Effects of Acapella versus Postural Drainage along with Diaphragmatic Breathing on Airway Clearance, Pulmonary Function and Dyspnea in Post-Operative CABG Patients
DOI:
https://doi.org/10.55735/zp6e4h31Keywords:
Acapella , Airway Clearance , Diaphragmatic breathing , Post-CABG , Postural drainage , Pulmonary FunctionAbstract
Background: Despite surgical advances, bronchopulmonary complications remain a leading cause of morbidity and mortality after coronary artery bypass grafting, delaying recovery and impairing pulmonary function. Effective airway clearance strategies are therefore critical for improving postoperative outcomes. Objective: To compare the effects of acapella versus postural drainage combined with diaphragmatic breathing on airway clearance, pulmonary function, and dyspnea in patients undergoing coronary artery bypass grafting. Methodology: In this randomised clinical trial, the sample was selected from Jinnah Hospital, Lahore, for seven months. Participants aged between 45-65 years, both genders, post-CABG patients, and cardiac rehab phase-1 patients were included in the study. Existing pulmonary complications, infection, or sepsis, unstable cardiovascular status, uncontrolled diabetes or other metabolic issues, impaired cognition, and required long-term intubation post-surgery were excluded. Digital spirometer measures pulmonary function tests, including FEV1, FVC, and FEV1/FVC ratios. The breathlessness, cough and sputum scale and MBDS are used to assess cough, dyspnea, ranging from 0 (no shortness of breath) to 10 (worst shortness of breath). Frequency tables, histograms, and bar charts were used, along with the chi-square test, to analyse demographic data. Independent sample t-test and Mann-Whitney U test were used to compare baseline characteristics and differences between the two groups. Paired sample t-test and Wilcoxon signed rank test were employed to assess pre- and post-intervention data within the same group. Results: At baseline, no significant differences were noted between groups for FVC (p=0.862), FEV1 (p=0.652), FEV1/FVC ratio (p=0.760), BCSS (p=1.000), and MBDS (p=0.807). After treatment, significant improvements were found in all parameters, with p=0.000. Conclusion: Acapella therapy, when combined with diaphragmatic breathing, proved more effective than postural drainage in optimising respiratory recovery among post-CABG patients.
Downloads
References
1. Atlinkson A. Surgical procedures: Coronary Artery Regeneration. Eurasian Journal of Chemical, Medicinal and Petroleum Research 2023; 2(5): 221-9.
https://doi.org/10.5281/zenodo.8263042
2. Bhide A, Datar S, Villa F. Coronary Artery Bypass Grafting - Impossible to Routine: Case Histories of Transformational Advances. Harvard Business School Accounting & Management Unit Working Paper No. 20-010 (2019).
https://doi.org/10.2139/ssrn.3427408 DOI: https://doi.org/10.2139/ssrn.3427408
3. Varma PK. Coronary Artery Bypass Grafting (CABG): Facts to Know. Kerala Medical Journal 2020; 13(1): 23-5.
4. Ntuli S. Morphological And Histological Analysis Of Vascular Conduit Options Used For Coronary Artery Bypass Grafting-A South African Perspective. 2023.
5. Nesreen G, Moustafa Mg, Mohamed M, Mona M. Autogenic Drainage versus Counter Rotation Effect on Blood Gases in Post Thoraco-Abdominal Surgery. The Medical Journal of Cairo University. 2019; 87(March): 859-63. DOI: https://doi.org/10.21608/mjcu.2019.52632
https://doi.org/10.21608/mjcu.2019.52632 DOI: https://doi.org/10.21608/mjcu.2019.52632
6. Mavroudis C, Dodge‐Khatami A, Backer CL. Coronary artery anomalies. Pediatric Cardiac Surgery 2023: 835-66. DOI: https://doi.org/10.1002/9781119282327.ch39
https://doi.org/10.1002/9781118320754.ch38 DOI: https://doi.org/10.1002/9781118320754.ch38
