ARTICLE INFO

Article Type

Original Research

Authors

Hosseinzadeh Yonesi   E. (1 )
Mircheraghi   S.F. (2 )
Mohammdzadeh Moghadam   H. (3 )
Mojalli   M. (* )






(* ) Nursing Department, Nursing & Midwifery Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(1 ) Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
(2 ) Internal Medicine Department, Medicine Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(3 ) Community Medicine Department, Medicine Faculty, Gonabad University of Medical Sciences, Gonabad, Iran

Correspondence

Article History

Received:  June  21, 2017
Accepted:  November 8, 2017
ePublished:  January 11, 2018

BRIEF TEXT


Chronic obstructive pulmonary disease is one of the major causes of mortality in developing and developed countries, and its morality rate is increasing [1]. … [2-7]. In the course of chronic obstructive pulmonary disease, there are periods of exacerbation of symptoms, which is called acute exacerbation of the disease.

… [8-10]. Different drugs such as airway dilators [11], corticosteroids [12], antibiotics and mucolytic [13] are used today to treat chronic obstructive disease. New medicine, despite its abilities and values, has problems in the treatment of certain diseases, especially chronic diseases [14]. In patients with chronic obstructive pulmonary disease, despite receiving of therapeutic treatment, there is no complete recovery, and only the symptoms of the disease in these people are reduced. Given the high cost of treatment, and the fact that each drug in addition to beneficial effects is along with unwanted side effect, the choice of a drug that has less side effects is preferred [15]. Today, the use of complementary and alternative therapies in nursing and patient care has been considered which can be better utilized in providing better care of patients [16]. … [17-20]. Thyme is considered to be a unique medicinal herb with the potent mucosal effects and reduces bronchospasm [21]. … [22].There are numerous mucosal and anti-cough products of thyme in various forms such as syrup, drops, elixirs, pills and capsules in many countries of the world [23], but in lung diseases, the best method of prescribing is its inhaling[24]. … [25, 26].

Given the anti-inflammatory and anti-spasm properties mentioned for thyme, its use for improving respiration and wheezing can be of benefit to patients. Considering the lack of studies and research findings on the effect of thyme inhaling on the respiratory rate and wheezing in patients with acute exacerbation of chronic obstructive pulmonary disease, the aim of this study was to determine the effect of thymus vulgaris inhaling on wheezing and respiratory rate in patients with acute exacerbation of chronic obstructive pulmonary disease.

A present study is a randomized, controlled, single-blind clinical trial.

This research was conducted in the society of patients with acute exacerbation of chronic obstructive pulmonary disease of the emergency department of the 22nd Bahman Hospital of Gonabad in 2016.

A total of 60 people were selected through convenience sampling method. The sample size was calculated based on a pilot study and 10 subjects (5 in the intervention group and 5 in the control group), using the formula for comparing the means and taking into account the 95% confidence coefficient, and 90% test power, and based on the number of respiration before and after calculation. After calculating 10% sample loss, the sample size was considered as 30 for each group. Then, the samples were randomly divided into two groups of intervention and control using the permutation blocks (Quadruple blocks). The criteria for entry into the research include the absence of an anatomical problem in case of consent to participate in the study, completion of the consent form, to be aware of time, place, and persons and to understand the purpose of the study, ages between 50 and 70 years, lack of sensitivity to perfumes and essential oils of plants, non-pregnancy, no other serious illness diagnosed by a specialist, no nausea and vomiting. Exit criteria were also the patients` unwillingness to continue the study, herbal inhaling sensitivity, and lack of tolerance to the mask of treating inhale.

