Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 The Effect of Pursed-Lips Breathing on ChildrenAos Respiratory Rate with Pneumonia in Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital Arini NurhidayatiA*.
Zulfa Mahdiatur Rasyida1 .
Suciana Ratrinaningsih2 1 AoAisyiyah University of Surakarta.
Indonesia 2 Dr.
Moewardi Regional General Hospital Article History Submitted: 23-03-2025 Revised: 29-04-2025 Accepted: 30-04-2025 org/10.
58545/jkki.
Copyright .
2025 Arini Nurhidayati This is an open-access article under the CC-BY-SA License.
Abstract Background: Pneumonia is a lower respiratory tract infection that can be fatal in children, caused by bacteria, viruses, or fungi.
Symptoms include fever, cough, and dyspnea.
One non-pharmacological therapy to address ineffective breathing patterns is Pursed Lips Breathing (PLB), which can improve alveolar expansion in each lung lobe, normalize respiratory rates, and promote relaxation in children with pneumonia.
Objective: This study aimed to determine the effect of PLB on respiratory frequency in childrens with pneumonia at Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital.
Surakarta.
Methods: A descriptive case study approach was used, involving two respondents diagnosed with Respiratory rate (RR) was measured before and after PLB intervention, administered twice daily .
orning and evenin.
for three Results: Post-intervention.
Respondent RAos RR decreased from 44 to 32 breaths/minute, while Respondent SAos RR improved from 32 to 20 breaths/minute.
Conclusion: PLB therapy demonstrated changes in respiratory frequency for both respondents.
Respondent RAos rate remained indicative of tachypnea, whereas Respondent S achieved a normal range, marked by improved breathing patterns.
Keywords: Children.
Pursed-Lips breathing.
Pneumonia.
Respiratory Correspondence Arini Nurhidayati AoAisyiyah University of Surakarta.
Indonesia Jl.
Ki Hajar Dewantara No.
Kota Surakarta.
Jawa Tengah 57146.
Indonesia Email: arini07nurhidayati@gmail.
How to cite:
Nurhidayati.
Rasyida.
, & Ratrinaningsih.
The Effect of Pursed-Lips Breathing on ChildrenAos Respiratory Rate with Pneumonia in Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital.
Jurnal Kesehatan Komunitas Indonesia, 5.
, 105-118.
https://doi.
org/10.
58545/jkki.
BACKGROUND
A child is an individual aged 0 to 18 (Anjaswanti et al.
, 2.
years, a period of growth and development Pneumonia is a leading infectious requiring special care, love, and affection cause of death in children, characterized by (Hasibuan & Suryana, 2.
During this inflammation of the lower respiratory tract stage, a child's organs are not yet fully due to bacterial, viral, or fungal infections.
developed, making them more susceptible Common pathogens include Streptococcus Staphylococcus Nurhidayati et al .
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 Haemophilus influenzae.
Mycobacterium tuberculosis.
Salmonella, pneumococcal bacteria.
Haemophilus influenzae type b (Hi.
, and respiratory syncytial virus (RSV).
Symptoms include fever, cough, dyspnea, and rapid breathing (Noviana & symptoms (Kosutova & Mikolka, 2.
Faozi, 2.
Management includes pharmacological According to the World Health Organization (WHO).
Inflammation to airway and non-pharmacological interventions, such as chest physiotherapy, vibration, the leading cause of death in children under five, accounting for 15% of global child techniques like Pursed Lips Breathing mortality, with 740,180 deaths in 2019.
(PLB).
According to Reni et al.
PLB
Indonesia, an estimated 19,000 children improves alveolar expansion, increases died from pneumonia that year (Faisal et alveolar pressure, aids secretion clearance, , 2.
National data reveals 79,320 and normalizes breathing patterns.
This pneumonia cases in infants (<1 yea.
with technique involves inhaling through the 169 deaths and 118,769 cases in toddlers .
- nose for 3 counts and exhaling slowly 4 year.
with 275 deaths (Indonesian Ministry of Health, 2.
In Central Java, promoting slow, deep breathing and better pneumonia prevalence rose from 1.
6% in respiratory control (Zulkifli et al.
, 2.
2018 to 1.
