor. Jakarta: Balitbang; 2013.
[5]. KemenkesRI. Rokok: Akar Masalah Jantung dan Melukai Hati Keluarga. In: Kemenkes R, editor. Jakarta: Biro Komunikasi dan Pelayanan Masyarakat, Kementerian Kesehatan RI; 2018.
[6]. Yatun RU, Widayati N, Purwandari R. Hubungan Nilai Aliran Puncak Ekspirasi (APE) dengan Kualitas Tidur pada Pasien PPOK di Poli Spesialis Paru B Rumah Sakit Paru Jember (Correlation between Peak Expiratory Flow Rate (PEFR) and Sleep Quality of Patient with COPD at B Lung Specialist Unit of. Pustaka Kesehatan. 4(1), 2016, 86-94.
[7]. Tengah DPJ. Profil Kesehatan Provinsi Jawa Tengah Tahun 2016. In: Kesehatan D, editor. Semarang: Dinas Kesehatan; 2016.
[8]. Fasitasari M. Terapi Gizi pada Lanjut Usia dengan Penyakit Paru Obstruktif Kronik (PPOK) Nutrition Therapy in Elderly with Chronic Obstructive Pulmonary Disease (COPD). Sains Medika. 5(1), 2013, 50-61.
[9]. Oemiati R. Kajian epidemiologis penyakit paru obstruktif kronik (PPOK). Media Penelitian dan Pengembangan Kesehatan. 23(2), 2013, 82-8.
[10]. Tuberkulosis P. pedoman diagnosis dan penatalaksanaan di Indonesia. Perhimpunan Dokter Paru Indonesia Jakarta. 2011.
[11]. Hanter MS, Shendy MAEHM. Bioscience Research.
[12]. Hedman L, Katsaounou PA, Filippidis FT, Ravara SB, Lindberg A, Janson C, Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the Eurest-Plus Itc Europe Surveys. Tobacco Induced Diseases. 16, 2018.
[13]. Kusumawardani N, Rahajeng E, Mubasyiroh R, Suhardi S. Hubungan Antara Keterpajanan Asap Rokok Dan Riwayat Penyakit Paru Obstruktif Kronik (PPOK) di Indonesia. Jurnal Ekologi Kesehatan. 15(3), 2017, 160-6.
[14]. Suryadinata RV. Pengaruh Radikal Bebas Terhadap Proses Inflamasi pada Penyakit Paru Obstruktif Kronis (PPOK). Amerta Nutrition. 2(4), 2018, 317-423.
[15]. Yao H, Rahman I. Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease. Toxicology and applied pharmacology. 254(2), 2011, 72-85.
[16]. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. European Respiratory Journal. 53(5), 2019, 1900164.
[17]. Susanti PFE. Influence of Smoking on Chronic Obstructive Pulmonary Disease (COPD). Jurnal Majority. 4(5), 2005.
[18]. Tarigan RB. Pengaruh latihan otot pernapasan terhadap ekspansi dada dan paru pada pasien PPOK di R.S. H. Adam Malik Medan. Depok: Universitas Indonesia; 2008.
[19]. Kurniati ID, Setiawan MR, Rohmani A, Lahdji A, Tajally A, Ratnaningrum K. Buku Ajar: Ilmu Penyakit Dalam. Unimus Press; 2017.
[20]. PDPI. Diagnosis dan Penatalaksanaan Penyakit Paru Obstruktif Kronik. Jakarta: Perhimpunan Dokter Paru Indonesia; 2011.
[21]. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis. 6, 2011, 199-208.
[22]. Joyce Black JH. Keperawatan Medikal Bedah. Singapore: Elsevier; 2014, 2862 .
[23]. Ningsih AD. Pengaruh Kombinasi Home Based Walking Exercise Dan Pursed Lips Breathing Terhadap Forced Expiratory Volume In One Second (Fev1) Dan Dyspnea Pasien PPOK: Univeritas Airlangga; 2018.
[24]. Türkan K, Emine Derya ?. Nursing care for patients with copd on long-term oxygen therapy<p>Uzun süreli oksijen tedavisi alan koah hastalar?nda hem?irelik bak?m?. Journal of Human Sciences. 13(2), 2016.
