The Effect of Inspiratory Breathing Muscle Exercise Using Respirometer on Changes in Lung Function and Dyspnea Severity in Tuberculosis Pleurisy Patients

Irmaini Irmaini, Herry Priyanto, Dewi Behtri Yanifitri


Background: Respirometer has been commonly used to improve lung function, prevent atelectasis and respiratory complications after surgery. The effectiveness of respirometer to improve lung re-expansion in pleural effusion has not been well studied. So far there is no such study implemented to examine this association in pleural effusion particularly tuberculosis pleurisy in Aceh.

Method: This was an experimental pretest-posttest controlled trial in patients with tuberculosis pleurisy hospitalized in dr. Zainoel Abidin Hospital between July and December 2019. Systematic random sampling was used to gather 40 samples, which then divided into intervention and control group consisted of 20 people in each group. All participants performed spirometry and were assessed for dyspnea severity using Borg scale after thoracocentesis and repeated 6 days later. Only intervention group received exercise using respirometer. Data were examined statistically using paired T-test and Mann Whitney Test.

Results: The majority of participants were male (68%) with mean age of 42 years old. Around one-third of samples were smokers with mean Brinkman Index of 273 (moderate). The nutritional status was mostly good with mean BMI of 21 (normal). There were significant improvements of FEV1 and FVC values before and after 6 days in both groups. However, if the improvements were compared between intervention and control groups, only FVC improved significantly in intervention group (P= 0.019) whereas FEV1 improved in both groups without significant difference (P= 0.456). Similar result was seen in dyspnea severity where both groups experienced improvement after 6 days with or without intervention.

Conclusion: Inspiratory muscle exercise using respirometer could improve lung function, particularly FVC value, significantly and could be an option for additional therapy to help lung re-expansion in tuberculosis pleurisy.


dyspnea; incentive spirometry; lung function; pleurisy tuberculosis; respirometer

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Jeon D. Tuberculous Pleurisy : An Update. Tuberc Respir Dis. 2014;3536:153–9.

Light RW. Update on tuberculous pleural effusion. Respirology. 2010;15(November 2009):451–8.

Mitrouska I, Klimathianaki M, Mitrouska I, Klimathianaki M. Effects of pleural effusion on respiratory function. Can Respir J. 2004;11(7).

Krell W, Rodarte J. Effects of acute pleural effusion on respiratory system mechanics in dogs. J Appl Physiol. 1985;(59):1458–63.

Jardins T Des, Burton GG, Phelps TH. Clinical Manifestations and Assessment of Respiratory Disease. Seventh Ed. Elsevier; 2016.

Loscalzo J, Fauci AS, Kasper DL, Braunwald E, Hauser SL, Jameson JL, et al. Harrison’s Pulmonary and Critical Care Medicine. McGraw Hill; 2010.

Valenza-Demet G, Valenza MC, Cabrera-Martos I, Torres-Sánchez I, Revelles-Moyano F. The effects of a physiotherapy programme on patients with a pleural effusion: A randomized controlled trial. Clin Rehabil. 2014;28(11):1087–95.

Ramírez-Sarmiento A, Orozco-Levi M, Güell R, Barreiro E, Hernandez N, Mota S, et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: Structural adaptation and physiologic outcomes. Am J Respir Crit Care Med. 2002;166(11):1491–7.

Hiling L, Bakow E, Fink J, Kelly C, Sobush D, Southorn PA. Incentive Spirometry - AARC Clinical Practice Guideline. Respir Care J. 1991;36(12):1402–5.

Agarwal K, Solomen S. Comparative study between chest mobility exercises with incentive spirometry versus chest mobility exercises with stacked breathing on chest expansion in subjects with unilateral pleural effusion. Int J Dev Res. 2016;6(6):8034–8.

Weiner P, Man A, Weiner M, Rabner M, Waizman J, Magadle R, et al. The Effect of Incentive Spirometry and Inspiratory Muscle Training on Pulmonary Function After Lung Resection. J Thorac Cardiovasc Surg. 1997;113(3):552–7.

Yanti B, et al. Clinical and Demographic Characteristics Differences between M.tuberculosis and M.bovis Infection in Bronchiolveolar Lavage of Pulmonary Tuberculosis Patients. J Respirologi Indones. 2019;39(4):238–44.

Zhai K, Lu Y, Shi H. Tuberculous pleural effusion. J Thorac Dis. 2016;8(7):486–94.

Narasimhan P, Wood J, Macintyre CR, Mathai D. Risk Factors for Tuberculosis. Pulm Med. 2013;

Broaddus VC, Murray JF, Nadel JA, Mason RJ, Ernst JD, Lazarus SC, et al. Murray & Nadel’s Textbook of Respiratory Medicine. 6th Editio. Broaddus C, editor. Elsevier; 2016.

Thomas R, Jenkins S, Eastwood PR. Physiology of breathlessness associated with pleural effusions. 2015;21(4):338–45.

Jindal S, Shankar P, Raoof S, Gupta D, Aggarwal AN, Agarwal R. Textbook of Pulmonary & Critical Care Medicine. Fisrt Edit. Jaypee Brothers Medical Publishers; 2011.

Scherer TA, Spengler CM, Owassapian D, Imhof E, Boutellier URS. Respiratory Muscle Endurance Training in Chronic Obstructive Pulmonary Disease Impact on Exercise Capacity , Dyspnea , and Quality of Life. Am J Respir Crit Care Med. 2000;162:1709–14.

Paisani DDM, Lunardi AC, Cristine C, Marques B, Porras DC, Tanaka C, et al. Volume Rather Than Flow Incentive Spirometry Is Effective in Improving Chest Wall Expansion and Abdominal Displacement Using Optoelectronic Plethysmography. 2013;1360–6.

Carvalho C, Paisani D, Lunardi A. Incentive spirometry in major surgeries: a systematic review. NCBI. 2011;15(5):343–50.

Eltorai AEM, Baird GL, Eltorai AS, Pangborn J, Jr VA, Cullen HA, et al. Incentive Spirometry Adherence : A National Survey of Provider Perspectives. Respir Care. 2018;63(5).

Narayanan A, Hamid S, Supriyanto E. Evidence regarding patient adherence with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic review. Can Respir J. 2016;25(1):17–26.



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Jurnal Respirologi Indonesia
pISSN: 0853-7704 - eISSN: 2620-3162
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