8% in 2023, with 52,033 cases Reni et al.
found that reported in toddlers (Central Java Health the mean respiratory rate (RR) dropped Office, 2.
Similarly.
Surakarta City saw a surge from 233 cases in 2022 to 473 breaths/min post-PLB, compared to 40.
in 2023 (BPS Surakarta, 2.
60 breaths/min in controls.
PLB
Hospitalized pneumonia patients experience respiratory marked by tachypnea, chest retractions, breaths/min strengthens respiratory muscles, slows expiration, prevents small airway collapse, and regulates breathing rate and depth.
nasal flaring, and abnormal breath sounds A preliminary study at Dr.
Moewardi (Faisal et al.
, 2.
Nursing challenges Hospital (February 2.
revealed 56 include ineffective breathing patterns, pneumonia cases in the Cempaka HCU airway clearance issues, hyperthermia, (November 2024AeJanuary The Effect of Pursed-Lips Breathing on Respiratory Rate in ChildrenAos with Pneumonia Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 with respiratory distress as the dominant bleeding, cardiovascular disorders, and Interviews indicated that pleural effusion.
patients and families lacked knowledge about PLB for dyspnea relief.
In this case study, two respondents were selected: Respondent 1.
An.
R, and Respondent 2.
An.
Both respondents met the inclusion and exclusion criteria of the METHODS This research utilized a descriptive Subjective and objective data case study design, aiming to analyze the implementation outcomes or phenomena interviews with the respondents and their occurring within a specific population by describing the current conditions of the Based on these findings, a research subjects based on observable and factual situations.
The subjects of the study according to NANDA-I .
: Ineffective were two respondents receiving treatment Breathing Pattern related to depression of in Cempaka High Care Unit.
Dr.
Moewardi the respiratory center (D.
The Regional Hospital, selected based on nursing intervention used was Airway predetermined inclusion and exclusion Management (I.
Based on the The inclusion criteria consisted of identified nursing problems, it is expected that after implementing nursing care for diagnosed with pneumonia and having a 3x8 hours, there will be improvement in respiratory rate greater than 24 breaths per breathing pattern, as defined by outcome criteria from NOC .
, including communication, along with their parents improved respiratory rate, improved depth or guardians who agreed to participate as of breathing, and decreased use of accessory muscles.
According to NIC respiratory support devices such as NRM, .
, the interventions for this problem HFNC, or ventilator.
Conversely, the include monitoring breathing patterns exclusion criteria included patients in .
ate, emergency condition with respiratory adventitious breath sounds, positioning in semi-FowlerAos 3Ae17 contraindications or medical diagnoses of breathing exercises, and collaborating in pursed-lip Nurhidayati et al .
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 the administration of pharmacological In this case study, data analysis therapy .
ronchodilators, expectorants, began with detailed data collection, mucolytic.
if indicated.
followed by data reduction to select Data relevant data categorized into subjective techniques or methods researchers use to and objective data.
This allowed for gather information.
According to Makbul accurate nursing problem identification.
, data collection can function as an All data independent method from data analysis or diagnosis, planning, implementation, and even serve as the primary tool for both data nursing evaluation were recorded and collection and analysis.
In this study, data documented according to standard nursing collected from The characteristic instruments.
The researcher documented nursing care results from the conducted data gathering along with two managed patients were presented treatment through pursed lips breathing Nursing research ethics are therapy to measure respiratory frequency crucial, especially since this study involved over three consecutive days.
Pre-test and post-test data were collected before and considerations were strictly observed.
The after the intervention, respectively.
The research was conducted after obtaining approval from the Head of the Ners descriptive analysis.
The data collection Profession Study Program at the Faculty of methods in this research consist of: .
Health Sciences.
Universitas AoAisyiyah Primary Data: data obtained directly from Surakarta, and respondents, including the effectiveness of Moewardi Regional General Hospital.
Pursed Ethical Lips Breathing Therefore, permission from Dr.
respiratory frequency in children with informed consent, where respondents were pneumonia in Cempaka High Care Unit, given detailed information about the study Dr.
Moewardi Regional Hospital.
and could choose to participate voluntarily.