[25]. Berbiglia VA. Orem’s self-care deficit theory in nursing practice. Nursing Theory-E-Book: Utilization & Application. 222, 2013.
[26]. Suryantoro E, Isworo A, Upoyo AS. Perbedaan Efektivitas Pursed Lips Breathing dengan Six Minutes Walk Test terhadap Forced Expiratory. Jurnal Keperawatan Padjadjaran. 5(2), 2017.
[27]. Agustiyaningsih T. Pengaruh Autogenic Training Dengan Pursed Lips Breathing Terhadap Kecemasan Dan Forced Expiratory Volume In 1 Second (Fev1) Pasien PPOK: Universitas Airlangga; 2018.
[28]. L. Ferracini Cabral ea. Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. eEuropan Journal Of Physical and Rehabilitation Medicine. 51, 2015.
[29]. Fajriah SN, Isnaini Herawati S, Sari YM. Pengaruh Respiratory Muscle Stretch Gymnastics (Rmsg) Terhadap Peningkatan Mobilitas Dinding Dada Pada Penderita Penyakit Paru Obstruksi Kronik (Ppok): Universitas Muhammadiyah Surakarta; 2014.
[30]. Nishigaki Y, Mizuguchi H, Takeda E, Koike T, Ando T, Kawamura K, Development of new measurement system of thoracic excursion with biofeedback: reliability and validity. Journal of neuroengineering and rehabilitation. 10(1), 2013, 45.
[31]. Yunani. effektivitas latihan peregangan otot pernapasan terhaddap penurunan nyeri pada pasien pasca coronary artery bypass grafting di rumah sakit jantung dan pembuluh darah harapan kita jakarta. Depok: Universitas Indonesia; 2008.
[32]. Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Corrigendum to ‘Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review’[J Physiother 62, 2016, 138–144]. Journal of physiotherapy. 64(2), 2018, 73.
[33]. Hetal M, Ashok BP. Respiratory Muscle Stretch Gymnastic In Elderly: Impact on Maximum Breathing Capacity, Peak Expiratory Flow Rate and Exercise Capacity. International Journal of Health Sciences and Research. 10(3), 2020, 145-58.
[34]. Mayer AF, Karloh M, dos Santos K, de Araujo CLP, Gulart AA. Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis. Physiotherapy. 104(1), 2018, 9-17.
[35]. Mendes LP, Moraes KS, Hoffman M, Vieira DS, Ribeiro-Samora GA, Lage SM, Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care. 64(2), 2019, 136-44.
[36]. Ganesh B, Goud A. Short term effects of respiratory muscle stretch gymnastics versus hold relax PNF on pulmonary functions and chest expansion in elderly individuals-a randomized clinical trial. IJAR. 3(7), 2017, 1018-22.
[37]. Conne; AM. Respiratory Muscle Training United Kingdon: Churchil Livingstone; 2018.
[38]. Associaton AL. Exercise and Lung Health USA: National Health Council; updated 2020; cited 2020.
[39]. Bahat G, Tufan A, Ozkaya H, Tufan F, Akpinar TS, Akin S, Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents. The Aging Male. 17(3), 2014, 136-40.
[40]. Borge CR, Hagen KB, Mengshoel AM, Omenaas E, Moum T, Wahl AK. Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC pulmonary medicine. 14(1), 2014, 184.
[41]. Wang Y, Shao W-b, Gao L, Lu J, Gu H, Sun L-h, Abnormal pulmonary function and respiratory muscle strength findings in Chinese patients with Parkinson’s disease and multiple system atrophy–comparison with normal elderly. PLoS One. 9(12), 2014.
[42]. Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, Conceição CS. Effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke: a systematic review with meta-analysis. Archives of physical medicine and rehabilitation. 97(11), 2014, 1994-2001.
[43]. Wada JT, Borges-Santos E, Porras DC, Paisani DM, Cukier A, Lunardi AC, Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial. International journal of chronic obstructive pulmonary disease. 11, 2016, 2691.
