The effect of Pursed Lips Breathing Exercises on the Oxygen Saturation Levels of Patients with Chronic Obstructive Pulmonary Disease in Persahabatan Hospital, Jakarta


Patients with chronic obstructive pulmonary disease can face increased resistance of airflow, air trapping, and lung hyperinflation. This condition can also cause decreased lung ventilation functions. Using a pursed lips breathing exercise can strengthen respiratory muscles that can improve oxygen saturation by maintaining airflow to bronchus and its branches and alveolus which then can prevent collapse in bronchiolus. The purpose of the study was to identify the effect of pursed lips breathing exercises on the oxygen saturation levels in patients with chronic obstructive lung disease in Persahabatan hospital, Jakarta. The design was quasi experimental, with a control group pre-post test design. A random sampling technique was used in the study. The exercise was provided to the intervention group for six days. The findings showed that the lung ventilation function is significantly different between preand post-intervention for both groups (p=0.00). Further, the average lung ventilation function in the intervention group is significantly different from that of the control group after intervention (p=0.012). In addition, while there is a significant relationship between subject age and the increase of the lung ventilation score (p=0.001), there was no relationship between height and the increase of oxygen saturation (p=0.091) and no significant relationship between sex and the increase of oxygen saturation (p=0.346). Based on these findings, the pursed lips breathing exercise is recommended to patients with chronic obstructive lung disease in order to improve the level of oxygen saturation.


Keywords: Oxygen saturation, Pursed lips breathing exercise, Chronic Obstructive Pulmonary Disease.

[1] Mukty, A. and Sampoerno, D. (September, 2016). Rehabilitasi pada Penyakit Paru Obstruktif Menahun. Presented at Simposium dan Kursus Penyakit Paru Obstruktif Menahun, Surabaya, Republic of Indonesia. J Indon Med Assoc, Volum: 66, Nomor: 9

[2] Abrosino, N., Foglio, K. and Bianci, L. (2016). Pulmonary Rehabilitation Programs in COPD. Retrieved from

[3] Almatsier, S. (2007). Penuntun diet: instalasi gizi perjan RS Dr. Cipto Mangunkusmo dan Asosiasi Dietisien Indonesia. Jakarta: PT Gramedia Pustaka Utama.

[4] Alsagaff, H. and Mukty, H. M. (2015). Dasar-Dasar Ilmu Penyakit Paru. Surabaya: Airlangga University Press.

[5] American College of Chest Physicians. (2016). Function Test of Lungs. Retrieved from http://www.chest. com.

[6] American Psychological Association. (2016). Publication Manual of the American Psychological Association (5th ed.). Washington, D.C.: American Psychological Association.

[7] American Thoracic Society. (2015). Standards for Diagnosis and Care of Patient with COPD. American Journal of Respiratory and Critical Care Medicine , vol. 152, pp. 77-120.

[8] Ariawan, I. (2016). Besar dan Metode Sampel pada Penelitian Kesehatan. Jurusan Biostatistik dan Kependudukan. Jakarta.

[9] Aschenbrenner, D. S., Cleveland, L. W. and Venable, S. J. (2016). Drug Therapy in Nursing. Philadelphia: Lippincott Williams & Walkins.

[10] Barnes, P. J. (2000). Chronic Obstructive Pulmonary Disease. The New England Journal of Medicine, issue 343, pp. 269-80.

[11] Bekkering, G. E., et al. (2013). Clinical Practice Guidelines for Physical Therapy in Patients with Chronic Obstructive Pulmonary Disease. In KNGF Guidelines for Physical Therapy in Patients with Chronic Obstructive Pulmonary Disease, p. 1-33. UK: Physical Therapy Reviews

[12] Bianchi, R., et al. (2014). Chest Wall Kinematics and Breathlessness during Pursed Lips Breathing in Patients with COPD. Chest, issue 125, pp. 459-65.

[13] Black, J. M. and Hawk, J. H. (2016). Medical Surgical Nursing; Clinical Management for Positive Outcomes. (8th ed.). St. Louis: Elsevier. Inc.

[14] Bruton, A. and Holgate, S. T. (2015). Hypocapnia and Asthma; A Mechanism for Breathing Retraining. Journal of American College of Chest Physicians, issue 127, pp. 1808-1811.

