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Dyspnea is a common symptom of pneumonia. This study found incentive spirometry (IS) was no more effective than placebo in preventing pulmonary complications in patients diagnosed with pneumonia. The cost effectiveness and clinical value of IS for pneumonia should be considered carefully.
Pneumonia is a frequently diagnosed condition with significant rates of morbidity and mortality (Mandell, 2015). Dyspnea, a distressing symptom of breathlessness that often leads patients to seek treatment, is a common clinical manifestation of pneumonia (Coccia, Palkowski, Schweitzer, Motoshi, & Ntusi, 2016). Dyspnea, defined as the awareness of having difficulty and discomfort with breathing (Coccia et al., 2016), is an individual and subjective experience (Coccia et al., 2016; Williams, Cafarella, Paquet, & Frith, 2015). Anxiety and fear related to pneumonia can exacerbate patients' experience of dyspnea and inhibit lung expansion, increase the risk of pulmonary complications, and lengthen recovery time (Williams et al., 2015).
Adjunct interventions that promote lung expansion and gas exchange in patients with pneumonia may reduce dyspnea and lower the risk of pulmonary complications. Incentive spirometry (IS) is a nonpharmacological intervention widely used to treat and prevent pulmonary complications during the postoperative period (Tyson, Kendig, Mabedi, Cairns & Charles, 2015). The IS device is used to increase lung expansion, decrease pleural pressure, and promote better gas exchange to prevent atelectasis and other respiratory complications (Paisani et al., 2013; Restrepo, Wettstein, Wittnebel, & Tracy, 2011). IS promotes deep breathing by providing patients with visual feedback on if they are able to meet the recommended inhalation volume (Paisani et al., 2013; Tyson et al., 2015).
The American Association for Respiratory Care Clinical Practice Guidelines Steering Committee conducted a systematic review of 54 clinical trials to update the organization's IS clinical practice guideline (Restrepo et al., 2011). Members found deep-breathing exercises provided the same benefit as IS in preventing postoperative pulmonary complications in preoperative and postoperative settings. Authors recommended IS should be used only in combination with deep-breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications. Additionally, they recommended against the use of IS to prevent atelectasis in patients following upper abdominal surgery and coronary artery bypass graft surgery. The committee did not mention use of IS for treatment of pneumonia.
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