Nursing Journal Volume 10.
Issue 2.
Page 194-201 e-ISSN: 2354-6050 https://ejurnal.
id/index.
php/JKep DOI: https://doi.
org/10.
32668/jkep.
THE EFFECT OF MODIFIED PURSED LIPS BREATHING TROUGH
PLAT ON RESPIRATORY RATE AND OXYGEN SATURATION IN
CHILDREN WHIT PNEUMONIA
Eva Yuliani Sastriani* Aco Mursyid Risna Damayanti Nurwahita Faculty of Health Sciences.
University of West Sulawesi.
Indonesia email: sastriani@unsulbar.
Keywords:
Oxygen Saturation Pneumonia Pursed Lips Blowing Play Respiratory Rate Abstract Pneumonia is the most common inflammatory lung disease in children.
One of the symptoms of pneumonia is an increased respiratory rate and decreased oxygen saturation due to alveolar inflammation, which makes it difficult for the body to obtain oxygen.
A non-pharmacological therapy that can be applied is tongue-blowing play based on the principles of Pursed Lips Breathing (Pursed Lips Blowing Pla.
This study aims to determine the effect of pursed lips blowing play on reducing respiratory rate and increasing oxygen saturation in children with pneumonia.
The research design used was a Quasi-Experimental study with a pre- and post-test without a control group.
The study was conducted at Pamboang Community Health Center with a sample size of 15 respondents, selected using purposive sampling.
Univariate and bivariate analyses were performed using the Paired t-test and Wilcoxon The intervention produced measurable clinical improvement, with the mean respiratory rate decreasing from 39.
80 to 35.
07 breaths/min .
= Ae p = 0.
, while the mean oxygen saturation increased from 92.
36% .
= 2.
p = 0.
These numeric improvements indicate a strong effect of modified PLB play on respiratory performance.
The results showed a significant effect on changes in respiratory rate and increased oxygen saturation after tongue-blowing play, with p-values of 0.
001 and 001, respectively.
Based on these findings, pursed lips blowing play is recommended as a nursing intervention for pneumonia patients.
Received: July 2025 Accepted: October 2025 Published: November 2025 A year The Authors.
Published by Published Jurusan Keperawatan.
Politeknik Kesehatan Kemenkes Jakarta i.
This is Open Access article under the CC-BY-SA License .
ttp://creativecommons.
org/licenses/by-sa/4.
0/).
DOI:
https://doi.
org/10.
32668/jkep.
INTRODUCTION
Pneumonia is an acute infection that affects lung tissue .
and is caused by bacteria, viruses, or fungi.
Pneumonia is the leading infectious cause of death among children worldwide.
2 The World Health Organization (WHO) reported that in 2019, pneumonia killed approximately 740,180 children under the age of Pneumonia affects children under five years old at a rate of around 30% in developing countries, which translates to 10Ae20 cases per 100 children each year, with a significant mortality rate.
3 More than 5 million children under the age of five die from pneumonia each year in developing countries.
4 Pneumonia is the leading cause of death in India, while in Indonesia is the second leading cause of death after 5 A common issue in caring for children with pneumonia in hospitals and other healthcare facilities is respiratory distress.
4 Signs of respiratory distress include nasal flaring, increased respiratory rate, and stridor accompanied by chest wall retraction.
The basic principle of pneumonia treatment in children is to eliminate the causative microorganisms with the appropriate antibiotics and to administer antipyretics for fever management.
7 Non-pharmacological treatments include encouraging rest, providing oxygen therapy, ensuring proper hydration to thin secretions, and maintaining adequate fluid intake.
Intravenous (IV) fluid therapy may be administered if the child is weak or unable to drink sufficient fluids.
6 This is because JKEP (Jurnal Keperawata.
Vol 10 Issue 2.
November 2025.
Page 194-201 e-ISSN: 2354-6050 children expend a significant amount of energy as a intervention using a blowing plate, making it more compensatory mechanism for breathing, which is suitable for pediatric patients .
Traditional PLB is evident in the use of accessory respiratory muscles in often challenging for children because it requires moderate to severe pneumonia cases.
1 This deep breathing technique is implemented to improve alveolar understanding of instructions.
By integrating PLB into a ventilation function, reduce the risk of atelectasis, and blowing play activity, this study introduces a child- enhance nutrient intake.
