Effect of physiotherapy on single breath count and breath holding time in COVID-19 patients

Sushama A. Bhandare, Sayali S. Rasal, Anil M. Sathe, Vaishnavi R. Nagpure, Urvi B. Parmar, Saraswati K. Iyer


Background: The novel Coronavirus is known to primarily affect the respiratory system and physiotherapy treatment is integral to combat this infection. However, the assessment of pulmonary function poses a difficult challenge considering the risk of spread of infection and sanitisation of the devices used. Single breath count (SBC) and breath holding time (BHT) can be thus adopted as bedside assessment tests for pulmonary function following physiotherapy treatment.

Method: In this a retrospective observational study of 51 COVID-19 patients, mean age 51.7±14.56 years, on room air, admitted in the step-down units of a tertiary care hospital. Patients received standard physiotherapy treatment, within safe hemodynamic limits. Pre and post treatment session SBC was recorded in 32 patients and BHT in 19 patients. Three reading were noted and the best of three readings were used for analysis.

Results: The paired t test was used to analyse SBC and BHT. Mean pre and post SBC was 18.25±8.96 and 23.31±9.96 respectively with a mean difference of 5.06 and p<0.0001. Mean pre and post BHT were 19.37 and 23.05 seconds respectively with a mean difference of 3.68 and p<0.0001.  Statistically significant difference in the pre and post treatment session SBC and BHT was observed, indicating a positive effect of physiotherapy treatment on pulmonary function.

Conclusion: Physiotherapy treatment shows significant improvement in the pulmonary function in COVID-19 patients. SBC and BHT tests can be used as assessment and prognostic tools for pulmonary function in COVID-19 patients.


COVID-19, Single breath count, Breath holding time, Physiotherapy

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Chatterjee P, Nagi N, Agarwal A, Das B, Banerjee S, Sarkar S et al. The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence. Indian J Med Res. 2020;151(2):147.

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J autoimmunity. 2020;102433.

Baig AM. Computing the Effects of SARS-CoV-2 on Respiration Regulatory Mechanisms in COVID-19. ACS Chem Neurosci. 2020;11(16):2416-21.

Shakerian N, Mofateh R, Rezaei N, Saghazadeh A, Rezaei N. Potential prophylactic and therapeutic effects of respiratory physiotherapy for COVID-19. Acta Bio Medica: Atenei Parmensis. 2021;92:1.

Bhandare SA, Rasal SS, Iyer SK. Correlation of peak expiratory flow rate and single breath count in normal adults. Int J Res Med Sci. 2021;9(7):1960.

Ushkow BS, Bartfield JM, Reicho PR, Raccio-Robak N. Single-breath counting for the assessment of bronchospastic patients in the ED. Am J Emergency Med. 1998;16(1):100-1.

Sudha BS, Sunitha MS, Nataraj SM, Dhar M. A study of reduction in breath-holding time in smokers and recovery among ex-smokers in bus depot workers. Int J Health Allied Sci. 2012;1(3):166.

Kumari A, Malik S, Narkeesh K, Samuel AJ. Single breath count: A simple pulmonary function test using a mobile app. Indian J Thoracic Cardiovascular Surg. 2017;33(4):369-70.

Bhargava R, Gogate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol. 1988;32(4):257-64.

Kalirathinam D, Guruchandran R, Subramani P. Comprehensive physiotherapy management in covid-19–a narrative review. Scientia Medica. 2020;30(1):e38030.

Kalita J, Kumar M, Misra UK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome. J Clin Neurosci. 2020;72:50-6.

Elsheikh B, Arnold WD, Gharibshahi S, Reynolds J, Freimer M, Kissel JT. Correlation of single‐breath count test and neck flexor muscle strength with spirometry in myasthenia gravis. Muscle nerve. 2016;53(1):134-6.

Escóssio AL, Araújo RC, Oliver N, Costa EC, Rizzo JÂ, Sarinho ES et al. Accuracy of single-breath counting test to determine slow vital capacity in hospitalized patients. Revista CEFAC. 2019;21:2.

Bartfield JM, Ushkow BS, Rosen JM, Dylong K. Single breath counting in the assessment of pulmonary function. Ann emergency med. 1994;24(2):256-9.

Ali SS, O’Connell C, Kass L, Graff G. Single-breath counting: a pilot study of a novel technique for measuring pulmonary function in children. Am J emergency med. 2011;29(1):33-6.

Bagavad GM, Roopa S, Subhashini AS, Syed Sulthan K. Effect of physical training on breath holding time in Indian subjects. Indian J Physiol Pharmacol. 2014;58(1):108-9.

Aggarwal V, Godbole G, Agawane S, Pophale H, Magar P, Killedar R et al. Correlation of breath holding time with spirometry test-An alternative non technician dependent surrogate test for spirometry. Med Pulse Int J Med. 2018;5:69-73.

Slim A, Hedhli A, Rouhou SC, Mbarek N, Taboubi A, Benkhaled S et al. Maximal voluntary inspiratory breath holding time test in patients with chronic obstructive pulmonary disease. Euro Respiratory J. 2018;52:PA4053.

Hedhli A, Slim A, Ouahchi Y, Mjid M, Koumenji J, Rouhou SC et al. Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease. Am J Men's Health. 2021;15(3):15579883211015857.

Desai U. The Novel Measurements and Correlations for Pulmonary Function Tests (TNMC-PFT) in interstitial lung diseases (ILD)-Using technology to simplify patient care. Pneumon. 2019;32(4):132-6.

Palaniyandi AK, Natarajan M, Chockalingam A, Karthick R, Chitrakumar A. Even a single breath count. J Dental Med Sci. 2017;16(9):70-2.