Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease

This study aims to determine the best choice of breathing exercises (BE) for patients with chronic obstructive pulmonary disease (COPD) via a network meta-analysis. We searched randomized controlled trials (RCTs) of adults with COPD investigating any BEs in MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases. The effects of comparative treatment on the St. George Respiratory Questionnaire as the outcome were analysed and ranked according to a surface under the cumulative classification curve (SUCRA) analysis. The network meta-analysis included six RCTs involving 280 patients with four intervention groups, comprising control, diaphragmatic breathing training (DBT), yoga, and singing course. Performing SUCRA, we reported that yoga is 75% likely to be the best treatment available as DBT with 66%, instead of 35% for singing and 21% for control. DBT and yoga seem to be the best choices for breathing exercises in people with COPD. •To assess best breathing exercise in chronic obstructive pulmonary disease among yoga, diaphragmatic breathing, and singing.•Trials with pursed-lip breathing and St. George's respiratory questionnaire as outcome are needed for further investigation.•The best breathing exercises for chronic obstructive pulmonary disease seem to be diaphragmatic breathing and yoga.