7. Crane LR, Katz MJ. Cardiac patient care: coronary artery disease (CAD). Australas Mark J 2022; 11: 1123-9.
8. Tripathi A, Sankari A. Postural drainage and vibration. StatPearls 2024.
9. Ashraf S, Hassan Z, Rehman SU. Effects of Postural Drainage And Deep Breathing Exercises On Dyspnea, Oxygen Saturation And Level Of Exertion In Elderly Post Covid-19 Patients. Pakistan Journal of Rehabilitation 2022; 11(2): 152-9. DOI: https://doi.org/10.36283/pjr.zu.11.2/020
https://doi.org/10.36283/pjr.zu.11.2/020 DOI: https://doi.org/10.36283/pjr.zu.11.2/020
10. Ahmed IM. Effect of mechanical chest vibration during chest physiotherapy on ventilator parameters and oxygen saturation in mechanically ventilated patients. International Egyptian Journal of Nursing Sciences and Research 2024; 4(2): 199-211. DOI: https://doi.org/10.21608/ejnsr.2024.335916
https://doi.org/10.21608/ejnsr.2024.335916 DOI: https://doi.org/10.21608/ejnsr.2024.335916
11. Afzal S, Shamsi M, Mushtaq A, Aabroo S, Huda NU, Haider MA. Combined Effects of Mechanical Ventilation and Postural Drainage in Acute Respiratory Distress Syndrome: Mechanical Ventilation and Postural Drainage in ARDS. Journal of Health and Rehabilitation Research 2024; 4(3): 1-6. DOI: https://doi.org/10.61919/jhrr.v4i3.1270
https://doi.org/10.61919/jhrr.v4i3.1270 DOI: https://doi.org/10.61919/jhrr.v4i3.1270
12. Li P. Clinical Research on Modified Postural Drainage for Secretion Clearance in Infants with Wheezing Bronchitis. Nigerian Journal of Clinical Practice 2025; 28(4): 552-60. DOI: https://doi.org/10.4103/njcp.njcp_812_24
https://doi.org/10.4103/njcp.njcp_812_24 DOI: https://doi.org/10.4103/njcp.njcp_812_24
13. Mehta AG, Patil SC, Patil CB, Chotai KT. Effectiveness of Postural Drainage and Forced Expiratory Technique Along with Segmental Relaxation Technique on Airway Clearance in Chronic Obstructive Pulmonary Disease Patients. Indian Journal of Forensic Medicine & Toxicology 2020; 14(4): 139-146.
14. Alfarizi M, Juliningrum PP, Sulistyorini L, Primirti ID. Combination of Chest Physiotherapy and Postural Drainage for Airway Clearance in Bronchopneumonia: A Case Study. Jurnal Kegawatdaruratan Medis Indonesia 2024; 3(1): 76-89. DOI: https://doi.org/10.58545/jkmi.v3i1.222
https://doi.org/10.58545/jkmi.v3i1.222 DOI: https://doi.org/10.58545/jkmi.v3i1.222
15. Ichiba T, Miyagawa T, Tsuda T, Kera T, Yasuda O. Changes in diaphragm thickness and 6-min walking distance improvement after inspiratory muscle training in patients with chronic obstructive pulmonary disease: Clinical trial. Heliyon 2023; 9(9):e20079. DOI: https://doi.org/10.1016/j.heliyon.2023.e20079
https://doi.org/10.1016/j.heliyon.2023.e20079 DOI: https://doi.org/10.1016/j.heliyon.2023.e20079
16. Jage B, Thakur A. Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients. Hong Kong Physiotherapy Journal 2022; 42(02): 81-9. DOI: https://doi.org/10.1142/S101370252250007X
https://doi.org/10.1142/S101370252250007X DOI: https://doi.org/10.1142/S101370252250007X
17. Yekefallah L, Zohal MA, Keshavarzsarkar O, Barikani A, Gheraati M. Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial. Advances in Respiratory Medicine 2019; 87(2): 77-82. DOI: https://doi.org/10.5603/ARM.2019.0013
https://doi.org/10.5603/ARM.2019.0013 DOI: https://doi.org/10.5603/ARM.2019.0013
18. Cai Y, Ren X, Wang J, Ma B, Chen O. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: a network meta-analysis. Archives of Physical Medicine and Rehabilitation 2024; 105(3): 558-70. DOI: https://doi.org/10.1016/j.apmr.2023.04.014
https://doi.org/10.1016/j.apmr.2023.04.014 DOI: https://doi.org/10.1016/j.apmr.2023.04.014
19. Ariadie DH, Sumardi S, Retnowulan H. The Effect of Pursed-Lip Breathing on Functional Capacity of Stable Chronic Obstructive Pulmonary Disease Patient Assessed by Six Minutes Walk Test. Acta Interna: The Journal of Internal Medicine 2020; 10(1): 29-36.
