Management Of Chronic Obstructive Pulmonary Disease Biology Essay

Chronic clogging pneumonic disease remains a major wellness attention load and the taking cause of decease that is increasing in prevalence worldwide ( Hurd S ; Chest 2000 ) .

Chronic clogging pneumonic disease is a respiratory complaint that is normally under-diagnosed and life-threatening, which alters the normal external respiration form and is non to the full reversible. It includes two distinguishable entities, chronic bronchitis and emphysema, one seldom happening without a grade of the other.

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The American thoracic society along with the European respiratory society ( 2005 ) has described COPD as, a disease province in which there is progressive airflow restriction that can non be wholly reversed. It is caused by coffin nail smoke and exposure to noxious atoms which triggers inflammatory procedure in the lung parenchyma. Furthermore, COPD is a preventable every bit good as a treatable disease.

Based on the World Health Organisation study in ‘World Health Statistics – 2008 ‘ , the deceases caused by Chronic Obstructive Pulmonary Disease in 2005 were above three million, puting it at the 6th taking cause of decease and it is expected to lift to the 3rd topographic point by the twelvemonth 2030.

In India, a survey conducted by Prof S.K.Jindal published in Indian Journal of Medical Research in 2006 reported that 5 % work forces and 2.75 % adult females doing a sum of 18 million Indian populations are enduring from this disease.

1.1 BACKGROUND OF THE PROBLEM

In Chronic Obstructive Pulmonary Disease, there is hypertrophy of the mucous secretion releasing secretory organs ensuing in increased mucous secretion production. The ciliary action is reduced ensuing in impaired remotion of secernments. Thereby the air passages become clotted with mucous secretion.

The air sac walls lose their snap and prostration thereby shuting the air transitions. The air passages prostration during halitus, therefore the inhaled air is unable to get away and remains trapped in the lungs as stale air.

The air passage prostration due to reduced snap and the clogging of mucous secretion increases the airflow opposition thereby increasing air pin downing taking to hyperinflation of the lungs. This increases the work of take a breathing. The contractile force of the respiratory musculus lessenings due to the altered length tenseness relationship of the respiratory musculuss. This decreases the musculus strength and endurance.

Reduced respiratory musculus strength and air passage narrowing reduces the Forced Expiratory Volume ( FEV ) and Peak Expiratory Flow Rate ( PEFR ) .

In due class, Dyspnoea becomes the common ailment. This limits the physical activity doing the patients more sedentary and the status worsens.

1.2 NEED FOR THE STUDY

Secretion remotion remains a critical portion in the direction of chronic clogging pneumonic disease.

The conventional Chest Physical therapy techniques include Diaphragmatic external respiration exercising, Clapping, Vibration, Chest wall mobility exercisings and Postural drainage. These techniques have shown to be effectual in uncluttering secernments. But hurtful effects of these manual techniques have besides been demonstrated by Campbell AH, O’Connell JM and Wilson F6. They are prone to bring on bronchospasm and blunt the decrease in FEV1.

Active Cycle of Breathing Technique ( ACBT ) and Autogenous Drainage ( AD ) require active engagement of the patient. Active rhythm of take a breathing technique include rhythms of insistent external respiration control, pectoral enlargement and forced termination.

Autogenous drainage is a respiratory technique which utilizes the expiratory air flow to mobilise the secernments. More research is required to compare the effects of Active rhythm of take a breathing technique and Autogenic drainage, and to warrant their inclusion in intervention protocol.

1.3 STATEMENT OF PROBLEM

This survey analyses the effects of Active rhythm of take a breathing technique and Autogenic drainage as airway clearance techniques on bettering pneumonic parametric quantities in COPD patients.

The survey is entitled as, “ A Comparison of Active Cycle of Breathing Technique and Autogenic Drainage on bettering Pneumonic Functions in patients with Chronic Obstructive Pulmonary Disease. ”

1.4 OBJECTIVE OF THE STUDY

i?? To better the external respiration form

i?? To better the pneumonic map

i?? To cut down dyspnoea

i?? To analyze the effects of Active rhythm of take a breathing technique and Autogenic drainage

1.5 HYPOTHESES

The survey is done on the background of Null hypotheses ( Ho ) which states that,

“ There is no important difference between Active Cycle of Breathing Technique and Autogenic Drainage on bettering pneumonic maps in patients with Chronic Obstructive Pulmonary Disease ”