Improving dietary patterns aims friendly, engaging method that improves cooperation to boost immunity and enhance the performance of the and facilitates effective respiratory muscle training .
immune system.
The relevance of this innovation is supported by the Pursed Lips Breathing (PLB) is a breathing exercise that clinical phenomenon observed at the research setting in focuses on prolonged exhalation to facilitate the Pamboang primary health care Majene city, where removal of trapped air from the lungs.
This technique pneumonia consistently ranks among the highest causes is one of the methods that can be used to reduce of pediatric hospitalization.
In 2023, the pediatric ward shortness of breath and improve lung function.
recorded 10,8% pneumonia cases, with a large Treatment using PLB will be simpler and more effective proportion of children presenting tachypnea and reduced if applied to children who can follow instructions.
oxygen saturation on admission .
These findings PLB therapy is administered to help address ineffective highlight the urgent need for non-pharmacological, airway clearance in pneumonia patients.
This therapy play-based respiratory interventions that can enhance aids in expanding the alveoli within the lung lobes, treatment outcomes and support the stabilization of facilitating the expulsion of secretions from the respiratory rate and oxygen saturation in children with respiratory tract during exhalation, and increasing alveolar pressure.
PLB exercises can also be performed in patients with severe airway obstruction.
By puckering METHODS the lips during exhalation, intrathoracic pressure is The research design used in this study is Quasi- maintained, helping to prevent respiratory failure and Experimental with a pre- and post-test without a control lung collapse.
12 During PLB, the airways remain open The population in this study consists of all during exhalation, gradually improving airflow, which pediatric patients with pneumonia in the Pamboang reduces shortness of breath and decreases respiratory Community Health Center area, totaling 63 children.
The sampling technique used is non-probability The PLB technique can be incorporated into play sampling with a purposive sampling approach.
Based on activities for children, making it easier to engage them the Power and Sample Size Program, the minimum by using the blowing principle.
13 Games that can be used required sample size is 14 children, with a 10% dropout include pursed lips blowing play11, bottle-blowing rate .
, resulting in a total sample of 15 children.
activities,12 blowing a melodica, and other similar blowing exercises.
10 The best way to use pursed lips blowing play is by applying the PLB technique, where Primary data directly from information and pre- and post-intervention results.
The the child inhales deeply and exhales through the mouth intervention in this study was adapted from the standard with pursed lips.
PLB technique.
The procedure consisted of the The novelty of this study lies in the modification of the following steps: .
the child was positioned in a conventional PLB technique into a play-based breathing comfortable sitting posture with relaxed shoulders.
JKEP (Jurnal Keperawata.
Vol 10 Issue 2.
November 2025.
Page 194-201 e-ISSN: 2354-6050 the child was instructed to inhale slowly through the differences in immunity between male and female nose for approximately two seconds.
exhalation was performed PLB for a longer duration .
hree to four Table 1.
Characteristics of Respondents second.
to create mild positive airway pressure.
Characteristics Age 3-6 Years 7-12 Years Total Gender Male Female during exhalation, the child was asked to blow onto a plastic plate toy to maintain pursed lips positioning and promote prolonged expiration.
the breathing cycle was repeated 5Ae10 times per session, twice daily, for four consecutive days.
This modification was designed to maintain the physiologic mechanism of PLB while Total Nutrition Status Underweight Good Nutrition Malnutrition Total Duration of illness 2 Days 3 Days Total Temperature Total increasing cooperation and engagement in pediatric The univariate data is presented descriptively in the form of frequency tables.
Statistical analysis was performed using the Wilcoxon test.
RESULTS AND DISCUSSION
Based on the results in Table 1, it was found that the majority of respondents were aged 3-6 years .
3%),
most were male .
0%), the majority of respondents with pneumonia had an underweight nutritional status .
3%), and most had a temperature greater than 37AC.
The most common age group is 3-6 years old .
3%),
while the least common age group is 7-12 years old .
7%).
The 3-6-year age group is at risk of developing pneumonia because their immune systems are still Poor and inadequate nutritional status can lead to weaker compared to those of adults.
14 For preschool immune system disorders.
Almost all mechanisms of the children, their growth is stable.
Development occurs body's defense deteriorate in a state of malnutrition.
through increased physical activity, improved skills, and Malnutrition disrupts the physiological function of the the development of thinking processes.
