Volume 12 • Number 4 • December 2021 • em00780

JOURNAL OF CLINICAL AND

RESEARCH ARTICLE
EXPERIMENTAL INVESTIGATIONS

Effect of Postural Drainage and Deep Breathing-Cough

Exercises on Oxygen Saturation, Triflo Volume and
Pulmonary Function Test in Patients with COPD
Selma Arık 1, Kıvan Çevik 2*

1
Department of Nursing, Health ABSTRACT
Sciences Institute, Manisa Celal
Bayar University, Manisa, Turkey Objective: The aim of this study was to examine the effect of postural drainage and deep
2
Department of Fundamentals
breathing-coughing exercises on oxygen saturation, triflo volume and pulmonary function test
Nursing, Faculty of Health Sciences, applied to patients with chronic obstructive pulmonary disease.
Manisa Celal Bayar University, Methods: Postural drainage and deep breathing-coughing exercises were performed twice a
Manisa, Turkey day, morning and evening for 7 days. Hemodynamic parameters were recorded four times a
day, pre-exercise and post-exercise. The forced vital capacity (FVC), forced expiratory volume
(FEV1) and FEV1 / FVC values obtained during the Pulmonary Function Test (PFT) were assessed
at the end of the first day of the study before the exercise and at the end of the 7th day.
Results: As a result of the analyzes performed, there was a statistically significant difference
in the oxygen saturation, triflo volume and pulmonary function test of the patients on all days
before and after exercise.
Conclusions: Postural drainage and deep breathing-coughing exercises are effective in
increasing oxygen saturation, triflo volume, pulmonary function tests.
Keywords: postural drainage, deep breathing exercises, cough exercises, COPD

Correspondence: recent years, these interventions are often

INTRODUCTION
Kıvan Çevik non-therapeutic. Therefore, pulmonary
Chronic obstructive pulmonary disease
Address: Department of rehabilitation applications aiming to
Fundamentals Nursing, Faculty of
(COPD) is a common, preventable and
improve the quality of life in all patients with
Health Sciences, Manisa Celal Bayar treatable disease. It is characterized by
respiratory problems, especially with COPD,
University, Manisa, Turkey persistent usually progressive airflow
have come to the fore [10].
Email: [email protected] restriction caused by an enhanced chronic
inflammatory response to harmful particles Pulmonary rehabilitation includes
or gases in the airways and the lung [1]. physical education programs consisting of
COPD, an increasingly serious public health patient education, psychosocial support,
problem all over the world, is one of the aerobic and empowering exercises and
leading causes of mortality and morbidity breathing exercises [8,11]. Depending on the
and a highly prevalent and costly disease needs of the patient, collaborative self-
especially in industrial and developing management strategies such as
countries [2-6]. Due to acute exacerbations implementing smoking cessation
of COPD, such factors as increases in intervention, adopting a healthy lifestyle and
medical expenditures and hospitalizations, performing regular exercises can be effective
loss of workforce, etc. cause serious in the early and appropriate treatment of
economic and social losses in all countries COPD exacerbations. Comprehensive
[7]. Optimal treatment of patients with pulmonary rehabilitation programs are an
COPD usually requires pharmacological and appropriate and effective way providing
nonpharmacological treatment [6,8,9]. these important components [6,9] and the
Received: 25.05.2021, Although medical and surgical treatments importance of these programs is increasing
Accepted: 07.09.2021 have led to significant improvements in day by day [12,13]. With the rehabilitation
https://doi.org/10.29333/jcei/11269 attempts to be performed in the early stage

