The Effect of Deep Breathing Exercise Applied With Triflo on Dyspnea, Anxiety and Quality of Life in Patients Treated for COVID-19: Randomized Controlled StudyPatients Treated for COVID-19: A Randomized Controlled Study

The world is facing an extremely important global epidemic. Coronavirus disease 2019 (COVID-19) epidemic, which first appeared in Wuhan, China in late 2019 and rapidly affected all countries of the world, was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. Coronavirus disease 2019 affects both the upper (i.e. sinuses, nose and throat) and lower (i.e. trachea and lungs) airways, causes respiratory tract diseases ranging from asymptomatic or cold to more severe lung diseases (Acute Respiratory Distress Syndrome-ARDS). COVID-19 has many symptoms. Dyspnea is one of the most prominent symptoms for COVID-19. The relationship between dyspneaand COVID-19 is not fully explained. Our clinical observations are of the opinion that dyspnea is observed even in patients with mild COVID-19 pneumonia.

Since COVID-19 affects the respiratory system, pulmonary rehabilitation has an important place in the treatment of patients. Deep breathing exercise applied within the scope of pulmonary rehabilitation expands the airways, facilitates gas exchange, increases the amount of oxygen reaching the cells, provides the release of tracheabronchial secretions, regulates the pulmonary circulation and thus increases the lung capacity. Deep breathing exercise also plays a role in lowering blood pressure and in reducing / relieving anxiety. Studies have stated that patients who are trained about deep breathing have better exercise status, that deep breathing exercise have increased systolic and diastolic blood pressure of and anxiety at statistically significant level. Triflo is a device that helps the patient to breathe deeply. It is seen as more advantageous in terms of use, as it provides visual information about the depth of breathing. The use of Triflo is used to support the determination of the patient's inspiration capacity, normal inspiration and deep breathing.

COVID-19, it has been determined that it improves respiratory function, quality of life and anxiety of the elderly and has little effect on depression.

The effects of COVID-19 disease on the lung and respiratory system appear to be quite serious. Since there is not enough information about the long-term results yet, its effect on patients and lungs after active period is not clearly known. The one of the most important data the investigators have now is that most of the patients experience dyspnea. In the literature, there has been no study examining the effect of respiratory exercise on dyspnea, anxiety and quality of life in patients diagnosed with COVID-19 pneumonia. However, applying deep breathing exercise with triflo in COVID-19 patients, can contribute to relieving dyspnea, reducing / eliminating anxiety, reducing / eliminating respiratory system complications, preserving / improving respiratory function, maintaining or increasing lung volume, accelerating recovery and increasing quality of life. In the light of this information, the aim of this study is to determine the effect of deep breathing exercise with triflo on dyspnea, anxiety and quality of life in patients with dyspnea who are hospitalized for COVID-19.

MATERIALS AND METHODS This single-centered, randomized controlled study will be held in Ankara city hospital in Turkey. Ethics committee approval was obtained from Ankara City Hospital Ethics Committee (Date:12/23/2020 Number:E.Kurul-E1-20-1403). The investigators also have received permission from the Ministry of Health of the Republic of Turkey for the study (Date:12/04/2020- Name and number: Hatice ÖNER CENGİZ-2020-12-04T12_09_16). Before the study, "enlightened informed consent" will be obtained from all participants. The entire study will be conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines and directives.