[15] Hinkle, J.L., Cheever, K.H. (2014) Brunner’s and suddarth Textbook of Medical Surgical Sursing. (12th ed.). Philadelphia: Williams & Wilkins.). Buist, A. S., et al. (2015) BOLD Collaborative Research, Colombia: The American College of Chest Physicians

[16] Chan-Yeung, M., et al. (2014). The Burden and Impact of COPD in Asia and Africa. Internationational Journal Tuberculosis and Lung Disease, vol. 8, p. 2-14.

[17] Comroe, J. H. (2015). Physiology of Respiratory (2nd ed.). Chicago: Year Book Medical Publishers.

[18] Craven, R.F, Hirnle, C.J. (2007). Fundamentals of Nursing: Human Health and Function (5th ed.). Philadelphia: Lippincott Williams & Wilkins.

[19] COPD International. (2014). Co-morbidities in Chronic Obstructive Pulmonary Disease from Assessment to Treatment. Retrieved February 25, 2018 from htm.

[20] Cuccurullo, S.J. (2014). Physical Medicine and Rehabilitation Board Review (3rd ed.). New York, Demos Medical Publishing

[21] Dechman, G. and Wilson, R. (2014). Evidence Underlying Breathing Retraining in People with Stable Asthma. Physical Therapy Journal, vol. 84, issue 12, pp. 1189-1197.

[22] Dempsey, P.A, Dempsey. A.D. (2002). Riset Keperawatan: Buku Ajar & Latihan (4th ed.). Jakarta: EGC.

[23] Durand, D. J. and Phillips, B. L. (2016). Blood Gases: Technical Aspects and Interpretation. In J. P. Goldsmith and E. H. Karotkin (Eds.), Assisted Ventilation of the Neonate (3rd ed.). Philadelphia: Saunders, pp. 257-71.

[24] Erstad, S. (2015). Pulmonary Rehabilitation for COPD. Retrieved February 10, 2017 from http://health.

[25] Enright, C. and Ionescu, A.A. (2014). Inspiratory Muscle Training and Prused Lip Breathing Improves Lung Function and Exercise Capacity in Adults with COPD. Retrieved February 10, 2017 from http: //

[26] Fishman, A. P. (2014). Pulmonary Rehabilitation Research. American Journal of Respiratory and Critical Care Medicine, issue 149, p. 825833.

[27] Fregonezi, G. A, Resqueti, V. R. and Rousa, R. G. (2014). Pursed Lips Breathing. Arch Broncopneumol, issue 40, pp. 279-82.

[28] Garntan, S. L. (2016). Chest Physical Therapy Treatment of the Patient with Chronic Obstructive Pulmonary Disease. In H. Haas and K. Axen (Eds.), Pulmonary Therapy and Rehabilitation, Principles and Practice (2nd ed.). Baltimore: Williams and Wilkins, p. 213236.

[29] Gosselink, R. (2013). Controlled Breathing and Dyspnea in Patients with Chronic Obstructive Pulmonary Disease (COPD). Journal of Rehabilitation Research and Development, vol. 40, issue 5, pp. 25-34.

[30] Gracia-Aymerich, J. (2001). Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation. American Journal of Respiratory and Critical Care, vol. 164, issue 6, pp 125 137.

[31] Buist, S. A. et al. (2017). Group, International Variation in the Prevalence of COPD (the BOLD Study): A Population-based Prevalence Study. Lancet, issue 370, pp. 741- 50

[32] Brindley, J. (2013). Breathe Well and Live Well with COPD: A 28-Day Reathing Exercise Plan. Retrieved February 10, 2017 from org/10.1016/j.cities.2005.01.001/j.cities.2005.

[33] Grove, S. K., Burns, N. and Hegstand, L. N. (2013). Instructor’s Manual to Accompany: The Practice of Nursing Research, Conduct, Critique and Utilization (2nd ed.). Philadelphia: W.B. Saunders Company.

[34] Guyton, K. Z. (2016). Human Physiology and Deseases Mechanism (11th ed.). Jakarta: Penerbit Buku Kedokteran EGC.

