BLOWING EXERCISE IN INCREASING LUNG CAPACITY IN CHILDREN WITH LUNG DISEASE: SYSTEMATIC REVIEW

Diseases of the lungs and airways are the most common conditions in the world, which can cause problems not only in the respiratory organs, but also abnormalities in the body's organ systems due to impaired air exchange during the breathing process. Infectious causes of lung and respiratory tract disease originate from bacterial, viral, fungal and parasitic infections, such as tuberculosis and pneumonia. Non-communicable causes of lung and respiratory diseases, originating from cigarettes or cigarette smoke, including pollution and hazardous materials, as well as genetics, such as COPD, asthma and lung cancer. The objective of this systematic review is to analyze blowing exercise by increasing lung capacity in children with lung disease. Methods used in compiling systematic reviews with electronic searches: ProQuest, ScienceDirect, SpingerLink, and SAGE Journals. The writing criteria are full text, keywords, abstract and publications in the 2019-2023 period. The research search found 11 articles that had been extracted. The results obtained, namely blowing exercise to increase lung capacity in children with pneumonia, have received a positive response and need to be developed dynamically.


INTRODUCTION
Age is a factor that can identify the risk of the disease being experienced.Different ages have different challenges and health problems experienced, especially at the age of children.This age is a vulnerable period in the emergence of disease.One of the health problems that often occur in children is lung disease.Lung and respiratory diseases are the most common conditions in the world.Which can cause problems not only in the respiratory organs but cause abnormalities in other systems that occur due to impaired respiratory air exchange (Robinson, 2018).It is estimated that the top 10 causes of death in the world in 2040 (Metrics, 2017).The morbidity of lung and respiratory tract diseases varies from mild and can heal on its own, for example, such as the flu to those that are severe and require treatment, such as tuberculosis, asthma, pneumonia to lung cancer.Infants and children are the most vulnerable groups to suffer and die from this disease.In fact, there is the nickname "The Big Five" for lung and airway diseases with the highest number of incidents and producing the world's largest burden of Disability-Adjusted Life-Years (DALYs), namely COPD (Chronic Obstructive Pulmonary Disease), asthma, acute respiratory infections, Tuberculosis (Tuberculosis), and lung cancer (Enarson, 2013).
Infectious causes of lung and respiratory tract disease originate from bacterial, viral, fungal and parasitic infections, such as tuberculosis and pneumonia.Non-communicable causes of lung and respiratory diseases, originating from cigarettes or cigarette smoke, including pollution smoke and other hazardous materials, as well as genetic/inherited, for example COPD, asthma and lung cancer (WHO, 2007).Compared with adults, the airways of children are more susceptible to obstruction because of their unique key anatomic attributes.Smaller radius causes higher resistance in the airways and increases the workload of breathing and susceptibility to inflammation.Consequently, the resulting increased work of breathing rapidly progresses to respiratory failure because the child has less respiratory reserve (Pfleger & Eber, 2013).
Abnormal breathing patterns can exacerbate respiratory muscle fatigue, causing dyspnea, low exercise capacity (Walsh & Oliver, 2016).In recent years, breathing exercises have attracted attention as a non-pharmacological breathing strategy aimed at correcting abnormal breathing patterns and promoting gas exchange between the lungs and capillaries to improve lung ventilation (Ozalevli et al., 2010).Several studies have shown that breathing exercises can improve gas exchange, encouraging the rehabilitation of COPD and asthma patients (Gosselink, 2003).Breathing is necessary for the purpose of maintaining active activity (Edwards, 2008), and regular breathing exercises increase lung capacity and increase respiratory support during a child's verbal activity.Following a program of breathing exercises can be a matter of life and death (Lange et al., 2011).However, it is difficult for children to remain interested in boring and long-lasting training models (Sonne & Jensen, 2016).Studies have concluded that play-based breathing systems are an effective way to increase children's compliance with breathing exercises.There are several methods for measuring respiration, including chest and abdominal movement detection, optical-based respiratory rate monitoring, and airflow-based methods (Al-Khalidi et al., 2011).
Patients with respiratory disorders experience decreased muscle strength and endurance, respiratory muscle fatigue, and energy consumption.Several studies, such as (BISaccioni et al., 2009), have shown that exercise programs and motor and respiratory therapy improve aerobic capacity, breathing patterns, muscle strength, and quality of life in patients with breathing, swallowing, and voice problems.Lung disease experienced by children can reduce the capacity of their lung organs.Therefore, it is necessary to do exercises that can be done by children, one of which is blowing exercise, which aims to increase lung capacity.So that children can continue their survival and development.

