Added Value of Adjuvant Breathing-Based Physiotherapy in the Management of Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

Background : Chronic obstructive pulmonary disease (COPD) is a progressive disorder marked by persistent airflow limitation and systemic manifestations, including respiratory muscle dysfunction and reduced exercise tolerance. Breathing-based physiotherapy is a key component of pulmonary rehabilitation, yet its isolated effects on functional and physiological outcomes remain incompletely defined. Objective to evaluate the effectiveness of a structured breathing exercise–based physiotherapy program in patients with stable COPD, compared with standard medical therapy alone . Methods : This randomized clinical trial at Mansoura University Hospitals (October 2024–2025), 100 clinically stable COPD patients were allocated to a control group receiving optimized medical therapy or an intervention group receiving medical therapy plus structured breathing exercises. Pre- and post-intervention assessments included arterial blood gases (PaO₂, PaCO₂, SaO₂), pulmonary function tests, body mass index, and six-minute walk test (6MWT). Results: The intervention group showed significant improvements compared with controls. Mean 6MWT increased from 326 ± 80 m to 399 ± 85 m (p < 0.001), while the control group showed insignificant change (362 ± 82 m to 375 ± 79 m; p = 0.34). FEV₁ improved from 62 ± 12% to 70 ± 10% (p < 0.001) and FVC from 72 ± 14% to 79 ± 12% (p < 0.001); controls had nonsignificant changes. PaO₂ increased (70 ± 12 to 78 ± 10 mmHg; p = 0.04), SaO₂ improved (92 ± 6% to 95 ± 4%; p = 0.05), and PaCO₂ decreased (45 ± 6 to 41 ± 5 mmHg; p = 0.03) in the intervention group. Conclusion : Structured breathing exercise–based physiotherapy significantly enhances exercise capacity, pulmonary function, and gas exchange in stable COPD when added to standard medical therapy, supporting its integration into routine management. Trial registration : ClinicalTrials.gov identifier: NCT06472167