[44]. Minoguchi H, Shibuya M, Miyagawa T, Kokubu F, Yamada M, Tanaka H, Respiratory Muscle Conditioning: Stretch Gymnastics of the Respiratory Muscles Respiratory Muscle Conditioning: Stretch Gymnastics of the Respiratory Muscles, 1993. Internal medicine. 41(10), 2002, 805-12.
[45]. Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. Journal of physiotherapy. 62(3), 2016, 138-44.
[46]. Parisien-La Salle S, Rivest EA, Boucher VG, Lalande-Gauthier M, Morisset J, Manganas H, Effects of pursed lip breathing on exercise capacity and dyspnea in patients with interstitial lung disease: a randomized, crossover study. Journal of cardiopulmonary rehabilitation and prevention. 39(2), 2019, 112-7.
References
[1]. GOLD. Global Strategy For The Diagnosis, Management, and Prevention Of Chronic Obstructive Pulmonary Disease. USA: GOLD; 2017.
[2]. WHO. Chronic obstructive pulmonary disease (COPD) USA: World Health Organization (WHO); cited 2019, 2017. Available from: https://www.who.int/respiratory/copd/en/.
[3]. Rhee CK, Chau NQ, Yunus F, Matsunaga K, Perng DW, APSR CAot. Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology. Respirology. 2019.
[4]. RI K. Riset Kesehatan Dasar, Riskesdas. In: RI K, editor. Jakarta: Balitbang; 2013.
[5]. KemenkesRI. Rokok: Akar Masalah Jantung dan Melukai Hati Keluarga. In: Kemenkes R, editor. Jakarta: Biro Komunikasi dan Pelayanan Masyarakat, Kementerian Kesehatan RI; 2018.
[6]. Yatun RU, Widayati N, Purwandari R. Hubungan Nilai Aliran Puncak Ekspirasi (APE) dengan Kualitas Tidur pada Pasien PPOK di Poli Spesialis Paru B Rumah Sakit Paru Jember (Correlation between Peak Expiratory Flow Rate (PEFR) and Sleep Quality of Patient with COPD at B Lung Specialist Unit of. Pustaka Kesehatan. 4(1), 2016, 86-94.
[7]. Tengah DPJ. Profil Kesehatan Provinsi Jawa Tengah Tahun 2016. In: Kesehatan D, editor. Semarang: Dinas Kesehatan; 2016.
[8]. Fasitasari M. Terapi Gizi pada Lanjut Usia dengan Penyakit Paru Obstruktif Kronik (PPOK) Nutrition Therapy in Elderly with Chronic Obstructive Pulmonary Disease (COPD). Sains Medika. 5(1), 2013, 50-61.
[9]. Oemiati R. Kajian epidemiologis penyakit paru obstruktif kronik (PPOK). Media Penelitian dan Pengembangan Kesehatan. 23(2), 2013, 82-8.
[10]. Tuberkulosis P. pedoman diagnosis dan penatalaksanaan di Indonesia. Perhimpunan Dokter Paru Indonesia Jakarta. 2011.
[11]. Hanter MS, Shendy MAEHM. Bioscience Research.
[12]. Hedman L, Katsaounou PA, Filippidis FT, Ravara SB, Lindberg A, Janson C, Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the Eurest-Plus Itc Europe Surveys. Tobacco Induced Diseases. 16, 2018.
[13]. Kusumawardani N, Rahajeng E, Mubasyiroh R, Suhardi S. Hubungan Antara Keterpajanan Asap Rokok Dan Riwayat Penyakit Paru Obstruktif Kronik (PPOK) di Indonesia. Jurnal Ekologi Kesehatan. 15(3), 2017, 160-6.
[14]. Suryadinata RV. Pengaruh Radikal Bebas Terhadap Proses Inflamasi pada Penyakit Paru Obstruktif Kronis (PPOK). Amerta Nutrition. 2(4), 2018, 317-423.
[15]. Yao H, Rahman I. Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease. Toxicology and applied pharmacology. 254(2), 2011, 72-85.
[16]. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. European Respiratory Journal. 53(5), 2019, 1900164.
[17]. Susanti PFE. Influence of Smoking on Chronic Obstructive Pulmonary Disease (COPD). Jurnal Majority. 4(5), 2005.