MATERIALS AND METHOD
Databases used in compiling this systematic review topic: ProQuest, ScienceDirect, SpingerLink, and SAGE Journals.Using the PICO format in identifying problems, interventions, group comparisons and outcomes, namely in children with lung disease is blowing exercise more effective than standard care in increasing lung capacity.By using the types of articles: Cohort studies, Case-Control studies, and Randomized Controlled Trials.

Inclusion and exclusion criteria
Inclusion criteria: patients with pulmonary disease, using English and Indonesian language references.Exclusion criteria: patients with disabilities, patients with psychiatric problems, articles included in the literature review, systematic review, and umbrella review.

Identifications of studies
Concepts and alternative PICO question formats: children with breathing disorders, Impact of blowing exercise, Standard care for children with lung disease, and measurement of lung capacity.Publications included in the literature reviews (n =11)

RESULTS
Based on the results of the publications included in the literature review in this article as many as 11 articles are summarized in the following table.The 90 respondents who underwent thoracoscopic pneumonectomy were divided into two groups of 45, using a completely randomized model.
The ABCDEF program of thoracoscopic pneumonectomy patients was found to be more effective in improving lung function at 3 months after discharge (p<0.05).There is no statistically significant difference (p>0.05).Different exercise tolerance (p<0.05).The incidence of postoperative complications in the experimental group was lower (p<0.05).Length of stay after surgery (p<0.05),but length of chest tube insertion was not significantly different between the intervention and control groups (p>0.05).

5.
ScienceDirect There was no significant difference in PFT values between the asthma and control groups before and after breathing exercises (P > 0.05).In the asthma group, there was a positive correlation between the percentage change in FEV1/FVC, FEF25-75 observed after breathing exercises and body mass index, waist circumference (P<0.05each).In the healthy group, the percentage change in FVC was higher (P<0.05).Among children with asthma, there was a greater increase in the percentage change in FEV1/FVC and in the percentage change in FEF25-75 in the treatment-free group of asthma (P < 0.05).

6.
ScienceDirect After preoperative breathing exercises, the intervention group differed significantly in terms of inspiratory capacity (P < 0.001) and walking distance of 6 minutes (P = 0.035) compared to the control group.On the first day after surgery, the intervention group had better inspiratory capacity and dyspnea than the control group.At discharge, dyspnea (P < 0.001), inspiratory capacity (P = treatment: A randomized controlled trial 0.003), anxiety (P < 0.001) and depression (P < 0.001) for patients in the intervention group improved significantly compared to controls.7. Respondents to this study were respondents with COPD, referred to a COPD-specific occupational therapist in the primary care setting, a total of 84 respondents.

DISCUSSION
Quality assessment for the determination of the article is carried out by the author by creating a frame of mind that raises the topic of discussion.A literature search based on keywords was carried out, thus obtaining the topic, "Clinical Issues of Blowing Exercise in Increasing Lung Capacity in Children with Lung Disease".The preparation of this literature review uses research articles or journals published for 5 years (2019)(2020)(2021)(2022)(2023).Journal criteria are research articles in English with research subjects being children with lung disease.Next, the authors began searching for articles in the database and screened the appropriate titles and abstracts to determine which articles were relevant to the topics discussed.Data analysis through a literature search conducted by the author relevant to the topic according to the provisions, all international articles.Furthermore, from the articles collected, a systematic analysis is carried out for each article with the results of using tools that have been adjusted to the types of articles found by the author.There are 4 databases used in screening for systematic review, namely from ProQuest, Science Direct, SpringerLink, and SAGE Journals.A total of 9 articles were obtained after screening based on keywords and according to the research questions.All articles have research categories in the last 5 years randomized controlled trial and casecontrol study designs.Search for articles through the keywords Lung Diseases, Blowing, and Lung Capacity.Through screening titles and abstracts in accordance with the limitations that have been made, including children with lung disease, blowing, standard care, and lung capacity.