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

of the disease, it is aimed to prevent the formation of Data Collection Method

permanent damage, to reduce symptoms and to increase The study data were collected by the researcher using the
exercise tolerance. The review of the pertinent literature has “Patient Information Form” through the face-to-face
revealed that pulmonary rehabilitation has a positive effect interview method. In order to accurately obtain data oxygen
on the physical and psychological parameters of patients, saturation, triflow volume and Pulmonary Function Test
that postural drainage and deep breathing and coughing were measured with the same devices at all participants. The
exercises improve the patients’ oxygen saturation and patients performed the deep breathing and coughing
pulmonary function tests, and that the length of hospital exercises, postural drainage and triflow respiratory exercises
stays and the need for medications decrease [14-18]. for an average of 30-45 minutes twice a day in the morning
The aim of this study was to investigate the effect of and evening for 7 days. Pre-exercise and post-exercise
postural drainage and deep breathing-coughing exercises oxygen saturation, triflow volume values were recorded four
applied to patients with chronic obstructive pulmonary times a day in the morning and evening (twice in the
disease on oxygen saturation, triflo volume and pulmonary morning and twice in the evening) for seven days. FVC,
function test. FEV1, FEV1 / FVC were measured on the 1st day of the
program before the exercises started and on the 7th day of the
METHODS
program after the exercises finished. During the deep
Study Design, Setting, and Participants breathing exercises, the incentive spirometer volume was
The study was a quasi-experimental study with 100 measured using the same brand spirometer in all the
patients with COPD who were diagnosed with COPD, have measurements. In terms of the reliability of the
inclusion criteria for the study and agreeing to participate in measurements, the PFT results were checked by the
the study between November 2016 and April 2017 in the Institution’s Chest Disease Specialist and if consensus was
state hospital in Turkey. To perform reliable measurements not reached, measurements were repeated. The incentive
were performed on the close/ similar group of participants, spirometer (triflow volume) measurements were repeated at
under the same conditions and supervision of a teaching least five times in case the patient could not perform well,
staff. The criteria for inclusion in the study were; [a) and of the data, the best one was taken into account. Oxygen
according to GOLD (2017) criteria, patients with COPD saturation values of the patients were measured using the
(Stage I, II, III) are categorized, (b) being older than 18 years same brand pulse oximeter device in all the measurements.
of age, (c) patients with stable COPD, (d) patients who can
Sample Size and Statistical Power Considerations
do the exercises properly, (e) patients who can speak and
A total of 217 patients were evaluated between the dates
understand Turkish, (f) agreeing to participate in the study
indicated. 117 individuals who did not meet the eligibility
after having provided a written consent. The criteria for
criteria were not accepted to participate in the studyThe
exclusion from the study were; (a) patients who cannot
study consisted of 100 patients who were admitted to the
properly do the exercises prepared for the study, (b) patients
state hospital between November 2016 and April 2017 with
who have had exacerbations in the past month, (c) patients
COPD and their sample was admitted to the specified dates
with a pulmonary disease comorbid to COPD, (d) patients
and accepted to participate in the research. The control
with congestive heart failure / coronary artery disease, (e)
group was not created because routine treatment of all the
patients with orthopedic problems (especially on the back) /
patients in the clinic was performed routinely (because of the
muscle-joint disease, (f) patients with an uncontrollable
ethical problem of not exercising). The participants in the
comorbid disease (diabetes, thyrotoxicosis), (g) patients with
study were chosen by a random sampling method. Power
active infection, (h) not agreeing to participate in the study.
analysis was performed to determine the size of the research
Data Collection sample [16]. Taking α = 5%, effect size (d) = 0.53, and 1 − β
Patient Identification form, Deep breathing-cough (power) = 0.99 (99,89%), minimum sample size was
exercises and Spirometer application steps form, Data calculated as 100.
Registration Form were used in the collection of data.
Ethical Considerations
Questionnaires were prepared by the researchers in
Before commencing the research, written permission was
accordance with the literature [16,19-21]. Patient
obtained from faculty’s ethics committee (Approval No.
Identification Form consisted of 18 questions on
20.478.486-337) and conformed to the principles outlined in
sociodemographic (age, sex, marital status, education level,
the Helsinki Declaration. Written permission was obtained
body mass index, etc.), disease and treatment (presence of
from the institutions where the study was to be carried out;
chronic illness, smoking and alcohol consumption, etc.). The
verbal and written informed consent was obtained from each
Data Registration Form contained the results of oxygen
of the patients for the present study. Patients were informed
saturation, respiratory function tests and the times (day) of
about the purpose and procedures of the study, the voluntary
the measurements.
nature of their participation, and the option to withdraw at
any time.