2. REVIEW OF LITERATURE

i?? William E. DeTurk, PT. , PhD. and Lawrence P. Cahalin, PT. , MS. , CCS has described Chronic Obstructive Pulmonary Disease as group of diseases where premature airway closure consequences in air caparison, increased lung volume and increased lung conformity. These characteristics finally consequences in hypoxia and hypercarbia.

i?? Ray et Al in his research have concluded that 4.08 % work forces and 2.55 % adult females from South India with a male-female ratio of 1.6 are enduring from chronic clogging lung disease.

i?? The World Health Organisation ( WHO ) in World Health Statistics 2008 has estimated that 80 million people are enduring from Chronic Airway disease. This disease accounted for 5 % of deceases globally that occurred during the twelvemonth 2005.

i?? Reddy KS, Shah B, Varghese C, Ramadoss A in 2005 has presented that 7 % of deceases in India are due to Chronic respiratory diseases.

i?? Surinder K. Jindal has reported that Tobacco or coffin nail smoke, exposure to Environmental baccy fume, indoor solid fuel burning, out-of-door air pollution, Ageing are some of the hazard factors of developing COPD.

i?? Lewis, Dirksen has reported that the lone familial abnormalcy which consequences in COPD is Hereditary Alpha 1 Anti Trypsin lack.

i?? Tan WC in 2005has added that low socio-economic position where infections are really common are besides risk factors for developing COPD.

i?? Bates has proposed that alterations in the little and big air passages, hyperactivity of air passages, harm of bronchioles and devastation of air sacs are the chief tissue degree alterations in chronic airflow restriction.

i?? Jan Stephen Tecklin and Scott Irwin has published that decreased expiratory air flow, ventilation-perfusion mismatch, increased ratio of Residual lung volume to entire lung capacity, hyperinflation are the common pathophysiological alterations in Chronic air passage obstructor

i?? Ann Thomson, Alison Skinner and Joan Piercy has published that Cough, Dyspnea related to attempt, mucopurulent phlegm, barrel thorax, wheeze particularly in the forenoon are the common clinical findings in Chronic airflow restriction.

i?? The European Respiratory Society and the American Thoracic Society COPD guidelines ( 2005 ) has classified COPD based on spirometric categorization as Mild COPD with FEV1 a‰? 80 % predicted ; Moderate COPD with FEV1 50-80 % predicted ; Severe COPD with FEV1 30-50 % predicted ; Very Severe COPD with FEV1 & lt ; 30 % predicted.

i?? Donna Frownfelter has suggested that Active rhythm of take a breathing technique added with postural drainage and percussion helps the patient in pull offing secernment clearance independently.

i?? James B Fink has claimed that ACBT is effectual in uncluttering airway and bettering pneumonic map similar to chest physical therapy.

i?? A. Hristara Papadopoulou and J Tsanakas has compared active rhythm of take a breathing technique and conventional physical therapy in cystic fibrosis and found that active rhythm of take a breathing technique is more effectual in mucus clearance from the distal bronchopulmonary sections thereby bettering pneumonic map.

i?? Marilyn Moffat has suggested that Active rhythm of take a breathing technique is effectual in call uping and uncluttering inordinate mucous secretion secernment. The addition in lung volume which occurs during ACBT reduces the airflow opposition, thereby increasing the pneumonic map.

i?? W. Darlene Reid and Frank Chung has suggested that active rhythm of take a breathing technique has a shearing consequence on mucous secretion thereby mobilising it from smaller air passages to the upper air passage. ACBT is better tolerated by patients and can be done without postural drainage.

i?? Davidson et Al compared the effects of autogenous drainage with percussion and postural drainage in cystic fibrosis and found that autogenous drainage was every bit effectual as the other interventions and patients showed a greater penchant for autogenous drainage

i?? Sam H. Ahmedzai and Martin F. Muers has reported that while executing autogenous drainage coughing is suppressed and the method is physically undemanding doing it extremely applicable to adynamic patient.

i?? Miller et Al compared autogenous drainage and active rhythm of take a breathing technique in cystic fibrosis and found that compared to ACBT, AD cleared mucous secretion faster and both techniques improved the respiratory map.

i?? Wagener et al demonstrated that there is no decrease in O impregnation when autogenous drainage is being performed.