[18]. Tarigan RB. Pengaruh latihan otot pernapasan terhadap ekspansi dada dan paru pada pasien PPOK di R.S. H. Adam Malik Medan. Depok: Universitas Indonesia; 2008.
[19]. Kurniati ID, Setiawan MR, Rohmani A, Lahdji A, Tajally A, Ratnaningrum K. Buku Ajar: Ilmu Penyakit Dalam. Unimus Press; 2017.
[20]. PDPI. Diagnosis dan Penatalaksanaan Penyakit Paru Obstruktif Kronik. Jakarta: Perhimpunan Dokter Paru Indonesia; 2011.
[21]. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis. 6, 2011, 199-208.
[22]. Joyce Black JH. Keperawatan Medikal Bedah. Singapore: Elsevier; 2014, 2862 .
[23]. Ningsih AD. Pengaruh Kombinasi Home Based Walking Exercise Dan Pursed Lips Breathing Terhadap Forced Expiratory Volume In One Second (Fev1) Dan Dyspnea Pasien PPOK: Univeritas Airlangga; 2018.
[24]. Türkan K, Emine Derya ?. Nursing care for patients with copd on long-term oxygen therapy<p>Uzun süreli oksijen tedavisi alan koah hastalar?nda hem?irelik bak?m?. Journal of Human Sciences. 13(2), 2016.
[25]. Berbiglia VA. Orem’s self-care deficit theory in nursing practice. Nursing Theory-E-Book: Utilization & Application. 222, 2013.
[26]. Suryantoro E, Isworo A, Upoyo AS. Perbedaan Efektivitas Pursed Lips Breathing dengan Six Minutes Walk Test terhadap Forced Expiratory. Jurnal Keperawatan Padjadjaran. 5(2), 2017.
[27]. Agustiyaningsih T. Pengaruh Autogenic Training Dengan Pursed Lips Breathing Terhadap Kecemasan Dan Forced Expiratory Volume In 1 Second (Fev1) Pasien PPOK: Universitas Airlangga; 2018.
[28]. L. Ferracini Cabral ea. Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. eEuropan Journal Of Physical and Rehabilitation Medicine. 51, 2015.
[29]. Fajriah SN, Isnaini Herawati S, Sari YM. Pengaruh Respiratory Muscle Stretch Gymnastics (Rmsg) Terhadap Peningkatan Mobilitas Dinding Dada Pada Penderita Penyakit Paru Obstruksi Kronik (Ppok): Universitas Muhammadiyah Surakarta; 2014.
[30]. Nishigaki Y, Mizuguchi H, Takeda E, Koike T, Ando T, Kawamura K, Development of new measurement system of thoracic excursion with biofeedback: reliability and validity. Journal of neuroengineering and rehabilitation. 10(1), 2013, 45.
[31]. Yunani. effektivitas latihan peregangan otot pernapasan terhaddap penurunan nyeri pada pasien pasca coronary artery bypass grafting di rumah sakit jantung dan pembuluh darah harapan kita jakarta. Depok: Universitas Indonesia; 2008.
[32]. Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Corrigendum to ‘Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review’[J Physiother 62, 2016, 138–144]. Journal of physiotherapy. 64(2), 2018, 73.
[33]. Hetal M, Ashok BP. Respiratory Muscle Stretch Gymnastic In Elderly: Impact on Maximum Breathing Capacity, Peak Expiratory Flow Rate and Exercise Capacity. International Journal of Health Sciences and Research. 10(3), 2020, 145-58.
[34]. Mayer AF, Karloh M, dos Santos K, de Araujo CLP, Gulart AA. Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis. Physiotherapy. 104(1), 2018, 9-17.
[35]. Mendes LP, Moraes KS, Hoffman M, Vieira DS, Ribeiro-Samora GA, Lage SM, Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care. 64(2), 2019, 136-44.
[36]. Ganesh B, Goud A. Short term effects of respiratory muscle stretch gymnastics versus hold relax PNF on pulmonary functions and chest expansion in elderly individuals-a randomized clinical trial. IJAR. 3(7), 2017, 1018-22.
[37]. Conne; AM. Respiratory Muscle Training United Kingdon: Churchil Livingstone; 2018.
[38]. Associaton AL. Exercise and Lung Health USA: National Health Council; updated 2020; cited 2020.
