Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1104

Bhramari Pranayama and Thoracic Mobility

Exercises for Moderate Chronic Obstructive
Pulmonary Disease (COPD): A Case Study
N Mageswaran1 Supritha Rao2
Principal BPT Intern, KVG Institute of Physiotherapy,
Aditya College of Physiotherapy, Sullia, Dakshina Kannada, India
Bangalore, India

Syamala Maheshwari3
Lecturer
Aditya College of Physiotherapy,
Bangalore, India

Abstract:- Chronic obstructive pulmonary disease approximately 41.9 deaths per 100000 individuals (5.7% of
(COPD) is a global health issue and a significant cause of total all-cause deaths). [3]
morbidity, disability, and mortality due to persistent
respiratory symptoms and airflow limitations. COPD is The risk factors for COPD are tobacco smoking,
diagnosed through pulmonary function testing, occupational exposures, air pollution, genetic factors, age,
particularly spirometry, which measures the post gender, lung growth and development, low socio-economic
bronchodilator FEV1/FVC ratio. The purpose of this status, respiratory infections, asthma and airway hyper-
study was to determine the effectiveness of Bhramari reactivity. The symptoms are dyspnea, chronic cough,
pranayama combined with thoracic mobility exercises on sputum production, wheezing, chest tightness, fatigue,
increasing exercise/activity tolerance in patient with weight loss, pedal edema (due to cor pulmonale), depression
moderate COPD. This case study is about a 60-year-old and anxiety. [4]
male with COPD who presented with breathlessness,
cough, and mMRC grade 2 dyspnoea. His FEV1 was COPD is typically identified based on symptoms and
58%, FVC was 75%, and FEV1/FVC (post associated risk factors. Pulmonary Function Testing (PFT) is
bronchodilator) was 63%. The patient was given utilized to diagnose, stage, and monitor the condition. This
Bhramari pranayama and thoracic mobility exercise for includes spirometry, laboratory testing, 6-minute walk tests,
a period of 4 days. After 4 days, there was improvement imaging of the lungs through radiography, oxygenation tests
in dyspnoea severity, exercise capacity, thoracic such as pulse oximetry or arterial blood gas analysis.
expansion, FEV1, FVC, FEV1/FVC, and CAT Diagnosing COPD is specifically done through spirometry,
questionnaire score. Hence, we concluded that Bhramari where the post bronchodilator FEV1/FVC must be less than
Pranayama and thoracic mobility exercises are effective 0.7 for the diagnosis to be established. [5]
in increasing exercise/activity tolerance in patient with
moderate COPD. Pranayama is generally a technique of prolongation
and control of breath. Prana means 'vital energy' or 'life
Keywords:- Bhramari Pranayama, Thoracic Mobility force’ and Ayama means 'extension' or 'expansion' in
Exercises, COPD, Case Study. Sanskrit. Bhramari is a type of pranayama. It is simple and
can be practiced by everyone irrespective of their age or
I. INTRODUCTION gender. To practice Bhramari pranayama, the practitioner
should sit in a comfortable pose and take slow, deep breaths
Davidson’s principles and practices of medicine through the nostrils. Upon exhaling, they must produce a
defines Chronic Obstructive Pulmonary Disease (COPD) as humming sound similar to that of a bumble bee with the lips
a preventable and treatable disease characterized by closed and ears blocked by fingers. [6]
persistent respiratory symptoms and airflow limitation that
is due to airway and/or alveolar abnormalities, usually Patients with COPD frequently experience dyspnea
caused by significant exposure to noxious particles or during normal daily activities when they use their upper
gases.[1] COPD is one of the important causes of morbidity, extremities. Furthermore, since the muscles responsible for
disability and mortality around the globe with a high arm movements and trunk stabilization are connected to the
prevalence (approximately 10%) in the population aged rib cage, this increases chest wall resistance, thereby
between 30-79 years. [2] The 2017 Global Burden of Disease limiting one's ability to increase tidal volume during arm
(GBD) study estimates that the global mortality of COPD is activities. Thoracic mobility exercises including active upper