15 Children are at respiratory system, which increases the risk of higher risk for pneumonia in toddlers, influenced by maximum lung ventilation.
This is due to a lack of anatomical differences in the respiratory tract between muscle mass in the chest muscles, leading to suboptimal male and female children.
14 The highest frequency of chest expansion.
pneumonia cases in children occurs in males .
0%),
with the remainder in females .
0%).
Male children Pneumonia is classified as a disease ranging from mild, are more susceptible to pneumonia compared to female non-acute conditions to life-threatening ones.
Chronic The respiratory tract in male children is diseases can affect quality of life, but frequent acute and smaller compared to female children, or there are recurrent infections can also impact the health of some JKEP (Jurnal Keperawata.
Vol 10 Issue 2.
November 2025.
Page 194-201 e-ISSN: 2354-6050 1 The symptoms of pneumonia in children do Therefore, the Wilcoxon test was used to analyze these not always correspond to the stage or duration of the The possible reasons for the discrepancy Table 2.
The Effect of Modified Pursed Lips Breathing Play on Oxygen Saturation in Children with Pneumonia between symptoms and the duration of the illness are the child's nutritional status, the presence of comorbidities, complications, the causative bacteria, and the presence of viral co-infections.
18 Therefore, the duration of the illness does not significantly affect the oxygenation Variabel Mean Std P-Value Oxygen Saturation Fever increases tissue oxygen demand and enhances CO2 production.
4 If the fever persists, the metabolic Based on Table 2, the change in oxygen saturation rate remains high, causing stored proteins in the body (SpO.
before and after the intervention was -2.
to break down, leading to muscle weakness and loss of with a standard deviation of 0.
Further analysis muscle mass, such as in the respiratory muscles and shows that the average oxygen saturation after the 17 The body attempts to adapt to the intervention is higher compared to before the increased carbon dioxide levels by increasing the intervention, with a p-value .
<=0.
, indicating frequency and depth of breathing to eliminate the a significant effect of tongue-blowing play on oxygen excess carbon dioxide.
16 Respiratory effort increases, saturation in children with pneumonia in the Pamboang and eventually signs and symptoms of hypoxemia Community Health Center area.
Figure 1.
Increase in Oxygen Saturation in Children with Pneumonia in the Pamboang Community Health Center Area The intervention resulted in a meaningful improvement in respiratory efficiency, as indicated by a significant reduction in the mean respiratory rate from 39.
Graph of Oxygen Saturation Increase breaths/min before the intervention to 35.
07 breaths/min afterward .
= Ae4.
73 breaths/min.
p = 0.
This numeric decline reflects a decreased respiratory workload and improved expiratory control, suggesting that modified PLB effectively enhances ventilation and reduces tachypnea in children with pneumonia.
Based on the results of the normality test, the p-values for pre-test and post-test oxygen saturation using the Based on Figure 1, it can be seen that the lowest average Shapiro-Wilk test were greater than = 0.
This oxygen saturation is the SpO2 before intervention 1, indicates that the data are normally distributed.
which is 92.
80%, and the value with the highest average.
Therefore, the data can be analyzed using a Paired T- indicating a significant increase, is the oxygen saturation Test.
after intervention 4, which is 95.
The results showed that the p-values for pre-test and Table 3.
The Effect of Modified Pursed Lips Breathing Play on Respiratory Rate Reduction in Children with Pneumonia post-test respiratory rates were less than = 0.
Therefore, it can be concluded that the data are not normally distributed, as the p-value is < = 0.
JKEP (Jurnal Keperawata.
Vol 10 Issue 2.
November 2025.
Page 194-201 Variabel Respiratory e-ISSN: 2354-6050 Mean The intervention resulted in a meaningful improvement Rank Value in oxygenation status, with mean oxygen saturation 7,50 0,001 increasing from 92.
80% before treatment to 95.
after the four-day intervention period .
= 2.
Based on Table 3, it shows that the mean rank is the This rise in SpOCC demonstrates enhanced reduction in the respiratory rate of children with alveolar ventilation and better gas exchange, indicating pneumonia before and after, which is 7.
50, while the p- that modified PLB play supports more effective oxygen value .
001 < 0.
indicates that there is an effect of perfusion in children with pneumonia.
playing tongue blowing on the reduction of respiratory Table 5.
Effect size of modified Pursed Lips Breathing (PLB) play on respiratory rate in children with pneumonia rate in children with pneumonia at the Pamboang Community Health Center Area.