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

Table 1. Pre-exercise and post-exercise oxygen saturation values of patients

Morning Test* Evening Test*
Day Oxygen saturation Oxygen saturation Oxygen saturation Oxygen saturation
P Z P Z
before exercise after exercise before exercise after exercise
Mean±SD Mean±SD Mean±SD Mean±SD
1.Day 87.86±4.10 92.97±3.52 0.000*** -8.670 87.793±.77 93.106±.76 0.000*** -7.900
2.Day 88.14±3.72 93.75±2.82 0.000*** -8.700 88.35±3.58 94.302±.36 0.000*** -8.640
3.Day 88.59±3.53 93.78±2.76 0.000*** -8.320 87.86±9.50 95.032±.27 0.000*** -8.680
4.Day 88.80±0.15 94.26±2.56 0.000*** -8.600 88.69±3.33 94.962±.16 0.000*** -8.680
5.Day 89.24±3.24 94.65±2.30 0.000*** -8.660 89.533±.26 95.48±1.95 0.000*** -8.550
6.Day 89.56±2.79 93.838±.87 0.000*** -8.280 89.99±3.09 95.55±2.09 0.000*** -8.510
7.Day 89.95±1.54 94.68±2.14 0.000*** -8.510 90.46±2.63 95.45±1.72 0.000*** -8.540
*Wilcoxon Signed Ranks Test p**<0.05 p***<0.001

Table 2. PFT and Triflow volume values measured on the 1st day of the program before the exercises started and on the 7th day of the
program after the exercises finished
1.st day (before exercise) 7.st day (after exercise)
PFT values Test*/p
Mean±SD Mean±SD
FVC 68.75±2.97 70.61±10.26 0.008**
FEV1 61.90±12.49 64.43±12.38 0.000***
FEV1/FVC 89.04±9.39 93.07±12.10 0.000***
Triflo volüme values 677.5±110.13 1148.5±96.87 0.000***
*Paired Samples Test p**<0.05 p***<0.001

Data Analysis According to Table 2, the values obtained on the 1 st day

Data were analyzed using the SPSS program evaluated in morning before the exercises were as follows: FVC: 68.75 ±
the computer environment. Descriptive statistics were used 2.97, FEV1: 61.90 ± 12.49, FEV1 / FVC: 89.04 ± 9.39. The
to define the sociodemographic and disease characteristics of values obtained on the 7th day evening after the exercises
the sample (number, percentage, mean, standard deviation). were as follows; FVC: 70.61 ± 10.26, FEV1: 64.43 ± 12.38,
The data obtained from the study were analysed on a FEV1 / FVC: 93.07 ± 12.10. The triflow volume value was
computer using the Wilcoxon Signed Ranks Test, Paired 677.5 ± 110.13 on the 1st day morning before the exercises
Samples Test, MannWhitney U Test, Kruskal Wallis Test. and 1148.5 ± 96.87 on the 7th day evening after the exercises.
There was a statistically significant difference between PFT
RESULTS
values measured on the first and seventh days and between
The mean age of the participants was 66.58±0,78 years,
the triflow volume values on the first and seventh days
74% were male, 82% were married, and 65% were educated
(p<0.05).
to primary school level. The participants’ mean body mass
index of 39% was regarded as above normal. The patients’ In Table 3, the participating patients’ oxygen saturation,
COPD stage routinely evaluated and recorded in the patient triflow volume and pulmonary function test (FVC, FEV1,
file by the Institution’s Chest Disease Specialist. It was FEV1 / FVC) values were compared in terms of some
determined that 66% of patients were in COPD II. stage, variables (age, gender, COPD stages, smoking status and
2.55% had a chronic illness and 41% of the patients did not conducting the breathing and coughing exercises).
smoke, 86% did not drink alcohol and 79% did not exercise The comparison of the participants’ mean scores for the
deep breathing-coughing. oxygen saturation, triflow volume and PFT values obtained
Table 1 shows the patients’ oxygen saturation values on the 1st day morning before the exercises and on the 7th
measured before and after postural drainage, and deep day evening after the exercises by gender revealed that there
breathing and coughing exercises performed in the morning were significant differences between the two genders in
and evening. On all days, the patients’ oxygen saturation terms of the mean scores for the oxygen saturation and
values increased after exercises and the difference was FEV1/FVC on the 7th day evening after the exercises, and for
statistically significant (p<0.05). the triflow volume and FEV1/FVC on the 1st day morning
before the exercises (p<0.05). The differences between the