[35] Haller, M., et al. (2014). Contunous Intra –Arterial Blood Gas and PH Monitoring in Critically Ill Patients with Severe Respiratory Failure: Propective, Criterion Standard Study. Critical Care Med, vol. 22, pp. 280-7.

[36] Martinez, al. (2015). Diagnosis and Treatment of Mild to Moderate COPD. Retrieved February 10, 2017 from

[37] Hastono, P. (2016). Modul Analisa Data. Depok: Tidak Dipublikasikan.

[38] Hay, F. (2015). Breathing Excercise. Retrieved February 10, 2017 from

[39] Hoeman, S. P. (2016). Rehabilitation Nursing: Process and Application (2nd ed.). St. Louis: Mosby.

[40] Hudak, C.M, Gallo, B.M. (2015). Critical Care Nursing: A Holistic Approach. Philadelphia: J.B. Lippincott Company.

[41] SE Huether, S.E., McCance, K.L (2016). Understanding Pathophysiology. St. Louis: Mosby.

[42] Indelicato, R. A. (2017). The Advanced Practice Nurse’s Role in Palliative Care and Management of Dypsnea. Retireved Retrieved February 10, 2017 from

[43] Kisner, C. and Colby, L. A. (2016). Therapeutik Exercise; Foundations and Techniues. Philadelphia: F. A. Davis.

[44] Lewis, S. M., Heitkemper, M. M. and Direksen, S. (2016). Medical Surgical Nursing; Assessment and Management of Clinical Problem (5th ed.). St. Louis: Cv. Mosby.

[45] Luckman, S. (2015). Medical Surgical Nursing, A Phsyco Physiologic Approach. (4th ed.). Philadelpia: WB. Saunders Company.

[46] Mangunnegoro, H., et al. (2014). PPOK Pedoman Diagnosis dan Penatalaksanaan di Indonesia. Jakarta: PDPI.

[47] McCloskey, J. C. and Bulechek, G. M. (2016). Nursing Interventions Classification (NIC) (2nd ed.). St. Louis: Mosby.

[48] McMorrow M.E. and Malarkey, L. M. (2016). Nurses’s Manual of Laboratory Tests and Diagnostic Procedures (2nd ed.). Philadelphia: W.B. Saunders Company.

[49] Morgan, M. D. L. and Britton, J. R. (2013). Chronic Obstructive Pulmonary Disease: Non-Pharmacological Management of COPD. Thorax, vol. 58, pp. 453-7.

[50] Notoatmojo, G. (2005). Metodologi Kesehatan. Jakarta: Rineka Cipta.

[51] Pagana, K. D. and Pagana, T. J. (2016). Diagnostic Testing and Nursing Implications: A Case Study Approach (5th ed.). St. Louis: Mosby.

[52] Mulyono, D. (2017). Rehabilitasi Pada Penderita Penyakit Paru Obstruksi Menahun. Cermin Dunia Kedokteran, issue 114, pp. 33-6.

[53] Nici, L., et al. (2016). American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, vol. 173, pp. 1390-413.

[54] Orozco, M. (2010). American Journal of Respiratory and Critical Care Medicine, vol. 164, pp 141-147

[55] Park, S. (2016). Pulmonary Rehabilitation for COPD. Retrieved February 10, 2017 from http://health.msn. com.

[56] Perhimpunan Dokter Paru Indonesia. (2016). Asma: Pedoman Diagnosis dan Penatalaksanaan Di Indonesia. Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia.

[57] . (2013). PPOK; Pedoman Diagnosis dan Penatalaksanaan di Indonesia. Jakarta: Balai Penerbit FKUI.

[58] Perry, A. G. and Potter, P. A. (2014). Clinical Nursing Skills Techniques (4th ed.). St. Louis: Mosby

[59] . (2015). Fundamentals of Nursing: Concepts, Process, and Practice. Diterjemahkan oleh Yasmin Asih (4th ed.). Jakarta: Penerbit Buku Kedokteran EGC.

[60] Petty, T. L. (1993). Pulmonary Rehabilitation in Perspective: Historical Roots, Present Status, and Future Projections. Thorax, vol. 48, p. 855862.

[61] Pollit, D. F. and Beck, C. T. (2016). Essentials of Nursing Research: Methods, Appraisal, and Utilization. (6th ed.). Philadelphia: Lippincott Williams & Walkins.

