<b>Combined Effects of Balloon Blowing Therapy with Percussion on Pulmonary Functions in Patients with Pneumonia</b>

Background: Pneumonia is a leading cause of morbidity and mortality globally, especially in low-resource settings where access to advanced diagnostic and therapeutic modalities is limited. Chest physiotherapy techniques, such as percussion and active cycle of breathing techniques (ACBT), are widely used to facilitate airway clearance. Balloon blowing therapy (BBT), a low-cost, non-invasive intervention, has shown promise in enhancing respiratory muscle strength and pulmonary function, but its combined effect with percussion in pneumonia has not been adequately studied. Objective: To evaluate the combined effects of balloon blowing therapy with percussion on pulmonary functions in patients with pneumonia. Methods: A single-blinded, randomized clinical trial was conducted at Services Hospital, Lahore, involving 40 adult pneumonia patients randomized into two groups. Group A received ACBT, BBT, and percussion; Group B received ACBT and percussion alone. Interventions were administered daily over 7 days. Primary outcomes included forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and FEV₁/FVC ratio, assessed by spirometry. Secondary outcomes were CASA-Q scores and breath sound evaluation via auscultation. Statistical analysis was performed using SPSS version 25 with significance set at p < 0.05. Results: Group A showed significantly greater improvement in FVC (mean difference: 2.01 L vs. 1.49 L; p < 0.001) and CASA-Q scores (p < 0.001). Both groups improved in FEV₁, but only Group A exhibited a notable reduction in FEV₁/FVC ratio due to disproportionate FVC gain. Conclusion: The combination of balloon blowing therapy with percussion significantly enhances pulmonary function and symptom resolution in pneumonia patients compared to standard physiotherapy, supporting its integration into respiratory rehabilitation protocols.