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

Table 3. Comparison of the patients’ oxygen saturation, Triflow volume and pulmonary function test [FVC, FEV1, FEV1 / FVC) values in
terms of some variables
Sociodemographic O2
Measuring Test** Triflo Volume Test** FVC Test** FEV1 Test** FEV1/FVC Test**
Features and n saturation
Time p/Z Mean±SD p/Z Mean±SD p/Z Mean±SD p/Z Mean±SD p/Z
Diseases Mean±SD
Age Groups
Before 41-54 6 91.68±1.72 0.327 800.00±282.84 0.183 79.50±30.40 0.489 81.00±29.69 0.241 101.00±4.24 0.618
Exercise 55-68 56 87.88±3.85 695.54±98.87 71.59±17.68 63.13±14.47 91.44±18.72
[1.day) 69-83 38 88.08±4.06 664.17±113.82 75.25±12.27 66.58±11.22 95.25±15.31
Age Groups
41-54 6 95.50±3.53 0.753 1150.00±70.71 0.652 79.50±27.57 0.811 82.00±26.87 0.355 102.00±8.48 0.948
After
55-68 56 95.54±1.63 1147.44±75.17 74.45±14.50 65.67±17.60 97.45±12.98
Exercise
1116.50±106.7
[7.day) 69-83 38 94.92±2.23 77.16±11.25 70.42±14.49 102.25±8.48
8
COPD Stages
0.001**
Before I. Stage 14 90.00±15.00 0.626 700.00±123.09 0.217 88.50±16.32 0.001*** 88.09±13.87 0.001*** 100.50±6.76
*
Exercise
II. Stage 66 89.00±16.02 600.00±56.87 68.42±11.02 60.65±12.34 91.00±14.22
[1.day)
III. Stage 20 90.07±13.08 650.47±112.34 56.52±13.45 44.50±15.08 76.50±13.57
COPD Stages
0.001**
After I. Stage 14 95.87±6.00 0.038*** 1200.00±0.00 0.666 89.64±13.87 0.001*** 93.50±14.56 0.001*** 105.03±8.92
*
Exercise
II. Stage 66 96.67±7.08 1200.00±0.00 69.50±14.67 63.35± 13.58 94.46±15.03
[7.day)
III. Stage 20 96.09±4.21 1200.00±0.00 58.87±12.43 48.50±13.89 80.50±14.51
Gender
Before 0.023** 0.000**
Female 74 87.93±3.96 0.971 689.86±110.09 69.00±15.28 0.790 60.81±16.69 0.164 84.62±18.39
Exercise * **
[1.day) Male 26 87.65±4.56 -0.336 642.31±93.48 -2.275 68.04±17.08 -0.637 65.00±14.47 -1.392 101.62±11.34 -4.493
Gender
After 0.000**
Female 74 95.74±1.59 0.005*** 1155.41±77.00 0.088 70.28±14.63 0.884 63.58±16.36 0.328 90.34±15.52
Exercise **