Secondary Data: data sourced indirectly, typically derived from existing records such as names, ages, and laboratory or confidentiality, guaranteed by protecting medical examination results.
all personal information and destroying data after two years.
veracity, involving The Effect of Pursed-Lips Breathing on Respiratory Rate in ChildrenAos with Pneumonia Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 honest disclosure of the study's purpose, participants, regardless of whether they determination, allowing respondents to agreed or declined to participate in the decide their participation without pressure freely and justice, ensuring fair and non3.
RESULTS
Table 1.
Respiratory rate before the application of Pursed Lips Breathing in children with pneumonia in Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital.
Surakarta.
Day Day 1 Day 2 Day 3 Child R Respiratory rate .
imes/minut.
Description Child S Respiratory rate .
imes/minut.
Tachypnea Tachypnea Tachypnea Description Tachypnea Tachypnea Normal Based on Table 1, before receiving February 15.
Child RAos respiratory rate was Pursed Lips Breathing therapy on February 42 breaths per minute, and Child SAos rate 14.
Child R had a respiratory rate of 44 was 24 breaths per minute.
On February 16, breaths per minute with signs of tachypnea Child RAos respiratory rate decreased to 38 and dyspnea, while Child S had a breaths per minute, and Child S's respiratory rate of 28 breaths per minute, respiratory rate reached normal limits at 22 also showing symptoms of dyspnea.
breaths per minute.
Table 2.
Respiratory rate after the application of Pursed Lips Breathing in children with pneumonia in Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital.
Surakarta.
Day Child R Respiratory rate .
imes/minut.
Description Child S Respiratory rate .
imes/minut.
Day 1 Tachypnea Day 2 Day 3 Tachypnea Tachypnea Description Tachypnea .
ecreased dyspne.
Normal Normal Based on Table 2, after receiving experiencing dyspnea.
On February 15.
Pursed Lips Breathing on February 14.
Child RAos respiratory rate decreased to 38 Child R had a respiratory rate of 40 breaths breaths per minute and Child SAos rate per minute and Child S had a respiratory dropped to 22 breaths per minute.
rate of 28 breaths per minute, both still February 16.
Child RAos respiratory rate Nurhidayati et al .
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 further improved to 32 breaths per minute and Child SAos rate reached 20 breaths per Table 3.
The development of respiratory rate before and after the implementation of Pursed Lips Breathing in children with pneumonia in Cempaka High Care Unit.
Dr.
Moewardi Regional Hospital.
Surakarta.
Day Child R Respiratory rate .
imes/minut.
Pre Post Change Child S Respiratory rate .
imes/minut.
Pre Post Change Day 1 Day 2 Day 3 Yes Yes Yes Based on Table 3, the application of Yes Yes Yes On day 2.
Child RAos pre-intervention Pursed Lips Breathing over three days from February 14Ae16, 2025, showed changes and .
, decreasing to 38 breaths per improvements in respiratory frequency for minute afterward.
Child S had a pre- intervention rate of 28 breaths per minute experienced tachypnea and dyspnea, with .
, which improved to 26 breaths per minute.
approaching normal levels.
On day 3.
Child RAos pre-intervention On day 1.
Child R had a pre- respiratory rate was 38 breaths per minute intervention respiratory rate of 44 breaths .
, which improved to 32 breaths per minute .
, which decreased per minute after the intervention.
Child S to 40 breaths per minute after the had a pre-intervention rate of 22 breaths per minute .
, which further intervention rate of 32 breaths per minute decreased to 20 breaths per minute .
, which decreased to 28 .
Child breaths per minute.
Table 4.
Comparison of the final respiratory frequency before and after the application of Pursed Lips Breathing.
Measurement Before After Improvement Respiratory rate .
imes/mi.
Child R Child S Based on Table 4, before the of 44 breaths per minute and Child S had intervention.
Child R had a respiratory rate 32 breaths per minute.
After three The Effect of Pursed-Lips Breathing on Respiratory Rate in ChildrenAos with Pneumonia Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 consecutive days of Pursed Lips Breathing damage, which may lead to severe damage, organ failure, permanent organ damage, or improved to 32 breaths per minute, and even death.
Symptoms observed include Child SAos rate improved to 20 breaths per dyspnea, prolonged expiratory phase, and These results indicate that the abnormal breathing patterns.
Child RAos application of Pursed Lips Breathing The impact of pneumonia in children significantly improved the respiratory leads to edema in lung alveoli, which allows frequency in both respondents.
organisms to enter and cause pneumonia.