[39]. Bahat G, Tufan A, Ozkaya H, Tufan F, Akpinar TS, Akin S, Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents. The Aging Male. 17(3), 2014, 136-40.
[40]. Borge CR, Hagen KB, Mengshoel AM, Omenaas E, Moum T, Wahl AK. Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC pulmonary medicine. 14(1), 2014, 184.
[41]. Wang Y, Shao W-b, Gao L, Lu J, Gu H, Sun L-h, Abnormal pulmonary function and respiratory muscle strength findings in Chinese patients with Parkinson’s disease and multiple system atrophy–comparison with normal elderly. PLoS One. 9(12), 2014.
[42]. Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, Conceição CS. Effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke: a systematic review with meta-analysis. Archives of physical medicine and rehabilitation. 97(11), 2014, 1994-2001.
[43]. Wada JT, Borges-Santos E, Porras DC, Paisani DM, Cukier A, Lunardi AC, Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial. International journal of chronic obstructive pulmonary disease. 11, 2016, 2691.
[44]. Minoguchi H, Shibuya M, Miyagawa T, Kokubu F, Yamada M, Tanaka H, Respiratory Muscle Conditioning: Stretch Gymnastics of the Respiratory Muscles Respiratory Muscle Conditioning: Stretch Gymnastics of the Respiratory Muscles, 1993. Internal medicine. 41(10), 2002, 805-12.
[45]. Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. Journal of physiotherapy. 62(3), 2016, 138-44.
[46]. Parisien-La Salle S, Rivest EA, Boucher VG, Lalande-Gauthier M, Morisset J, Manganas H, Effects of pursed lip breathing on exercise capacity and dyspnea in patients with interstitial lung disease: a randomized, crossover study. Journal of cardiopulmonary rehabilitation and prevention. 39(2), 2019, 112-7.
[2]. WHO. Chronic obstructive pulmonary disease (COPD) USA: World Health Organization (WHO); cited 2019, 2017. Available from: https://www.who.int/respiratory/copd/en/.
[3]. Rhee CK, Chau NQ, Yunus F, Matsunaga K, Perng DW, APSR CAot. Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology. Respirology. 2019.
[4]. RI K. Riset Kesehatan Dasar, Riskesdas. In: RI K, editor. Jakarta: Balitbang; 2013.
[5]. KemenkesRI. Rokok: Akar Masalah Jantung dan Melukai Hati Keluarga. In: Kemenkes R, editor. Jakarta: Biro Komunikasi dan Pelayanan Masyarakat, Kementerian Kesehatan RI; 2018.
[6]. Yatun RU, Widayati N, Purwandari R. Hubungan Nilai Aliran Puncak Ekspirasi (APE) dengan Kualitas Tidur pada Pasien PPOK di Poli Spesialis Paru B Rumah Sakit Paru Jember (Correlation between Peak Expiratory Flow Rate (PEFR) and Sleep Quality of Patient with COPD at B Lung Specialist Unit of. Pustaka Kesehatan. 4(1), 2016, 86-94.
[7]. Tengah DPJ. Profil Kesehatan Provinsi Jawa Tengah Tahun 2016. In: Kesehatan D, editor. Semarang: Dinas Kesehatan; 2016.
[8]. Fasitasari M. Terapi Gizi pada Lanjut Usia dengan Penyakit Paru Obstruktif Kronik (PPOK) Nutrition Therapy in Elderly with Chronic Obstructive Pulmonary Disease (COPD). Sains Medika. 5(1), 2013, 50-61.
[9]. Oemiati R. Kajian epidemiologis penyakit paru obstruktif kronik (PPOK). Media Penelitian dan Pengembangan Kesehatan. 23(2), 2013, 82-8.
[10]. Tuberkulosis P. pedoman diagnosis dan penatalaksanaan di Indonesia. Perhimpunan Dokter Paru Indonesia Jakarta. 2011.
[11]. Hanter MS, Shendy MAEHM. Bioscience Research.
[12]. Hedman L, Katsaounou PA, Filippidis FT, Ravara SB, Lindberg A, Janson C, Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the Eurest-Plus Itc Europe Surveys. Tobacco Induced Diseases. 16, 2018.