[62] Price, S. and Wilson, L. M. (2016). Pathophysiology. Clinical Concepts of Disease Processes. St. Louis: Mosby Year Book. Inc.

[63] Pratiknya, A. W. (2016). Dasar-Dasar Metodologi Penelitian Kedokteran Dan Kesehatan. Jakarta: PT. Raja Grafindo Persada.

[64] Alderman, L (2016). Proper Breathing Techniques. Retrieved February 10, 2017 from http://www.

[65] Rahmawati, R. (2016). Perlu Terapi Efektif. Retrieved February 10, 2017 from

[66] Respiratory Team. (2016). Breathing Techniques and Position to Help Reduce Breathlessness. Retrieved February 10, 2017 from Wiltshire: Salisbury Healthcare Scientists

[67] Rasmin, M. and Wihastuti, R. et al. (2014). Diagnostik Dan Terapi; Prosedur Tindakan Bidang Paru Dan Pernapasan. Jakarta: Bagian Pulmonologi FKUI.

[68] Ruane, L. E. (2014). Global Initiative for COPD. Retrieved February 10, 2017 from http://www.goldcopd. org, pp. 3-5.

[69] Saetta, M. et al. (2001). Cellular and Structural Bases of Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care, vol. 163, issue 6 pp 116 -127

[70] Sastroasmoro, S. and Ismael, S. (2016). Dasar-Dasar Metodologi Penelitian Klinis (2nd ed.). Jakarta: Sagung Seto.

[71] Shea, J. and Martinez, C. A. (2016). Pulmonary Critical Care Associates of East Texas. Retrieved February 10, 2017 from

[72] Sitorus, R. (2014). Panduan Penyusunan Dan Penulisan Tesis Dan Disertasi. (Program Pascasarjana, Fakultas Ilmu Keperawatan UI, 2014).

[73] Smletzer, S. C. and Bare, B. G. (2015). Brunner & Suddarth’s: Textbook of Medical Surgical Nursing. Philadelphia: Lippincott.

[74] Spahija, J., Marchie, M. and Grassino, A. (2015). Effects of Imposed Pursed Lips Breathing on Respiratory Mechanics and Dyspnea at Rest and During Exercise in COPD. Chest, vol. 128, pp. 640-50.

[75] Kardjito, T. and Hariadi, S. (2016). Epidemiologi Penyakit Patti Obstruktif Menahun. Dalam: Simposium dan Kursus Penyakit Paru Obstruktif Menahun. Surabaya Juni, vol. 2, pp. 117.

[76] Tiep, B. L., et al. (2016). Pursed Lips Breathing Training Using Ear Oximetry. Chest, vol. 90, pp. 218-221.

[77] Troosters, T., et al. (2000) Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Retrieved February 12, 2017 from

[78] Spengler, C. M., et. al. (2015). Respiratory Training. Retrieved from

[79] Sudoyo, A. W., et al. (2009). Buku Ajar Ilmu Penyakit Dalam Jilid II (5th ed.). Jakarta: Interna Publishing.

[80] Sugiyono, P. (2015). Statistik untuk Penelitian. Bandung: CV. Alfabeta.

[81] Thomas, M., et al. (2016). Breathing Retraining for Dysfunctional Breathing in Asthma: A Randomised Controlled Trial. BMJ Publishing Group & British Thoracic Society, issue 58, pp. 110-115.

[82] Timby, B. K., Scherer, J. C. and Smith, N. E. (2016). Medical Surgical Nursing: Introductory (7th ed.). Philadelphia: Lippincott.

[83] Tomey, A. M. (2016). Nursing Theorists and their Work. (6th ed.). Philadelphia; Mosby Elseiver.

[84] Weiner, P and Mc Connell, A. K. (2005). Respiratory Muscle Training in Chronic Obstructive Pulmonary Disease: Inspiratory, Expiratory, or Both?. Retrieved February 25, 2018 from http://www.medscape. xom/viewarticle/499951.

[85] Yunus, F. (2017). Penatalaksanaan Penyakit Paru Obstruksi. Cermin Dunia Kedokteran, issue 114, pp. 20-32.