What is an Incentive Spirometer?

An incentive spirometer is a medical device used to help improve lung function after surgery – especially lung surgery – or after an illness such as pneumonia. It’s also commonly prescribed to patients recovering from heart surgery or any other surgery involving prolonged anesthesia and/or post-operative, in-bed recovery.

Purpose of the Incentive Spirometer

The incentive spirometer helps retrain your lungs to take slow, deep breaths, which can be difficult and/or painful following surgery or prolonged illness. The device measures how well your lungs fill up with air and helps the lungs maintain patency thus preventing atelectasis (collapse of the alveoli [air sacs] of the lungs).¹

Contraindications

The incentive spirometer is an effective, prophylactic tool for most people but may be contraindicated for the following groups of patients:²

• Patients who are unable to be instructed or supervised to assure proper use of the device.
• Patients who are uncooperative or unable to understand/demonstrate proper use of the device.
• Patients who are unable to take an effective deep breath.

Please note: the presence of an open tracheal stoma is not a contraindication but requires adaptation of the device.²

Benefits of the Incentive Spirometer

When used properly, the incentive spirometer has amazing effects on the lungs. One of the most important benefits includes the absence of, or the improvement in, signs and symptoms of atelectasis as evidenced by the following:¹

• Decreased respiratory rate
• Resolution of fever
• Return to normal heart rate
• Resolution of crackles/rales (abnormal lung sounds); return of normal breath sounds
• Normal chest X-ray
• Increased vital capacity (VC) and peak expiratory flow
• Return of functional residual capacity (FRC) or VC to pre-operative values

Moreover, the device can also help improve the muscles that control inspiration as evidenced by the following:¹

• Attainment of pre-operative flow and volume levels
• Increased forced vital capacity (FVC)

How to Use an Incentive Spirometer

The incentive spirometer is a plastic device that consists of a clear tube with a moveable piston. The tube is marked with a gradient scale to measure your progress. The tube is connected to an inhalation nozzle and another tube with a small ball in it to indicate whether you are inhaling with sufficient force. Benefits of the device are fully dependent upon its proper use.^[1]

To follow are step by step instructions on how to use an incentive spirometer:^[2]

1. Move the slider on the outside of the large column to the level your doctor recommended.
2. Stand or sit at the edge of the bed or as upright in bed as possible.
3. Hold the device in front of you in an upright position.
4. Place the mouthpiece in your mouth and seal your lips tightly around it.
5. Begin by exhaling normally. Next, inhale as slowly and as deeply as possible. Notice the piston in the large column moving upward. Try to move the piston to the preset level that your doctor recommended. When you’ve inhaled as much as possible, try to hold your breath for 2 to 5 seconds.
6. Remove the mouthpiece and exhale normally. Repeat steps 1 through 6 as many times as your doctor recommended. After you’re finished, try to cough a few times to loosen any mucus that has built up in your chest.

Please note: if you’ve just had surgery and have an incision on your chest or abdomen, try holding a pillow over the incision while you’re using the incentive spirometer and/or when you cough. This will help support the area and minimize pain.¹

How Often Should I Use the Incentive Spirometer?

A number of experts suggest using the incentive spirometer 5 to 10 breaths per session, at a minimum, every hour while you’re awake.^[3] Your doctor may recommend a different schedule and it’s always best to follow her instructions.

Tip: to keep track of your progress, write down each time you perform this exercise and how far the piston moves upward in the larger column.  Then, show the record to your doctor at your follow-up appointment.

For more information about using an incentive spirometer, talk to your primary care provider, pulmonologist or respiratory therapist.

 _{[1] COPD Foundation. What is an Incentive Spirometer and How Do I Use It? Accessed March 18, 2018.}

_{[2] WebMD. Breathing Exercises: Using a Manual Incentive Spirometer. Last updated September 9, 2014.}

_{[3] AARC Clinical Practice Guideline: Incentive Spirometer. Respir Care 1991;36(12):1402–1405.}