Figure 2.
The Effect of Modified Pursed Lips Breathing Play on the Reduction of Respiratory Rate in Children with Pneumonia The statistical test results using the Wilcoxon test Graph of Respiratory Rate Reduction showed a p-value of 0.
001, which is less than 0.
meaning there is an effect of playing tongue blowing on the reduction of respiratory rate in children with pneumonia in the Puskesmas Pamboang area.
Based on the results shown in Figure 1, the respiratory rate measurement before intervention 1 showed the highest value at 6.
7, while the lowest value was the respiratory rate after intervention 4, with a value of 1.
This indicates a significant reduction in respiratory rate from the first .
to the eighth .
The Wilcoxon test results show a p-value of 0.
001 < 0.
meaning there is an effect of playing tongue blowing on Based on the graph above, it can be seen that the the reduction of respiratory rate in children with respiratory rate in relation to playing tongue blowing shows the highest mean value for the respiratory rate It is clearly seen in the graph of respiratory rate before intervention 1, which is 6.
7, while the lowest reduction after the tongue-blowing intervention.
The mean value, indicating a significant decrease, is the respiratory rate before intervention 1 shows the highest respiratory rate after intervention 4, which is 1.
value, serving as the baseline for measuring changes in Table 4.
Effect size of Modified Pursed Lips Breathing (PLB) play on oxygen saturation in children with pneumonia respiratory rate reduction.
After intervention 1, a reduction in the respiratory rate was observed, indicating the effect of playing tongue blowing in effectively addressing the respiratory rate issue in children with pneumonia.
Moving on to the respiratory rate before intervention 2, a further reduction was noted from the previous measurement, meaning that playing JKEP (Jurnal Keperawata.
Vol 10 Issue 2.
November 2025.
Page 194-201 e-ISSN: 2354-6050 tongue blowing continues to have a positive impact on enhance the flexibility of the chest cavity and addressing respiratory rate issues.
The respiratory rate diaphragm, as well as train the expiratory muscles, after intervention 4 proves that the conclusion of the increasing airway pressure during expiration.
This study shows a significant effect of tongue-blowing exercise can also induce a breathing pattern, especially intervention on reducing the respiratory rate in children slowing down the respiratory rate, and it should be with pneumonia.
performed regularly.
Pursed lips breathing, when Administering the tongue-blowing game is effective in performed by blowing into a melodica, has an effect on regulating respiratory rate and breathing patterns, reducing shortness of breath, anxiety, and improving reducing air trapping, improving alveolar ventilation for quality of life.
10 Pursed lips breathing is a breathing better gas exchange, without increasing respiratory technique that is done calmly and relaxed to slow down effort, and coordinating and regulating the breathing the expiratory process and help expel trapped air from rate to make breathing more effective and reduce the airways.
With this technique, the exhaled air is shortness of breath.
Breathing exercises using the resisted by the two lips, creating a more positive pursed lips technique involve two mechanisms: strong pressure in the oral cavity.
10 This positive pressure inhalation and forceful, prolonged exhalation.
8 Forceful spreads throughout the narrowed airways, helping them and prolonged exhalation during pursed lips breathing stay open.
Opening the airways allows air to flow out of can reduce respiratory resistance and accelerate the the constricted passages and slightly reduces the effort intake or exhalation of air.
Forced and prolonged of the respiratory muscles, thereby alleviating shortness expiration can speed up both inhalation and exhalation, of breath.
thus preventing air sacs in the alveol.
Breathing exercises are performed to improve breathing CONCLUSION coordination, from rapid and shallow breathing to deep From the results of this study, it is concluded that the and slow breathing.
12 This exercise technique includes diaphragmatic breathing and pursed lips breathing to intervention was conducted.
Likewise, the oxygen improve ventilation and synchronize the work of the saturation increased after the intervention with the abdominal and chest muscles.
Pursed lips breathing also breath technique using the pursed lips blowing toys.
improves breathing patterns, increases tidal volume, and reduces shortness of breath.
Pursed-lips breathing ACKNOWLEDGMENT enhances respiratory muscle function, ventilation, and Thanks to the LPPM Universitas Sulawesi Barat for The study found that the pursed lips breathing technique providing funding for the research implementation process.
can increase the expansion of the alveoli in all lobes and REFERENCES