i?? Jamal Ali Moiz, Belsare, Kamal Kishore conducted a survey on 30 male acute aggravation COPD patients comparing ACBT and AD. They concluded that ACBT and AD are every bit effectual in bettering secernment clearance and can be included in the intervention protocol.

i?? Savci S, I D Inal, Arikan H compared the effects of Active rhythm of take a breathing technique and Autogenic drainage and concluded that Autogenic drainage is every bit effectual as ACBT and Peak Expiratory Flow Rate showed greater addition in AD group.

i?? Vitacca, L. Bianchi, Ambrosino, Clini has reported that deep diaphragmatic external respiration exercising increases the tidal volume and improves the blood gases besides declining dyspnoea and increasing the work of external respiration.

i?? Scot Irwin has published that diaphragmatic external respiration exercising improves oxygenation, reduces the respiratory rate and minimizes the post-operative complications.

i?? Haggerty MC, Z Wallack and Jones have reported that FEV1 is used in placing and sorting Chronic Obstructive Pulmonary Disease

i?? Anthonisen, Kiley has reported FEV1 as the classical lung parametric quantity to depict the patterned advance of a intervention in chronic clogging pneumonic disease.

i?? Nicola A.H and Amir S has reported that Peak Expiratory Flow Rate indicates the patient ‘s inspiratory and expiratory attempt and is a relatively cheap step of pneumonic map that can be easy performed by the patient.

i?? Patricia A. Downie has suggested PEFR measured through extremum flow metre as the easiest and most consistent method for supervising lung map

i?? Karla R, Sunita C, Robert M. Smith has reported Modified Borg Scale as a valid and dependable tool which can be used in supervising the intervention result in COPD patients.

i?? Cazzola, P.J.Barnes, P.Palange has reported modified borg graduated table as a standard method for evaluation dyspnoea in patients with COPD. It is easy consistent in both long term and short term.

3. MATERIALS AND METHODOLOGY

The intent of this survey is to analyze the effects of Active Cycle of Breathing Technique and Autogenic Drainage on bettering lung map in patients with chronic clogging lung disease. The research design was selected so that it may function as a guideline for planning and implementing the survey in a manner that is most likely to accomplish the end.

3.1 Materials

Inch tape

Stethoscope

Sphygmomanometer

Physical therapy appraisal chart

Patient appraisal chart

Peak flow metre

Chair

3.2 METHODOLOGY

3.2.1 Study Design

This is a two group simple randomized experimental survey design done in the pre trial – station trial format.

3.2.2 Study Puting

This survey was carried out in the Department of Pulmonology and Critical Care, Sri Ramakrishna Hospital, Coimbatore.

3.2.3 Study Duration

This survey was carried out for a period of six months.

3.2.4 Sampling

Thirty topics with chronic clogging lung disease are selected and assigned to two groups of 15 each through simple random sampling.

Group A – this group underwent diaphragmatic external respiration exercising and Active rhythm of external respiration technique

Group B – this group underwent diaphragmatic external respiration exercising and Autogenic Drainage

3.2.5 Inclusive Standards

Mild and Moderate chronic clogging disease patients

Both males and females

Age bound of 30 – 50 old ages

Patients willing to take part on a voluntary footing

3.2.6 Exclusive Standards

Chronic COPD

Acute aggravations of COPD

Restrictive lung upsets

Asthma

Bronchiectasis

Tuberculosis

Pneumonic intercalation

Pneumothorax

Uncontrolled high blood pressure

Uncontrolled diabetes

Systemic diseases

Haemodynamic instability

Previous abdominal or thoracic surgeries

Hernia

3.2.7 Outcome Parameters

Forced Expiratory Volume in 1 2nd ( FEV1 )

Peak Expiratory Flow Rate ( PEFR )

Rate of Perceived Exertion ( RPE )

Data Collection Procedure

The patients are treated daily from the twenty-four hours of referral. The result parametric quantities are recorded on the twenty-four hours of referral and on the seventh twenty-four hours of intervention in the patient ‘s assessment chart.

3.2.9 Statistical Tools

Pre trial and station trial values of the survey are collected and assessed for fluctuations in betterment and their consequences were analyzed utilizing Independent ‘t ‘ Trial

Where,

S= combined standard divergence

d1 and d2 = Difference between initial and concluding readings in Group A and Group B severally.

n1 and n2 = Number of patients in Group A and Group B severally.