After approving the project and agreement of the Ethics Council of Gondabad University of Medical Sciences with the ethics code of IR.GMU.REC.1395 and registering at the Iranian Registry of Clinical Trials with the code of IRCT2017020732436N1, the researcher selected the patients for the research. After explaining the research objectives to the patient or his legal guardian, written and informed consent was obtained. One minute before the intervention, the number of respiratory cases in the two groups was calculated by counting chest up and down for one minute by a researcher helper who was not aware of the intervention, and the information about the patient's visit was collected and recorded by a stethoscope with the help of an internist specialist. The intervention group received Thymus vulgaris 1% inhaling as much as 5ml for 15 minutes through inhaling treatment mask, and the control group used distilled water inhaling for the same amount and duration with inhaling treatment mask. One minute after the intervention, again, the number of respiration and information about the visiting of patients were recorded. Data analysis was performed using SPSS 22 software. Chi-square test was used to analyze the gender homogeneity of the control and intervention groups and the severity of their wheezing after intervention. Independent t-test was used to examine the age status of the two groups and compare the mean of respiratory rate before and after the inhaling, and paired t-test was used to intra-group study of number of the respiration before and after inhaling in two groups of control and intervention.

The mean age in the control and intervention groups was 60.96±8.29 and 60.33±8.25 years respectively. Also in the control group 16(53.3%) and 14(46.7%) were female and male respectively, and in the intervention group, 11(36.7%) and 19(63.3%) were female and male respectively. The two groups was not significantly different in terms of age and gender and they were homogeneous (p>0.05). In the intervention group, after inhaling, the mean number respiratory rate was significantly reduced compared to before, but there was no significant change in the control group (Table 1). After inhaling, the severity of wheezing in the intervention group was reduced in 17 (56.3%) patients and was unchanged in 13(43.7%) patients. In the control group, however, the severity of wheezing was reduced in 3(10.0%) persons and did not change in 27(90%). The reduction of wheezing severity in the intervention group was significant (p=0.001).

The thyme inhaling intake group had a significant decrease in the number of respiration and wheezing. Given the newness of this research, there was no direct finding that confirms our research results. However, researchers have used thyme as herb with antispasmodic properties on the smooth muscle, anti-inflammatory and antimicrobial properties which are the main components for the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease. Among them, in the study by Boskabady et al. about the effect of thyme loosening on the smooth muscle of the pig`s trachea have shown that the effect of thyme is comparable to that of theophylline [27]. Van Den Broucke's study also states that the thyme flavonoid substance well inhibit contraction caused by cellular depolarization, which causes the block of calcium channel. This finding is well documented by the antispasmodic properties of thymus plant [28]. Meister et al. have exposed the smooth muscle of pig`s trachea to thyme extract and have confirmed the antiprostaglandin and antispasmodic effects of thyme [29]. However, in the study of Bayat et al., thyme drops did not affect the severity of wheezing in patients with chemical bronchitis [30]. The results of this study were inconsistent with the results of this study. According to the researcher, this inconsistency cannot be decisive factor in the rejection of the bronchodilatory effects of thyme, but maybe the inability to dilate airways in patients with bronchitis is due to possible lung fibrosis in the patient. … [31-42].

Given that many studies, including the current study, have confirmed the antispasmodic, anti-inflammatory and antimicrobial effects of thyme, inhaling of thyme should be considered as an option to improve the oxidation in patients with chronic obstructive pulmonary disease. Also, inhaling treatment, can be used as a convenient and non-invasive approach which does not require specific time and high-cost equipment and is applicable in health centers and homes. Although, after further research, one can definitely comment on this, it is recommended to use thyme inhaling at higher concentrations and at specific intervals for patients to test the results.

The limitation of this study was the sensitivity to the herbal essential oil smell in other patients who were in the patient's room, but were not included in the study, that the pungent smell of thyme was not pleasant for some patients.

Thymus vulgaris inhaling is effective in reduction of wheezing and respiratory rate in patients with chronic obstructive pulmonary disease in acute exacerbation phase.

In the end, the Graduate Council of the Nursing and Midwifery Faculty and the Student Research Committee of Gonabad University of Medical Sciences and the respectful colleagues of the Emergency Department of the 22nd Bahman Hospital and all the patients participating in this study and their families are thanked and appreciated.

Non-declared

The project is approved by the Ethics Committee of Gonabad University of Medical Sciences with code IR.GMU.REC.1395.

This research is a part of the dissertation at the Master's Degree in Nursing Intensive Care Units, Nursing and Midwifery Faculty of Gonabad University of Medical Sciences.

TABLES and CHARTS

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