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1104

limb exercises are effective in reducing dyspnea and  Palpation

improving lung function, functional capacities and quality of
life in patients with COPD.[7,8]  All findings from inspection were confirmed.
 Trachea- Centrally placed.
II. CASE DESCRIPTION  Movements of chest- Reduced bilaterally.
 Tactile fremitus- Normal and equivocal.
A. Subjective assessment  Thoracic expansion measurement difference during
inspiration and expiration-
 Chief Complaints-
A 60- year old male with the history of COPD  Axillary level- 1.5cm
presented with the complaints of breathlessness, cough with  Nipple level-1cm
difficulty in expelling the phlegm and easy fatigability.  Xiphoid level-1cm

 History of Present Illness –  Auscultation

Patient was said to be apparently normal 4 years ago,
then he developed dyspnoea, which was insidious in onset,  Breath sounds- Decreased intensity of breath sounds.
gradually progressive in nature, initially of Grade 1  Vocal fremitus -Normal and equivocal
Modified Medical Research Council (mMRC) progressed to
Grade 2 mMRC in past 2 years. Dyspnoea aggravates on C. Investigations
walking, stair climbing and going slight uphill, relieves on
taking medications, no seasonal variations and no diurnal  Chest X-ray –
changes. The patient had COPD Assessment Test(CAT)
score of 25. Patient had cough since 4 years which was  Lung hyper inflation
insidious in onset, gradually progressive in nature and  Flattened hemi-diaphragms
associated with expectorations (scanty, whitish and mucoid
consistency). Patient had easy fatigability which was  PFT(Spirometry)-
insidious in onset, gradually progressive, aggravates during
exacerbation and relieves by taking rest. The patient was  FEV1- 58%
thus admitted to the KVG Medical College and Hospital's  FVC- 75%
inpatient unit of the respiratory medicine and was referred  FEV1/FVC (post bronchodilator)- 63%
for physiotherapy.
III. INTERVENTION
B. Objective Assessment
The patient undertook a course of physiotherapy
 Physical Examination
treatment consisting of Bhramari pranayama and thoracic
mobility exercises for a period of 4 days.
 Initial Physical Exam-
Temperature 97.5°F, heart rate 80bpm, SpO2 98% on  Bhramari Pranayama
room air, respiratory rate 21 breaths/min, BP 130/80mmHg,
height 169cm, weight 60kg, BMI 21kg/m2.Patient was  Frequency- 3 times/day
pallor. No icterus, cyanosis, clubbing, lymphadenopathy or
 Time-15 minutes
edema.
 Type- Breathing exercise
 Constitutional-
 Thoracic Mobility Exercises
Moderately built, well nourished, conscious, co-
operative, well oriented to time, place and person.
 Frequency-3 times/day
 Systemic Examination  Intensity- According to patient’s tolerance level
 Time-15 minutes
 CVS- S1 and S2 heard, no murmur.  Type-Range of motion exercise
 CNS- No focal neurological deficit.  Along with physiotherapy, the patient also received
bronchodilators and mucolytics.
 Respiratory System-

 Inspection

 Shape of chest – Barrel

 Trachea- Appears to be placed centrally
 Movements of chest- Reduced bilaterally
 Accessory muscle usage- Not seen

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1104

Fig 1 Patient Performing Bhramari Pranayama Fig 2 Patient Performing Thoracic Mobility Exercise

IV. RESULTS

Table 1 Results
Outcome measures Values
Pre treatment Post treatment
mMRC Grade 2 Grade 1
CAT questionnaire 25 11
6 minute walk distance( The predicted value was from 411m to 563.5m for the patient) 405m 420m
PFT(spirometry)
FEV1 58% 64%
FVC 75% 79%
FEV1/FVC 63% 75%
Thoracic expansion measurement difference
Axillary level 1.5cm 1.8cm
Nipple level 1cm 1.4cm
Xiphoid level 1cm 1.6cm