X1 and X2 = Mean of Group A and Group B severally.

4. TREATMENT TECHNIQUES

4.1 ACTIVE CYCLE OF BREATHING TECHNIQUE

The Active rhythm of take a breathing technique combines repeated rhythms of three phases. They are:

Breathing control

Thoracic enlargement exercisings

Forced expiratory technique

This technique involves flexible regimens which can be adapted for every patient ‘s convenience. Each set can be performed in coveted figure of repeats as the status requires. The intervention can be stopped when two back-to-back miffs at low lung volume remains unproductive and dry. This technique can be performed to a upper limit of 20 proceedingss per session for 2 Sessionss in a twenty-four hours.

4.1.1 Breathing Control

This stage involves diaphragmatic external respiration in normal tidal volume for 5 – 10 seconds. This is a relaxation stage. It should be ensured that the patient ‘s upper thorax and shoulders are relaxed and merely the lower thorax and venters are active.

4.1.2 Thoracic Expansion Exercises

This stage emphasises on inspiration. Deep inspiration followed by a breath clasp of 3-4 seconds is encouraged. Additional proprioceptive facilitation can be provided by puting the patient ‘s manus over the thorax.

4.1.3 Forced Expiratory Technique

This stage includes one or two effectual miffs with breath control in between. An effectual miff is performed with mouth O-shaped and glottis unfastened. The abdominal musculuss are recruited to bring forth greater expiratory force. Huffing at low lung volume will call up the secernments from distal air passages and snorting at high lung volume will unclutter those secernments.

4.2 AUTOGENIC Drain

Autogenous drainage is a self-drainage technique that utilises expiratory air flow to call up the secernments. This involves three stages,

Unsticking stage

Roll uping stage

Evacuating stage

4.2.1 Unsticking Phase

In this stage the patient is instructed to take a quite inspiration and so a deep halitus in the expiratory modesty volume. This low lung volume take a breathing call up the secernments into the larger air passages.

4.2.2 Collecting Phase

In this stage the patient is instructed to take a breath from low to mid lung volume into the inspiratory modesty volume. This mobilises the secernments from the larger air passages into the cardinal air passages.

4.2.3 Evacuating Phase

In this stage the patient is instructed to take a breath in high lung volume so that the secernments are mobilised into the windpipe. Then the secernments can be evacuated by snorting.

This technique can be performed for 30 – 40 proceedingss per session for two Sessionss in a twenty-four hours.

5. DATA PRESENTATION, ANALYSIS AND INTERPRETATION

5.1 DATA PRESENTATION

5.1.1 Demographic Data

Group – A ( Active Cycle of Breathing Technique )

Age in old ages

No. Of patients

Males

Females

30-40

6

3

40-50

4

2

Entire = 15

Group – B ( Autogenic Drainage )

Age in old ages

No. Of patients

Males

Females

30-40

5

4

40-50

4

2

Entire = 15

5.1.2 FORCED EXPIRATORY VOLUME IN ONE SECOND

a ) Group – A ( Active Cycle of Breathing Technique )

Pre trial

Post trial

Difference d1

68

78

10

66

74

8

75

80

5

70

77

7

64

73

9

64

75

11

64

72

8

63

70

7

75

81

6

73

82

9

75

83

8

69

75

6

69

76

7

71

79

8

75

82

7

Mean = 65.13

Mean =77.13

Mean = 7.73

FEV1 IN ACBT Group

B ) Group – B ( Autogenic Drainage )

Pre trial

Post trial

Difference d2

71

80

9

75

85

10

65

74

9

65

75

10

72

82

10

59

70

11

61

72

11

68

77

9

63

72

9

72

80

8

71

81

10

68

76

8

65

75

10

73

83

10

70

79

9

Mean = 67.86

Mean =77.4

Mean = 10.73

FEV1 IN AD Group

5.1.3 Peak Expiratory Flow Rate

a ) Group – A ( Active Cycle of Breathing Technique )

Pre trial

Post trial

Difference d1

140

240

100

120

180

60

120

200

80

100

150

50

160

250

90

160

230

70

130

210

80

150

220

70

130

190

60

100

160

60

170

220

50

100

190

90

180

250

70

110

180

70

130

210

80

Mean = 133.33

Mean = 205.33

Mean = 72

PEFR in ACBT Group

B ) Group – B ( Autogenic Drainage )