CONCLUSIONS AND SUGGESTIONS
Diseases of the respiratory system often occur at the age of children; this is because the child's organs are still developing.Children with lung disease are often found when children are undergoing treatment in hospital which is the main cause of childcare or as a complication of other diseases.Lung disease also affects the capacity for lung expansion which can cause shortness of breath in children, obstruction in the airways, exudate buildup and decreased lung function.Care is needed in optimizing the recovery of children's health even in hospitalization conditions.However, it is not uncommon for hospitalization to result in child-care trauma.Therefore, atraumatic treatment is needed to reduce the impact of hospitalization trauma on children.one of them is by breathing relaxation using blowing.So that there is an increase in lung capacity in children with pulmonary disease.To restore function in the recoil and compliance.The results of research conducted by Barghi et. al (2022) showed that evaluating the effect of BBE (Ballon blowing Exercise) on dyspnea and oxygenation in acute phase COVID-19 patients showed a statistically significant difference in SpO2 in the two groups.Evaluation of use of the UL-OPEP device in children with CF for 1 month, determining its effectiveness compared to current standards of care (ie, use of existing devices) in a total of 36 responders in a local hospital's CF pediatric service (O' Sullivan et al, 2021).Another study stated that pulmonary rehabilitation developed to combat PEEPi and modulate lung function, exercise tolerance, hospitalization and HRQoL in COPD patients had clinically and statistically significant differences (p<0.001) at the end of the study, namely at 18 months (Lin et al., 2019).Zou et al., (2022) in their study stated that there was an effect of the ABCDEF pulmonary rehabilitation program on lung cancer patients who had undergone surgery in respondents who underwent thoracoscopic pneumonectomy which were divided into two groups with a completely randomized model found significant results.Meanwhile, other tests show how pulmonary function tests in children who play the block flute regularly affect diaphragmatic breathing (Atakul et al., 2022).There is an effect of giving breathing exercises to non-small cell lung cancer patients who receive surgical treatment at random to 65 respondents after preoperative breathing exercises (Y.Q. Wang et al., 2020).The results of research conducted by Struder et al., (2019) stated that playing the trumpet had a significant effect on lung function by recruiting 147 respondents.The effectiveness of home monodisciplinary OT in COPD patients is mentioned in a study conducted by Koolen et al., (2021) that it is effective for respondents with COPD disease.Another study stated that liuzijue qigong could improve the ability to control breathing and comprehensive speech in dysarthria stroke patients in all study respondents, a total of 98 patients participated for three weeks, significant in both groups.

ACKNOWLEDGEMENT
Breathing exercises using the blowing technique in children who are hospitalized with lung disease are effective in reducing the traumatic impact of hospitalization while children are undergoing treatment.Among them are using Pulse Lip Breathing, blowing trumpets, using traditional toys, balloon blowing, applications used for monitoring, using OT, chest breathing exercises with deep breaths, blowing beam flutes, pulmonary rehabilitation programs with ABCDEF and PEEPi, and using comparison devices. .Lung diseases that children suffer from include dyspnea in acute phase COVID-19 patients, cystic fibrosis, COPD patients, lung cancer, asthma, patients undergoing surgery, COPD patients, and patients with abnormal respiratory control.Interventions in the form of breathing exercises with blowing are effective in children with lung disease when compared to those given standard care to increase lung capacity.Increased lung capacity will also have an impact on the length of stay in children in the hospital.Many studies have been carried out by adjusting the characteristics and goals of the treatment.The results of the analysis of the articles in this systematic review have complied with the rules of searching the literature in accordance with the guidelines and tools used.This has been explained through in-depth criticism of roles that are in accordance with the articles design.

Table 1 .
Extraction of data results