[7.days) Male 26 94.62±1.83 -2.793 1128.85±83.87 - 1.709 71.54±18.10 -0.145 66.85±15.28 0.979 103.92±12.47 -4.037
Smoking
Before Yes 20 88.00±4.32 0.794 690.00±115.39 0.556 70.90±15.73 0.512 59.75±17.11 0.959 86.85±18.20 0.518
Exercise
No 80 87.83±4.07 -0.261 674.38±106.13 -0.589 68.21±15.72 -0.655 62.44±16.00 -0.052 89.59±18.50 -0.647
[1.day)
Smoking
After Yes 20 95.90±1.77 0.154 1165.00±69.01 0.300 70.50±11.51 0.663 61.15±16.39 0.540 88.25±17.52 0.146
Exercise
No 80 95.34±1.70 -1.424 1144.38±81.51 -1.088 70.64±16.43 -0.435 65.25±16.00 -0.612 95.28±15.26 -1.453
[7.days)
Exercise Situation
Before Yes 21 88.76±3.17 0.397 680.95±111.21 0.989 65.90±15.88 0.400 60.33±19.44 0.657 84.43±26.11 0.706
Exercise
No 79 87.62±4.30 -0.847 676.58±107.36 -0.014 69.51±15.64 -0.842 62.32±15.31 0.445 90.27±15.71 -0.377
[1.day)
Exercise Situation
After Yes 21 95.29±1.76 0.750 1121.43±90.23 0.064 68.52±15.47 0.456 64.62±19.53 0.589 91.57±20.84 0.694
Exercise
No 79 95.49±1.72 -0.319 1155.70±75.10 -1.850 71.16±15.58 -0.588 64.38±15.17 -0.178 94.48±14.41 0.394
[7.days)
*Mann Whitney U Test ** Kruskal Wallis Test p***<0.05 p****<0.001

other mean scores for the other factors were not significant that all their mean scores increased on the 7th day evening
(p>0.05). after the exercises and that there were significant differences
The comparison of the mean scores for the oxygen between the mean scores for the oxygen saturation on the 7th
saturation, triflow volume, and PFT on the 1st day evening day evening after the exercises, and between the mean scores
before the exercises and on the 7th day evening after the for the FVC, FEV1, FEV1/FVC on the 1st day morning before
exercises according to the patients’ COPD stages indicated the exercises and on the 7th day evening after the exercises