Pre trial

Post trial

Difference d2

130

250

120

110

170

60

150

240

90

100

180

80

130

220

90

100

200

100

100

190

90

150

250

100

130

200

70

130

220

90

100

190

90

110

200

90

120

230

110

140

230

90

100

190

90

Mean = 120

Mean = 210.67

Mean = 90.66

PEFR IN AD GROUP

5.1.4 Rate Of Perceived Exertion

a ) Group – A ( Active rhythm of take a breathing technique )

Pre trial

Post trial

Difference d1

6

3

3

8

7

2

5

2

3

6

4

2

4

2

2

7

5

4

4

2

2

6

2

4

3

1

2

8

4

4

5

2

3

8

6

2

7

4

3

6

4

2

7

5

2

Mean = 6

Mean = 3.53

Mean =2.67

RPE IN ACBT GROUP

B ) Group – B ( Autogenic Drainage )

Pre trial

Post trial

Difference d2

4

0.5

3.5

8

5

3

4

0

4

5

2

3

6

3

3

7

5

4

8

5

3

5

1

4

5

2

3

6

0.5

5.5

8

4

4

7

4

3

4

1

3

6

4

2

7

5

2

Mean = 6

Mean = 2.8

Mean = 3.33

RPE IN AD GROUP

5.2 DATA ANALYSIS & A ; INTERPRETATION

Independent ‘t ‘ trial is used to compare the significance in the betterments shown between the Groups A and B utilizing the undermentioned expression,

5.2.1 Forced Expiratory Volume In One Second ( FEV1 )

FORCED EXPIRATORY VOLUME IN ONE SECOND ( FEV1 )

Group

Mean value

Calculated

‘t ‘ value

Table

‘t ‘ Value

Pre-test

Post-test

South dakota

Group A

65.13

77.13

1.29

3.82

2.048

Group B

67.86

77.4

The difference between the post-test and pre-test values of Group A & A ; Group B sing Forced expiratory volume in one second is 3.82. The ‘t ‘ value obtained ( 3.82 ) is greater than the table value demoing that there is a important difference between the Groups A & A ; B.

COMPARISON OF FEV1 IN ACBT AND AD GROUPS

5.2.2 Peak Expiratory Flow Rate ( PEFR )

PEAK EXPIRATORY FLOW RATE ( PEFR )

Group

Mean value

Calculated

‘t ‘ value

Table

‘t ‘ value

Pre-test

Post-test

South dakota

Group A

133.33

205.33

14.6

3.51

2.048

Group B

120

210.67

The difference between the post-test and pre-test values of Group A & A ; Group B sing Peak expiratory flow rate is 3.51. The ‘t ‘ value obtained ( 3.51 ) is greater than the table ‘t ‘ value demoing that there is a important difference between the Groups A & A ; B.

COMPARISON OF RPE IN ACBT AND AD GROUPS

5.2.3 Rate Of Perceived Exertion ( RPE )

Rate OF PERCEIVED EXERTION ( RPE )

Group

Mean value

Calculated

‘t ‘ value

Table

‘t ‘ value

Pre-test

Post-test

South dakota

Group A

6

3.53

0.849

2.15

2.048

Group B

6

2.8

The difference between the post-test and pre-test values of Group A & A ; Group B sing Rate of perceived effort is 2.15. The ‘t ‘ value ( 2.15 ) obtained is greater than the table ‘t ‘ value demoing that there is a important difference between the Groups A & A ; B.

COMPARISON OF RPE IN ACBT AND AD GROUPS

6. Discussion

The chief aim of this survey is to analyse the efficaciousness of Active Cycle of Breathing Technique ( ACBT ) and Autogenous drainage ( AD ) on bettering the pneumonic map in Chronic Obstructive Pulmonary Disease patients.

Thirty topics were assigned to two groups of 15 each of which one group received Active rhythm of take a breathing technique and the other received Autogenous drainage. Both the groups received diaphragmatic external respiration exercising as a common intervention. The result parametric quantities that were assessed are:

Forced Expiratory Volume in one second ( FEV1 )

Peak Expiratory Flow rate ( PEFR )

Rate of Perceived Exertion ( RPE )

The betterment within a group is analysed by comparing the average values of the pre trial readings and station trial readings. The betterment among two groups are analysed utilizing independent ‘t ‘ trial at a significance degree of 0.05.

