Effect of Pursed-Lip Breathing With Different I:E Ratios on Respiratory Outcomes in COPD Patients

NCT07573826 | Not Yet Recruiting DMC

• 1 other identifier: 0511028601
• Study Type: interventional
• Target: 122
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this clinical trial is to evaluate whether different inspiratory-expiratory (I:E) ratios in the pursed-lip breathing (PLB) technique can improve respiratory outcomes in patients with stable Chronic Obstructive Pulmonary Disease (COPD) aged 40 years and older. The primary purpose is to determine whether a specific breathing intervention can improve respiratory function. The main questions it aims to answer are: Does PLB with different I:E ratios (1:3, 1:4, and 1:5) reduce respiratory rate in COPD patients? Does PLB with different I:E ratios improve oxygen saturation and reduce dyspnea severity? Researchers will compare PLB with I:E ratios of 1:3, 1:4, and 1:5 and a control group receiving standard care to see if different ratios produce different effects on respiratory rate, oxygen saturation, and dyspnea levels. Participants will: Perform pursed-lip breathing using assigned I:E ratios (1:3, 1:4, or 1:5) for 10 minutes Be assigned to either an intervention group or a control group (standard care) Have their respiratory rate measured before and after the intervention Have their oxygen saturation measured using a pulse oximeter Report their dyspnea level using the Modified Borg Scale before and after the intervention

Conditions

Chronic Obstructive Pulmonary Disease (COPD)

Keywords

Pursed-Lip Breathing I:E ratio in COPD; Oxygen saturation; dyspnea scale; respiratory rate

Outcome Measures

Primary Outcomes (3)

• Primary Outcome 1: Respiratory Rate

  Respiratory rate measured as the number of breaths per minute at rest using direct observation for 60 seconds

  Baseline and immediately after 10-minute intervention

• Primary Outcome 2: Oxygen Saturation (SpO₂)

  Peripheral oxygen saturation measured using a calibrated pulse oximeter at rest.

  Baseline and immediately after 10-minute intervention

• Primary Outcome 3 Dyspnea Level

  Dyspnea assessed using the Modified Borg Scale (0-10), where higher scores indicate more severe breathlessness.

  Baseline and immediately after 10-minute intervention

Study Arms (4)

Arm Group 1, PLB I:E 1:3

EXPERIMENTAL

Participants perform PLB with inspiratory-expiratory ratio 1:3 (2 seconds inspiration, 6 seconds expiration)

Other: Participants perform PLB with inspiratory-expiratory ratio 1:3 (2 seconds inspiration, 6 seconds expiration)

Arm Group 2, PLB I:E 1:4

EXPERIMENTAL

Participants perform PLB with inspiratory-expiratory ratio 1:4 (2 seconds inspiration, 8 seconds expiration)

Other: Participants perform PLB with inspiratory-expiratory ratio 1:4 (2 seconds inspiration, 8 seconds expiration)

Arm Group 3, PLB I:E 1:5

EXPERIMENTAL

Participants perform PLB with inspiratory-expiratory ratio 1:5 (2 seconds inspiration, 10 seconds expiration)

Other: Participants perform PLB with inspiratory-expiratory ratio 1:5 (2 seconds inspiration, 10 seconds expiration)

Arm Group 4, Standard Therapy

NO INTERVENTION

Participants receive standard care without structured PLB intervention

Interventions

Participants perform PLB with inspiratory-expiratory ratio 1:3 (2 seconds inspiration, 6 seconds expiration) OTHER

Participants will be allocated into four study arms: three intervention groups and one control group. Intervention Groups (PLB with Different I:E Ratios): Participants in the intervention arms will perform Pursed-Lip Breathing (PLB) with specific inspiratory-to-expiratory (I:E) ratios as follows: Group 1: I:E ratio 1:3 (2 seconds inspiration, 6 seconds expiration) The procedure will be conducted in a seated position (high Fowler's position). Participants will be instructed to inhale slowly through the nose and exhale through pursed lips according to the assigned ratio. A metronome will be used to standardize breathing timing. Each session will last approximately 10 minutes and will be supervised by the researcher to ensure correct technique and safety. stru

Arm Group 1, PLB I:E 1:3

Participants perform PLB with inspiratory-expiratory ratio 1:4 (2 seconds inspiration, 8 seconds expiration) OTHER

Participants will be allocated into four study arms: three intervention groups and one control group. Intervention Groups (PLB with Different I:E Ratios): Participants in the intervention arms will perform Pursed-Lip Breathing (PLB) with specific inspiratory-to-expiratory (I:E) ratios as follows: Group 2: I:E ratio 1:4 (2 seconds inspiration, 8 seconds expiration) The procedure will be conducted in a seated position (high Fowler's position). Participants will be instructed to inhale slowly through the nose and exhale through pursed lips according to the assigned ratio. A metronome will be used to standardize breathing timing. Each session will last approximately 10 minutes and will be supervised by the researcher to ensure correct technique and safety.