V. DISCUSSION the effect of Yoga breathing (Pranayama) on exercise

tolerance in patients with COPD. They concluded that
This study aimed to determine the effectiveness of pranayama was associated with improved exercise tolerance
Bhramari pranayama combined and thoracic mobility in patients with COPD and may have significant clinical
exercises on increasing exercise/activity tolerance in patient benefits for symptomatic patients with COPD. [13]
with moderate COPD. A significant reduction was observed
in dyspnoea after the treatment in the patient. The exercise The muscles of the upper ribcage and shoulder girdle,
tolerance improved on the other side. which are responsible for respiratory and postural functions,
have thoracic and extra thoracic attachment points. Any
During the pranayama, the lung inflates to the exercise that affects shoulder or trunk will mobilize the
maximum, stimulating pulmonary stretch receptors. The chest. [14] Upper extremity muscular training enhances the
stretch receptors reduce the tracheobronchial smooth muscle strength of the inspiratory muscles and improves ADL
tone, resulting in decreased airway resistance and improved performance in patients with COPD. It also decreases
pulmonary function. [9] A study done by Jaysheela H states fatigue and dyspnea perception during ADL. [15,16] The
that Bhramari pranayama is effective in minimizing thoracic mobility exercises address both the structural and
dyspnoea in COPD patients and improving their pulmonary functional aspects of respiratory health, promoting optimal
functions. [10] The controlled breath and vibrational hum lung mechanics, enhancing endurance, and improving
contribute to strengthening of respiratory muscles. The overall quality of life for individuals navigating the
resonance created during humming sound stimulates the complexities of COPD.
vagus nerve, which raises vagal tone and activates the
parasympathetic nervous system. Thus, promoting relaxation This study has limitations, the subject received
and influencing respiratory regulation. [11,12] Kaminsky DA bronchodilators and mucolytics. This might also have had an
et al. (2017) at Vermont and Texas, USA, conducted a impact on dilating the bronco tubes, loosening the secretions
randomized double-blind, controlled pilot trial to find out and expelling the phlegm. The study was conducted only for

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1104

4 days and the long term effects were not analyzed. So, [4]. GOLD. Global initiative for chronic obstructive lung
further study with large population size is recommended to disease global strategy for the diagnosis,
evaluate the effectiveness of Bhramari Pranayama combined management, and prevention of chronic obstructive
and thoracic mobility exercises on increasing pulmonary disease 2023 report[Internet].2023.
exercise/activity tolerance in patient with moderate COPD. Available from: https://goldcopd.org .
[5]. Agarwal AK, Raja A, Brown BD. Chronic
VI. CONCLUSION obstructive pulmonary disease. National Centre for
Biotechnology Information [Internet].Florida:
The present study demonstrated that Bhramari StatPearls Publishing;2022. Available from:
pranayama has positive impact on dyspnoea and loosening https://pubmed.ncbi.nlm.nih.gov/32644707/ .
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maintaining the range of motion on upper limb and [Internet]. Bihar, India: Yoga Publications Trust;
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 Patient Informed Consent: function, functional capacity, dyspnea scale, and
A written consent was obtained from the patient. quality of life in patient with stable chronic
obstructive of lung disease. Open Access Maced J
 Funding: Med Sci [Internet]. 2019;7(4):p567–572. Available
No external funding received. from: http://dx.doi.org/10.3889/oamjms.2019.113
doi:10.3889/oamjms.2019.113.
 Conflicts of Interest: [8]. Mulay SU, Devi TP, Jagtap VK. Effectiveness of
There is no conflict of interest concerned with this shoulder and thoracic mobility exercises on chest
study. expansion and dyspnoea in moderate chronic
obstructive pulmonary disease patients. Int J
ACKNOWLEDGEMENT Physiother Res [Internet]. 2017;5(2):p1960–1965.
Available from: https://www.ijmhr.org/IntJPhysiother
We extend our sincere gratitude to Dr. Dinesh P V Res/IJPR.2017.115 doi: 10.16965/ijpr.2017.115.
(department of community medicine) and Dr. Prithiraj Ballal [9]. Raju Nr N, Deepika S, Pratibha K, Tr KP, Navoday
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College and Hospital, for their valuable suggestions and respiratory system [Internet]. Ujconline.net. Available
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ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1104

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