Which breathing techniques help with COPD?
Pursed-lip breathing, diaphragmatic breathing, breathing control and positions that ease breathlessness are commonly taught to people with COPD. A Cochrane review found that breathing exercises improved walking distance, although effects on breathlessness and quality of life were inconsistent. They are usually taught alongside exercise training in pulmonary rehabilitation.
Why are breathing techniques used in COPD?
In COPD, air can become trapped in the lungs, and breathing becomes fast and shallow during activity or anxiety. Breathing techniques aim to slow breathing, improve the efficiency of the breathing muscles, reduce trapped air and help people feel more in control.
They are commonly taught as part of pulmonary rehabilitation, and British Thoracic Society guidance on pulmonary rehabilitation covers the components of programmes for people with chronic respiratory disease 2.
What is pursed-lip breathing?
Pursed-lip breathing involves breathing in gently through the nose and breathing out slowly through pursed lips, as if blowing out a candle, taking about twice as long to breathe out as to breathe in. This creates gentle back pressure that helps keep airways open and slows breathing.
It is useful during activities such as climbing stairs or lifting, and for recovering after exertion.
What is diaphragmatic breathing?
Diaphragmatic breathing, or abdominal breathing, encourages use of the diaphragm rather than the upper chest and shoulder muscles. Sitting or lying comfortably with one hand on the chest and one on the abdomen, the person breathes in so that the abdomen rises more than the chest.
Some people with severe COPD find this technique difficult or uncomfortable, so it is taught and adapted individually.
What does the evidence show?
A Cochrane review of 16 studies with 1,233 people with COPD found that three months of yoga with pranayama timed breathing improved six-minute walk distance by 45 metres compared with control 1. Single studies of pursed-lip breathing and diaphragmatic breathing reported improvements of 50 and 35 metres respectively 1.
Effects on breathlessness and quality of life were inconsistent across trials, and no significant adverse effects were reported. The review concluded that breathing exercises may be useful for people who cannot take part in exercise training 1.
Which positions help breathlessness?
Leaning forward while sitting with the forearms resting on the thighs or a table, standing leaning forward with hands on a wall or railing, or leaning back against a wall can reduce the work of breathing and help recovery.
Combining these positions with breathing control, slow relaxed breathing using the lower chest with the shoulders relaxed, helps during episodes of breathlessness.
What about airway clearance?
People who produce a lot of sputum may benefit from airway clearance techniques, such as the active cycle of breathing techniques, which combines breathing control, deep breaths and huffing, or devices that create vibration or pressure during breathing out.
A respiratory physiotherapist can teach the technique that suits individual needs.
How can breathing techniques help during daily tasks?
Combining breathing control with movement makes tasks easier. For example, breathing out while doing the effortful part of a task, such as standing up, lifting or reaching, and breathing in during the easier part.
Pacing tasks, sitting to wash or dress, keeping frequently used items within easy reach and planning rest breaks help conserve energy. An occupational therapist can suggest practical changes at home.
What should I do during a sudden episode of breathlessness?
Stop and rest in a position that eases breathing, such as sitting and leaning forward. Relax the shoulders, use pursed-lip breathing and try to slow the breath gradually. Use your reliever inhaler or other treatments as prescribed.
Having a written plan agreed with your clinician helps you know what to do and when to seek help. If breathlessness does not settle with your usual measures, seek medical help.
When should breathing difficulties be assessed urgently?
Seek urgent medical help for severe breathlessness that does not improve with rest and usual treatment, chest pain, blue lips, confusion or drowsiness.
Increased sputum, change in sputum colour, fever or worsening breathlessness over a few days may indicate a flare-up.
Frequently asked questions
How often should I practise breathing exercises?
Practise when relaxed several times a day so the techniques come naturally during breathlessness.
Can breathing exercises replace inhalers?
No. Breathing techniques complement, but do not replace, prescribed medicines.
Does singing help COPD?
Some people find singing for lung health groups helpful for breathing control and wellbeing, though research is still developing.
Can anxiety make COPD breathlessness worse?
Yes. Anxiety and breathlessness can feed each other. Breathing control and relaxation techniques help.
Sources
- Breathing exercises for chronic obstructive pulmonary disease — Cochrane Database of Systematic Reviews (2012)
- British Thoracic Society guideline on pulmonary rehabilitation in adults — Thorax (2013)
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