The inflammatory process in the lungs DISCUSSION affects tissues, reduces lung capacity.
Observation Results of Respiratory narrows bronchial passages, and increases Frequency Before the Application of Pursed Lips Breathing Therapy increase airway retention and reduce These The observation results showed that expiratory volume, potentially causing before receiving Pursed Lips Breathing To prevent this, monitoring therapy, both respondents experienced and evaluation of oxygen administration tachypnea .
bove normal respiratory rat.
are necessary, as suggested by Togodly with a nursing diagnosis of ineffective .
To optimize breathing in children breathing pattern.
In Child R, an 8-year- with pneumonia, breathing exercises such old, the respiratory rate on the first day was as Pursed Lips Breathing can be performed.
44 breaths per minute.
The child exhibited This study aligns with Reni et al.
short and rapid breathing patterns, used .
, who found that the average accessory muscles for breathing, and reported experiencing dyspnea.
In the Breathing in the intervention group was second patient.
Child S, aged 12, the patient 33 breaths per minute, while in the complained of dyspnea and was using nasal control group it was 40.
93 breaths per oxygen at 6 liters per minute (NRM).
The Another study conducted by respiratory rate was 32 breaths per minute.
Azizah et al.
showed a significant According to Adawiah & Yanto difference in respiratory rate (RR) between .
, pneumonia can cause ineffective before and after Pursed Lips Breathing breathing patterns due to resistance in intervention, with a p-value of 0.
000 < 0.
breathing efforts, leading to dyspnea.
These theories correspond with the Hypoxemia can cause tissue and organ Pursed Lips Nurhidayati et al .
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
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php/jkki eISSN 2503-2801, pISSN 2985-3435 Child R experienced dyspnea pressure pushes the diaphragm upward, and rapid breathing due to fever and a history of pneumonia.
Child S also experienced these symptoms due to pneumonia and fever.
exhalation during Pursed Lips Breathing Prolonged decreases respiratory frequency, improves Observation Results of Respiratory airflow, and reduces dyspnea (Ramadhani Frequency After the Application of et al.
, 2.
These findings align with Adawiah & Pursed Lips Breathing Therapy Based on the results shown in Table Yanto 2, respiratory frequency decreased after the implementing Pursed Lips Breathing for implementation of Pursed Lips Breathing two days reduced respiratory rate from therapy in both patients.
Both respondents 5 to 21 breaths per minute, indicating its showed changes in their breathing patterns after the therapy.
Child R reported that respiratory rates.
Sadat et al.
also after receiving Pursed Lips Breathing, confirmed that performing Pursed Lips Breathing for 15Ae20 minutes twice daily for dyspnea reduced, and the respiratory rate two days significantly lowered respiratory dropped to 32 breaths per minute.
rate, improved breath sounds, and reduced Similarly.
Child S reported improved dyspnea levels.
Therefore, regular practice breathing patterns, reduced dyspnea, and of Pursed Lips Breathing can improve lung felt more relaxed, with the respiratory rate capacity, strengthen respiratory muscles, reaching a normal level of 20 breaths per and enhance overall respiratory status.
Pursed Lips Breathing is a breathing Development of Respiratory Frequency exercise consisting of two mechanisms:
Before and After Pursed Lips Breathing deep inhalation and active, prolonged Implementation Normally, exhalation occurs Based on Table 3, measurements without excessive energy use.
However, taken over three consecutive days of Pursed Pursed Lips Breathing involves prolonged Lips Breathing practice showed changes in Deep inhalation and prolonged respiratory frequency in both respondents.
exhalation strengthen abdominal muscles.
Each increasing intra-abdominal pressure.
This For Child R, the respiratory The Effect of Pursed-Lips Breathing on Respiratory Rate in ChildrenAos with Pneumonia Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 rate decreased from 44 breaths per minute Karnianti & Kristinawati .
before the intervention to 32 breaths per found that before Pursed Lips Breathing, minute on the third day.
This improvement the average RR was 25 breaths per minute, was supported by the use of high-flow but decreased by an average of 2.
5 breaths nasal cannula (HFNC) oxygen therapy at per minute over three days.
Adriadi et al.