20. Ubolnuar N, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Kruapanich C, Mathiyakom W. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Annals of Rehabilitation Medicine 2019; 43(4): 509-23. DOI: https://doi.org/10.5535/arm.2019.43.4.509
https://doi.org/10.5535/arm.2019.43.4.509 DOI: https://doi.org/10.5535/arm.2019.43.4.509
21. Jaiswal KK, Das AK. Effectiveness of acapella, flutter and active cycle of breathing technique on lung function in COPD patients: A comparative study. Indian Journal of Physiotherapy and Occupational Therapy 2019; 13: 71. DOI: https://doi.org/10.5958/0973-5674.2019.00014.5
22. Kumaresan P, Ravichandran U, Singh D, Seraman M. Effect of Short-term Respiratory Proprioceptive Neuromuscular Facilitation on Peak Expiratory Flow Rate and Six-minute Walk Test in Patients with Stable Chronic Obstructive Pulmonary Disease: A Quasi-experimental Study. Journal of Clinical & Diagnostic Research 2022; 16(6). DOI: https://doi.org/10.7860/JCDR/2022/55928.16458
https://doi.org/10.7860/JCDR/2022/55928.16458 DOI: https://doi.org/10.7860/JCDR/2022/55928.16458
23. Mandavilli PB, Apparao P, Mounika RG, Chintada GS. Effect of Acapella Versus Active Cycle of Breathing Techniques to Improve Airwayclearance and Exercise Capacity in Subjects with Bronchiectasis. IJCRT Research Journal| UGC Approved and UGC Care Journal| Scopus Indexed Journal Norms 2025; 15(2): 50795-819.
24. Shilpa N, Veena H. Peak flow meter and digital spirometer: A comparative study of peak expiratory flow rate values. National Journal of Physiology, Pharmacy and Pharmacology 2020; 10(6): 508-510.
https://doi.org/10.5455/njppp.2020.10.02047202004052020 DOI: https://doi.org/10.5455/njppp.2020.10.02047202004052020
25. Lewthwaite H, Jensen D, Ekström M. How to assess breathlessness in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease 2021; 16:1581-98. DOI: https://doi.org/10.2147/COPD.S277523
https://doi.org/10.2147/COPD.S277523 DOI: https://doi.org/10.2147/COPD.S277523
26. Abu-Odah H, Liu X-L, Wang T, et al. 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 2025; 33(5): 442. DOI: https://doi.org/10.1007/s00520-025-09474-x
https://doi.org/10.1007/s00520-025-09474-x DOI: https://doi.org/10.1007/s00520-025-09474-x
27. Hasanpour Dehkordi A, Ebrahimi-Dehkordi S, Banitalebi-Dehkordi F, Salehi Tali S, Kheiri S, Soleimani Babadi A. The effect of teach-back training intervention of breathing exercise on the level of dyspnea, six-minutes walking test and FEV1/FVC ratio in patients with chronic obstructive pulmonary disease; a randomized controlled trial. Expert Review of Respiratory Medicine 2021; 15(1): 161-9. DOI: https://doi.org/10.1080/17476348.2020.1822740
https://doi.org/10.1080/17476348.2020.1822740 DOI: https://doi.org/10.1080/17476348.2020.1822740
28. Zisi D, Chryssanthopoulos C, Nanas S, Philippou A. The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: A systematic review. Heart & Lung 2022; 53: 89-98. DOI: https://doi.org/10.1016/j.hrtlng.2022.02.006
https://doi.org/10.1016/j.hrtlng.2022.02.006 DOI: https://doi.org/10.1016/j.hrtlng.2022.02.006
Downloads
Published
License
Copyright (c) 2025 The Healer Journal of Physiotherapy and Rehabilitation Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
