Breathing Exercises for COPD

Having a health condition like COPD makes breathing more difficult. And feeling short of breath causes anxiety that leads to worsening breathlessness. Breathing exercises for COPD can help you strengthen your breathing muscles, get more oxygen and breathe with less effort.^[1]  The two most common breathing exercises for COPD are pursed-lip breathing and diaphragmatic breathing. Practicing these techniques on a daily basis will help decrease your anxiety and improve your breathing.

Pursed-Lip Breathing

According to the Cleveland Clinic, pursed-lip breathing improves ventilation, decreases the work of breathing, improves breathing patterns, promotes relaxation and relieves shortness of breath.

The following steps detail how to perform pursed-lip breathing:^[2]

1. Sit in a comfortable position and relax your neck and shoulder muscles.
2. With your mouth closed, slowly inhale through your nose while counting to two. Breathe normally avoiding a full, deep breath. If it helps, count to yourself: inhale, one, two.
3. Before you exhale, purse your lips as if you were getting ready to whistle or gently blow out the flame of a candle.
4. Exhale slowly out of pursed lip while counting to four. If it helps, count to yourself: exhale, one, two, three, four.
5. Repeat steps 1 through 4 until breathlessness is under control.

Practicing pursed-lip breathing on a daily basis, 3 to 4 times a day even when you’re not short of breath will allow you to master the technique so you can call upon it when breathlessness does occur.

Diaphragmatic Breathing

The diaphragm – a dome-shaped sheet of muscle separating the chest and abdominal cavities – is the principle muscle of breathing, contracting and relaxing with each breath. But diaphragm dysfunction is an important consequence of the progression of the severity of COPD.^[3] When the diaphragm weakens, people with COPD develop a breathing pattern that uses accessory muscles (neck, shoulders and rib muscles) to breathe. Diaphragmatic breathing is a technique that helps correct this habit by strengthening the diaphragm and abdominal muscles allowing more air to move in and out of the lungs. When used with pursed-lip breathing (see above) and practiced regularly, people with COPD can increase their exercise tolerance and live a better quality of life.

Practice the following steps 5 to 10 minutes at a time, 3 to 4 times a day to learn how to perform diaphragmatic breathing:

1. Lie down with your knees bent. Place a pillow underneath your legs to support your back. You can also do this exercise while sitting or standing upright once you’re comfortable performing the exercise lying down.
2. Place one hand on your abdomen, just below your waist and the other hand on your chest.
3. Inhale slowly and deeply through your nose while gently pushing out your abdomen. You should be able to feel the hand on your abdomen moving outward. Remember to allow your diaphragm do the work while your neck, shoulder, chest and rib muscles remain still.
4. Exhale slowly through pursed lips while gently pushing inward and upward on your abdomen to help empty your lungs completely.
5. Repeat steps 1 through 4 for 5 to 10 minutes.

At first, you may notice it takes an increased effort to use the diaphragm correctly. You may even get tired while performing this exercise. Don’t give up. If you continue to practice the technique on a daily basis, diaphragmatic will become easy and automatic.² 

_{[1] WebMD. “COPD and Exercise: Breathing and Exercise Programs for COPD”. Last reviewed July 11, 2014.}

_{[2] Cleveland Clinic. “Pursed Lip Breathing”. Last reviewed May 21, 2014.}

_{[3] Cancelliero-Gaiad, Karina M. et al. “Respiratory Pattern of Diaphragmatic Breathing and Pilates Breathing in COPD Subjects.” Brazilian Journal of Physical Therapy 18.4 (2014): 291–299. PMC. Web. 8 Jan. 2016.}

By Deborah Leader RN, BSN, PHN