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

(p<0.05). However, there were no differences between the [24]. In Güell et al.’s study the patients with COPD
mean scores for the oxygen saturation on the 1st day morning participated in a 12-month rehabilitation program [25]. The
before the exercises, and between the mean scores for the patients had respiratory exercises in the first three months,
triflow volume on the 1st and 7th days (p>0.05). aerobic exercises in the second 3 months, and respiratory
The comparison of the patients’ mean scores for the and limb coordination exercises in the following six months.
oxygen saturation, triflow volume and PFT values obtained After the program, while the FVC value increased, FEV1
on the 1st day morning before the exercises and on the 7th value did not change.
day evening after the exercises in terms of factors such as age, In Sutbeyaz et al.’s study, there were significant increases
smoking status and conducting the breathing and coughing in FVC, FEV1 / FVC values of the patients after they had
exercises demonstrated no significant differences (p>0.05). respiratory exercises, air-shifting technique, voluntary
isocapnic hyperpnea and shoulder belt exercises for three
DISCUSSION
days a week for six weeks [26]. The results of the present
The comparison of the effects of postural drainage and
study are consistent with those in the literature.
deep breathing and coughing exercises on oxygen saturation
summarized in Table 1 revealed that the mean post-exercise In their study, Onodera and Yazaki found no changes in
oxygen saturation values were higher than pre-exercise PFT values after a 3-week pursed lip and diaphragmatic
values and the difference between them was statistically respiratory exercise [27]. In Kara et al.’s study, PFT values
significant. In their study, Gürgün et al. determined that the did not change statistically significantly [18]. In Yoshimi et
oxygen saturation level increased from 71 before the al.’s study, 31 patients underwent a pulmonary rehabilitation
rehabilitation to 77 after the rehabilitation in the program for 2 days a week for 6 weeks, but their FEV1 values
experimental group, but that there was no difference in the did not change [28]. The results of the present study are
control group [22]. In their study conducted to investigate consistent with the results of Yoshimi et al.’s study. On the
the effect of pursed lips and diaphragmatic respiratory other hand, in other similar studies in the literature, different
exercises on pulmonary function tests, Kara et al. reported results were obtained. This difference may have been
that oxygen saturation which was 92.4 before the exercises resulted from many factors such as the characteristics of
increased to 96.5 after the exercises [18]. In their study, patients, types of the diseases, stages of the disease, types of
Faager, Stahle and Larsen found that pursed lip exercises the treatment, the environment and duration of respiratory
increased oxygen saturation rates in patients with moderate exercises and the type of applications performed within
or severe COPD [17]. Gosselink reported that pursed lips pulmonary rehabilitation.
respiratory exercises improved oxygenation in patients [14]. The literature review revealed that deep breathing
Çiçek and Akbayrak reported that in the experimental exercises performed with an incentive spirometer were
group, oxygen saturation values measured after the effective in reducing postoperative pulmonary
respiratory exercises were higher than those measured before complications and encouraged patients to exercise [29,30].
the respiratory exercises, but the difference was not In Aslangiray’s study conducted with the patients having
statistically significant [15]. Although the duration and undergone coronary artery bypass, the experimental group
method of respiratory exercises varied from one study to had a deep breathing exercise training with an incentive
another, the results of the present study were similar to the spirometer, and it was observed that the exercises positively
results of other studies in the literatüre [14,15,17,18,22]. affected postoperative incentive spirometer volumes [19].
Overend et al. systematically investigated 35 studies and
When the effect of postural drainage and deep breathing
reported that deep breathing exercises performed with an
and coughing exercises on respiratory function test values
incentive spirometer was effective in reducing postoperative
and triflow volume values was analyzed in line with the
pulmonary complications [29]. The results of the present
results given in Table 2, the analysis demonstrated that the
study are similar to those in the literature. Because the
mean values obtained at the end of the seventh day were
incentive spirometer provides visual feedback for patients, it
higher than were those obtained on the first day, and the
is thought that the volume averages which increase day to
difference between them was statistically significant. The
day motivate patients and thus it can be routinely used in
review of the literature showed that the results of the studies
nursing practices as an approach improving respiratory
which investigated the effect of exercise programs on
functions.
respiratory functions varied. In a study conducted by Çiçek
and Akbayrak, all the PFT values of the patients in the In Table 3, the participating patients’ oxygen saturation,
experimental group increased statistically significantly after triflow volume and pulmonary function test values were
the respiratory exercises [15]. Ecevit reported that there was compared in terms of some variables. The comparison of the
a significant improvement in FEV1 and FVC values of the participants’ mean scores for the oxygen saturation, triflow
patients with chronic lung disease after rehabilitation [23]. volume and PFT values obtained on the 1st day morning
In Takigawa et al.’s study, significant increases were reported before the exercises and on the 7th day evening after the
in the expected value of FEV1 after pulmonary rehabilitation exercises by gender revealed that there were significant