The FEV1 values showed betterment in ACBT group every bit good as in AD group. In ACBT group, the average pre-test value was 65.13 and the average post-test value was 77.13. One patient recorded the highest betterment of 11 % and one patient recorded the least betterment of 5 % in the FEV1 values. Thus the FEV1 value has shown betterment in the ACBT group.

In Autogenic drainage group, the average pre-test value was 67.86 and the average post-test value was 77.4. Two patients showed highest betterment of 11 % and one patient recorded the lowest betterment of 8 % . Thus FEV1 value has shown betterment in Autogenic drainage group excessively.

On comparing the betterment of FEV1 in both the groups utilizing independent’t ‘ trial, the ‘t ‘ value obtained was 3.82. At 28 grades of freedom the table’t ‘ value is 2.048 with 0.05 significance. Thus the obtained ‘t ‘ value is greater, stressing that there is a important difference between both the groups. Among both the groups the autogenous drainage group has showed greater betterment compared to the active rhythm of take a breathing technique group.

The Peak expiratory flow rate besides showed betterment in both the groups. In the Active rhythm of take a breathing Technique group, one patient showed greater betterment of 100 liters and one patient showed the least betterment of 50 liters. The average pre-test value was 133.33 and the average post-test value was 205.33.

In the Autogenic drainage group, the average pre-test value was 120 and the average post-test value was 210.67 with one patient entering the highest betterment of 120 liters and one patient entering the lowest betterment of 60 liters. Therefore peak expiratory flow rate has increased in both the groups, with Autogenic drainage group demoing greater betterment.

The independent’t ‘ trial analysis of both the groups besides revealed a ‘t ‘ value of 3.51 which was greater than the table ‘t ‘ value 2.048. Therefore there is a important difference between both the groups on bettering peak expiratory flow rate.

Analysis of the 3rd parametric quantity, Rate of Perceived Exertion, showed a average pre-test value of 6 and a average post-test value of 3.53 in the Active of take a breathing technique group. One patient recorded the highest difference of 4 in the evaluation and eight others recorded the least difference of 2.

In Autogenic drainage group, the average pre-test value was 6 and the average post-test value was 2.8. One patient recorded the highest difference of 5.5 and two others recorded a minimum difference of 2 in the evaluation. Therefore, there is greater decrease of sensed effort in the Autogenic drainage group.

The independent’t ‘ trial analysis of both the groups revealed a table ‘t ‘ value of 2.15 which is greater than the table ‘t ‘ value of 2.048 demoing that there is a important difference between both the groups.

Therefore independent ‘t ‘ trial analysis of all the three parametric quantities showed a statistically important difference between both the groups. The average post-test values of each parametric quantity have demonstrated greater betterment in the autogenous drainage group.

Decision

The result of the statistical analysis reveals that both the interventions, Active rhythm of take a breathing technique and Autogenic drainage better pneumonic map in Chronic Obstructive pneumonic disease patients. But relatively Autogenous drainage has shown greater betterment than active rhythm of take a breathing technique. This survey proposes and provides the grounds that Autogenic drainage is every bit effectual as Active rhythm of take a breathing technique on bettering pneumonic map in COPD patients.

Therefore, the Null hypothesis is rejected and it can be concluded that there is a important difference between Active rhythm of take a breathing technique and Autogenic drainage on bettering pneumonic map in COPD patients.

Restriction

Though carried out with the best of attempts, the survey has the undermentioned restrictions:

The sample studied was little and much stipulated

The survey was a short-run survey

Modified Borg graduated table is a subjective graduated table wherein reduces its dependability

The standard for patient choice was much stipulated and merely mild to chair COPD patients without any other pneumonic pathology were selected. Severe COPD patients are excluded. Therefore, the range of the consequence is really forced.

To execute these two techniques, forbearance and good apprehension is needed.

Seasonal fluctuations which can change the pneumonic maps can non be neglected.

Suggestion

The farther surveies could be modified to suit the undermentioned alterations:

Survey with larger population is recommended

Survey with long term follow is suggested

Survey with terrible COPD patients can besides be done

Survey can be conducted with these techniques in lung diseases other than COPD to compare their efficiency

More nonsubjective parametric quantities can be utilized in entering the efficaciousness of some parametric quantities.