The current study will be a single-blind, parallel-group randomized controlled trial involving 62 patients diagnosed with smog-induced pneumonia. The study will compare the effects of Buteyko Breathing Technique (BBT) with Incentive Spirometry (IS) on respiratory outcomes.
Participants will be randomly assigned to two groups using a concealed allocation method. The experimental group will receive Buteyko Breathing Technique along with standard medical care, while the control group will receive Incentive Spirometry along with standard medical care.
Both interventions will be performed twice daily for approximately 20-30 minutes per session for seven days or until hospital discharge.
Primary outcomes will include oxygen saturation (SpO₂), dyspnoea severity, exercise tolerance, sputum clearance, and respiratory symptom burden. Assessments will be conducted at baseline (Day 0), mid-intervention (Day 3), post-intervention (Week 2), and follow-up (Week 4).
The study will be conducted at the pulmonary wards of Combined Military Hospital (CMH) and The Indus Hospital, Lahore.
The hypothesis is that Buteyko Breathing Technique may produce greater improvements in oxygen saturation, dyspnoea reduction, exercise tolerance, and sputum clearance compared with Incentive Spirometry in patients with smog-induced pneumonia.
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Parallel
Buteyko Breathing Technique (BBT)
Other interventionButeyko Breathing Technique involves controlled nasal breathing with breath-holding and relaxed exhalation. Participants perform slow nasal inhalation followed by relaxed exhalation at a rate of approximately 6 deep breaths per 30 seconds. Strategic breath-holds after exhalation are incorporated to reduce hyperventilation and increase physiological CO₂ levels. Sessions are supervised twice daily for 20-30 minutes over 7 days or until hospital discharge. Intensity is maintained within patient comfort limits. SpO₂ and Borg dyspnoea scores are monitored during sessions. Sputum volume is recorded post-session. Daily sputum diary is maintained. The goal is to improve breath control, reduce dyspnoea, and facilitate sputum clearance.
Incentive Spirometry (IS)
DeviceThis intervention uses an Incentive Spirometry device to promote deep lung inflation. Participants perform slow maximal inhalation to achieve target volume, followed by a 2-3 second breath hold, then slow exhalation. Sessions are supervised twice daily for 20-30 minutes, plus 10 deep breaths per hour while awake, over 7 days or until hospital discharge. Intensity is maintained at gentle maximal inhalation without discomfort. SpO₂ and Borg dyspnoea scores are monitored during sessions. Sputum volume is recorded post-session. Daily sputum diary is maintained. The goal is to improve lung expansion, oxygenation, and inspiratory capacity.
Peripheral Oxygen Saturation (SpO₂)
Peripheral oxygen saturation (SpO₂) will be measured at rest using a fingertip pulse oximeter. SpO₂ is reported as a percentage (%) ranging from 0% to 100%, with higher values indicating better oxygenation status. Normal resting values are typically 95%-100%.
Six-Minute Walk Distance (6MWD)
Functional exercise capacity will be assessed using the Six-Minute Walk Test (6MWT) according to the American Thoracic Society guidelines. The outcome will be reported as the total distance walked in six minutes, measured in meters (m). Greater walking distance indicates better functional exercise capacity.
Sputum Wet Weight
Sputum production will be measured as sputum wet weight (grams) using pre-weighed sterile collection containers and a calibrated digital weighing scale. Results will be reported in grams (g). Higher values indicate greater sputum production, whereas lower values indicate improvement.
Dyspnoea Severity Score (Modified Borg Dyspnoea Scale)
Dyspnoea severity will be assessed using the Modified Borg Dyspnoea Scale. The scale ranges from 0 (no breathlessness) to 10 (maximal breathlessness). Higher scores indicate worse breathlessness.
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