Arm Group 2, PLB I:E 1:4

Participants perform PLB with inspiratory-expiratory ratio 1:5 (2 seconds inspiration, 10 seconds expiration) OTHER

Participants will be allocated into four study arms: three intervention groups and one control group. Intervention Groups (PLB with Different I:E Ratios): Participants in the intervention arms will perform Pursed-Lip Breathing (PLB) with specific inspiratory-to-expiratory (I:E) ratios as follows: Group 3: I:E ratio 1:5 (2 seconds inspiration, 10 seconds expiration) The procedure will be conducted in a seated position (high Fowler's position). Participants will be instructed to inhale slowly through the nose and exhale through pursed lips according to the assigned ratio. A metronome will be used to standardize breathing timing. Each session will last approximately 10 minutes and will be supervised by the researcher to ensure correct technique and safety.

Arm Group 3, PLB I:E 1:5

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with stable COPD
• Age ≥ 40 years
• Able to follow breathing instructions
• Willing to participate and provide informed consent

You may not qualify if:

• Cognitive impairment or decreased consciousness
• Severe cardiovascular disease (heart failure, coronary artery disease, pulmonary hypertension)
• Asthma-COPD overlap (ACO)
• Acute respiratory infection (e.g., pneumonia)
• Neuromuscular disorders affecting respiratory muscles

Sponsors & Collaborators

• Scholastica Fina Aryu Puspasari: lead
• STIKes Panti Rapih Yogyakarta: collaborator

Related Publications (6)

• Hammoda Abu-Odah, Liu, N. X.-L., Wang, T., Zhao, I. Y., Yorke, J., Tan, J.-Y. B., & Molassiotis, A. (2025). Modified Borg Scale (mBorg), the numerical rating scale (NRS), and the Dyspnea-12 scale (D-12): Cross-scale comparison assessing the development of dyspnea in early-stage lung cancer patients. Supportive Care in Cancer, 33(5). https://doi.org/10.1007/s00520-025-09474-x

  BACKGROUND

• Gusmarta, G., & Oktarina, Y. (2025). Case Report : Implementation of Pursed-Lips Breathing Technique on Respiratory Rate and Oxygen Saturation in Chronic Obstructive Pulmonary Disease (COPD) Patients in the Pulmonary Ward of Raden Mattaher Hospital Jambi. Jurnal Keperawatan Universitas Jambi, 9(3), 8-12. https://doi.org/10.22437/jkuj.v9i3.47490

  BACKGROUND

• Cavalheri, V., Burtin, C., Formico, V. R., Nonoyama, M., Jenkins, S., Spruit, M. A., & Hill, K. (2020). Exercise training for people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (4), CD010039. https://doi.org/10.1002/14651858.CD010039.pub2

  BACKGROUND

• Burge, A. T., Gadowski, A. M., Jones, A., Romero, L., Smallwood, N. E., Ekström, M., Reinke, L. F., Saggu, R., Wijsenbeek, M., & Holland, A. E. (2024). Breathing techniques to reduce symptoms in people with serious respiratory illness: A systematic review. European Respiratory Review, 33(174), 240012. https://doi.org/10.1183/16000617.0012-2024

  BACKGROUND

• Bhatt, S. P., Nakhmani, A., Fortis, S., Strand, M. J., Silverman, E. K., Sciurba, F. C., et al. (2023). FEV1/FVC severity stages for chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 208(6), 676-684. https://pubmed.ncbi.nlm.nih.gov/37339502/

  BACKGROUND

• Anon. (2025, March 4). What is the recommended inspiratory to expiratory (I:E) ratio for ventilator settings in chronic obstructive pulmonary disease (COPD) exacerbation? Droracle.ai. https://www.droracle.ai/articles/22727/what-is-the-recommended-inspiratory-to-expiratory-ie-ratio

  BACKGROUND

MeSH Terms

Conditions

Pulmonary Disease, Chronic Obstructive

Interventions

Inhalation; Exhalation

Condition Hierarchy (Ancestors)

Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Respiratory Mechanics; Respiration; Respiratory Physiological Phenomena; Circulatory and Respiratory Physiological Phenomena

Study Officials

• Scholastica FA Puspasari, Master

  STIKes Panti Rapih Yogyakarta

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Scholastica Fina Aryu Puspasari, Master

CONTACT

+62821-3433-1244; scholastica_fina@stikespantirapih.ac.id

Bernadeta Eka Noviati, Magister

CONTACT

+62 896-2816-5916; eka_noviati@stikespantirapih.ac.id

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Ns.,M.Kep

Model Details: This study uses a parallel assignment interventional model in which participants with stable Chronic Obstructive Pulmonary Disease (COPD) are randomly allocated to one of four groups: three intervention groups and one control group. Each intervention group receives the same type of behavioral intervention-pursed-lip breathing (PLB)-but with different inspiratory-expiratory (I:E) ratios (1:3, 1:4, and 1:5), while the control group receives standard care without structured PLB. The study follows a pretest-posttest design, where outcome measures are assessed at baseline and immediately after a single 10-minute intervention session. There is no crossover between groups, and each participant is exposed to only one assigned condition throughout the study. The intervention is administered in a controlled clinical setting with participants in a standardized high-Fowler position to ensure consistency. All groups are observed during the same time frame, and outcome assessments are conducted us

Study Record Dates

• First Submitted: April 30, 2026
• First Posted: May 7, 2026
• Study Start: May 4, 2026
• Primary Completion (Estimated): August 7, 2026
• Study Completion (Estimated): August 14, 2026
• Last Updated: May 7, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share