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

differences between the two genders in terms of the mean present study, only one-fifth of the patients in the sample
scores for the oxygen saturation and FEV1/FVC on the 7th group were smokers and that those who were nonsmokers
day evening after the exercises, and for the triflow volume were probably passive smokers.
and FEV1/FVC on the 1st day morning before the exercises It was determined that the differences between the mean
(p<0.05). The differences between the other mean scores for values for the oxygen saturation, triflow volume and PFT in
the other factors were not significant (p>0.05). terms of the patients’ performing the deep breathing and
The comparison of the mean scores for the oxygen coughing exercises were not significant. This difference
saturation, triflow volume, and PFT on the 1st day evening might also be due to the fact that the patients were not
before the exercises and on the 7th day evening after the knowledgeable enough about the exercises, that the number
exercises according to the patients’ COPD stages indicated of exercising patients was not many and that the patients
that all their mean scores increased on the 7th day evening who exercised did not exercise effectively.
after the exercises and that there were significant differences
CONCLUSION AND RELEVANCE TO CLINICAL
between the mean scores for the oxygen saturation on the 7th
day evening after the exercises, and between the mean scores
PRACTICE
for the FVC, FEV1, FEV1/FVC on the 1st day morning before Postural drainage and deep breathing-coughing
the exercises and on the 7th day evening after the exercises exercises, which are part of the pulmonary rehabilitation
(p<0.05). Pulmonary function tests play a crucial role in the program in the care and management of COPD individuals,
diagnosis of the disease, and they also have an important role are effective in increasing oxygen saturation, triflo volume,
in determining the severity of the disease and in the planning and pulmonary function tests. It is thought that nurses can
of treatments. In particular, FEV1 is the parameter based on take an effective role in training patients on the importance
the classification of COPD severity. In Şirintaş’s study of exercises and how to perform exercises effectively, and in
(2010), the rehabilitation program conducted in a similar encouraging them to regularly exercise, and the patients can
way was determined to significantly affect the FEV1 and FVC benefit from the exercises for therapy. It is recommended
values of the stage II and III COPD patients [31]. In their that future studies should be conducted with larger sample
study, Faager, Stahle and Larsen reported that pursed lip groups including both the experimental group and the
respiratory exercises increased the oxygen saturation rate in control group, and that in-service training programs and
the stage II and III COPD patients [17]. The findings of the certificate programs related to pulmonary rehabilitation
present study are consistent with those of other studies in the should be arranged.
literature. LIMITATIONS
The comparison of the mean values for the oxygen Because this present study included only diagnosed Stage
saturation, triflow volume and PFT were in terms of the age I, Stage II and Stage III COPD patients and was conducted
groups of the patients demonstrated that the differences only in one institution, it cannot be generalized to other
between the oxygen saturation, triflow volume and PFT patient groups or institutions. In addition, because all the
values were not significant. Given the morbidity of COPD patients exercised, they were not assigned to experimental
increases with age, is probably due to the fact that the and control groups.
patients’ age groups in the sample group were close to each Author Note 1: This research was produced from master’s thesis
other and that the number of young patients was not high. which name is “Effect of Postural Drainage and Deep Breathing-Cough
Exercises on Haemodynamic Parameters in Patients with COPD”
The comparison of the mean values for the oxygen
Author Note 2: This research was presented in Adnan Menderes
saturation, triflow volume and PFT were in terms of the
University I. International Health Sciences Congress (Aydın- Turkey,
patients’ smoking status demonstrated that the differences 28 /06 / 2017 - 01/07 / 2017).
between the oxygen saturation, triflow volume and PFT
Author contributions: All authors have sufficiently contributed to
values were not significant. Active smoking or exposure to the study, and agreed with the results and conclusions.
environmental cigarette smoke is the most important risk
Funding: No funding source is reported for this study.
factors for the development of COPD [32]. Smoking is
Acknowledgements: We would like to thank all the patients.
responsible for 80-90% of lung cancer cases. In Turkey,
according to the data released by the Ministry of Health Declaration of interest: No conflict of interest is declared by
authors.
Turkish Public Health Institution Global Adult Tobacco
Research conducted in 2012, 27.1% of those aged 15 and over
were currently smokers and the incidence of smoking was REFERENCES
higher in males than was that in females [33]. The results of 1. Global Initiative for Chronic Obstructive Lung Disease.
the present study showed that cigarette smoking was not 2017 (GOLD 2017).
effective on oxygen saturation, triflow volume and PFT
values. This finding is different from the results in the
literature. This difference might be due to the fact that in the

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 Effect of Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test

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