[13]. Kusumawardani N, Rahajeng E, Mubasyiroh R, Suhardi S. Hubungan Antara Keterpajanan Asap Rokok Dan Riwayat Penyakit Paru Obstruktif Kronik (PPOK) di Indonesia. Jurnal Ekologi Kesehatan. 15(3), 2017, 160-6.
[14]. Suryadinata RV. Pengaruh Radikal Bebas Terhadap Proses Inflamasi pada Penyakit Paru Obstruktif Kronis (PPOK). Amerta Nutrition. 2(4), 2018, 317-423.
[15]. Yao H, Rahman I. Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease. Toxicology and applied pharmacology. 254(2), 2011, 72-85.
[16]. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. European Respiratory Journal. 53(5), 2019, 1900164.
[17]. Susanti PFE. Influence of Smoking on Chronic Obstructive Pulmonary Disease (COPD). Jurnal Majority. 4(5), 2005.
[18]. Tarigan RB. Pengaruh latihan otot pernapasan terhadap ekspansi dada dan paru pada pasien PPOK di R.S. H. Adam Malik Medan. Depok: Universitas Indonesia; 2008.
[19]. Kurniati ID, Setiawan MR, Rohmani A, Lahdji A, Tajally A, Ratnaningrum K. Buku Ajar: Ilmu Penyakit Dalam. Unimus Press; 2017.
[20]. PDPI. Diagnosis dan Penatalaksanaan Penyakit Paru Obstruktif Kronik. Jakarta: Perhimpunan Dokter Paru Indonesia; 2011.
[21]. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis. 6, 2011, 199-208.
[22]. Joyce Black JH. Keperawatan Medikal Bedah. Singapore: Elsevier; 2014, 2862 .
[23]. Ningsih AD. Pengaruh Kombinasi Home Based Walking Exercise Dan Pursed Lips Breathing Terhadap Forced Expiratory Volume In One Second (Fev1) Dan Dyspnea Pasien PPOK: Univeritas Airlangga; 2018.
[24]. Türkan K, Emine Derya ?. Nursing care for patients with copd on long-term oxygen therapy<p>Uzun süreli oksijen tedavisi alan koah hastalar?nda hem?irelik bak?m?. Journal of Human Sciences. 13(2), 2016.
[25]. Berbiglia VA. Orem’s self-care deficit theory in nursing practice. Nursing Theory-E-Book: Utilization & Application. 222, 2013.
[26]. Suryantoro E, Isworo A, Upoyo AS. Perbedaan Efektivitas Pursed Lips Breathing dengan Six Minutes Walk Test terhadap Forced Expiratory. Jurnal Keperawatan Padjadjaran. 5(2), 2017.
[27]. Agustiyaningsih T. Pengaruh Autogenic Training Dengan Pursed Lips Breathing Terhadap Kecemasan Dan Forced Expiratory Volume In 1 Second (Fev1) Pasien PPOK: Universitas Airlangga; 2018.
[28]. L. Ferracini Cabral ea. Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. eEuropan Journal Of Physical and Rehabilitation Medicine. 51, 2015.
[29]. Fajriah SN, Isnaini Herawati S, Sari YM. Pengaruh Respiratory Muscle Stretch Gymnastics (Rmsg) Terhadap Peningkatan Mobilitas Dinding Dada Pada Penderita Penyakit Paru Obstruksi Kronik (Ppok): Universitas Muhammadiyah Surakarta; 2014.
[30]. Nishigaki Y, Mizuguchi H, Takeda E, Koike T, Ando T, Kawamura K, Development of new measurement system of thoracic excursion with biofeedback: reliability and validity. Journal of neuroengineering and rehabilitation. 10(1), 2013, 45.
[31]. Yunani. effektivitas latihan peregangan otot pernapasan terhaddap penurunan nyeri pada pasien pasca coronary artery bypass grafting di rumah sakit jantung dan pembuluh darah harapan kita jakarta. Depok: Universitas Indonesia; 2008.
[32]. Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Corrigendum to ‘Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review’[J Physiother 62, 2016, 138–144]. Journal of physiotherapy. 64(2), 2018, 73.
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