10 LPM FiO2 40%, along with other .
also reported a significant decrease pharmacological and inhalation therapies.
in respiratory rate from 31.
125 to 26.
In Child S, the respiratory rate was initially breaths per minute, with a p-value of 0.
32 breaths per minute with NRM oxygen < 0.
05, confirming the effectiveness of at 6 LPM.
By days 2 and 3, oxygen support Pursed Lips Breathing in improving was changed to nasal cannula at 5 LPM, respiratory parameters.
and the patient reported reduced dyspnea.
After Pursed Lips Breathing.
Comparison of Final Respiratory Rate respiratory rate reached a normal level of Before and After Pursed Lips Breathing 20 breaths per minute.
These results Intervention indicate that both patients improved from Based on Table 4, after three tachypnea to within the normal respiratory consecutive days of Pursed Lips Breathing range .
Ae30 breaths per minut.
therapy, respiratory frequency decreased.
To optimize breathing in children In Child R, the rate remained above normal with pneumonia.
Pursed Lips Breathing but showed improvement.
In contrast.
Child S achieved a normal respiratory rate diaphragmatic breathing.
This exercise of 20 breaths per minute.
The faster enhances residual lung capacity after improvement in Child S compared to Child inhalation, activates alveolar pressure in R may be due to the more severe condition each lobe, improves air circulation during in Child R, who required HFNC oxygen exhalation, and supports better gas support at 10 LPM FiO2 40% and Pursed Lips Breathing involves additional inhalation therapy, whereas exhaling through pursed lips, which Child S only needed nasal cannula oxygen strengthens respiratory muscles, slows at 3 LPM on the third day.
down exhalation, prevents airway collapse.
Regular practice of Pursed Lips and controls breathing depth and speed Breathing is recommended to enhance its (Reni et al.
, 2.
This endorphin release, promoting relaxation Nurhidayati et al .
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 and comfort, thereby reducing respiratory respondents suggests that Pursed Lips Breathing helps enhance diaphragmatic Consistent The activity and enhancing parasympathetic improve air circulation during exhalation.
This results in slower heart rate and support better gas exchange, which aligns with previous studies showing its (Handayani et al.
, 2.
responses, decreasing sympathetic nerve effectiveness in reducing respiratory rate and improving overall respiratory status.
The faster improvement observed in Child
CONCLUSION
The results of the study conducted by S compared to Child R may be attributed to the researcher on respondents Child R and the more severe condition of Child R, who Child S regarding the application of Pursed required higher oxygen support through Lips HFNC at 10 LPM FiO2 40% along with respiratory frequency in children with pharmacological and inhalation therapies, pneumonia at Dr.
Moewardi Regional whereas Child S only needed nasal cannula General Hospital indicate that before the oxygen at 3 LPM on the third day.
Regular practice of Pursed Lips Breathing is experienced tachypnea, characterized by recommended as it stimulates endorphin abnormally high respiratory rates, with Child R having a respiratory rate of 44 breaths per minute and Child S at 32 parasympathetic function, lowers heart breaths per minute, both showing signs of rate, and facilitates vasodilation, all of dyspnea and using accessory muscles for which contribute to improved respiratory Following the implementation of Pursed Lips Breathing over three pharmacological intervention should be consecutive days, there was a noticeable improvement in respiratory patterns, as incorporated into routine care for children Child RAos respiratory rate decreased to 32 experiencing dyspnea due to pneumonia.
Breathing Therefore, breaths per minute, still above normal, while Child S reached a normal respiratory rate of 20 breaths per minute, indicating better breathing control and reduced AUTHOR CONTRIBUTIONS The conceptualization, data collection and The Effect of Pursed-Lips Breathing on Respiratory Rate in ChildrenAos with Pneumonia Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 1.
April 2025, pp 105-118 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 Arini Nurhidayati.
Zulfa Respiratory Rate Pada Anak Dengan Mahdiartur Rasyida.
Suciana Ratriningsih.
Pneumonia.
Writing and manuscript revisions: Arini http://jurnal.
Nurhidayati, com/index.
php/Jp Zulfa Mahdiartur 233Ae240.
Rasyida.
Anjaswanti.
Azizah.
, & Leonita.
Studi Meta-Analisis: Faktor
ACKNOWLEDGMENT