Breathing exercises for COPD: techniques that ease breathlessness

Why breathing techniques help in COPD

In COPD the airways are narrowed and the lungs have lost some of their springiness, so air gets trapped when you breathe out. When you are breathless you naturally breathe faster, which leaves even less time to breathe out, so more air is trapped and each breath gets harder. Breathing techniques break that cycle: they slow your breathing, lengthen the out-breath and help you save energy for the things you want to do.

The techniques

• Pursed-lip breathing: breathe out slowly through pursed lips. The most useful single technique for breathlessness.
• Blow as you go: breathe out during the hard part of any effort, such as standing up or lifting.
• Paced breathing: match your breathing to your steps on stairs and when walking.
• Positions that ease breathlessness: lean forward with your arms supported to recover.
• Breathing control: gentle, relaxed breathing to recover between efforts.
• Active cycle of breathing: to clear phlegm, if you produce a lot.
• Inspiratory muscle training: for weak breathing muscles, usually with a physiotherapist.

What the research shows

A Cochrane review of 16 studies with 1,233 people with COPD found that breathing exercises practised for 4 to 15 weeks improved how far people could walk in six minutes. Effects on breathlessness and quality of life were inconsistent. The reviewers suggested breathing exercises may be most useful for people who can’t take part in exercise training.

Not every technique suits everyone. In a small study of seven people with severe COPD, learning diaphragmatic breathing made their breathing less efficient and tended to make them more breathless. That is one reason it is best to be assessed by a respiratory physiotherapist.

For breathing muscle training, a meta-analysis of 32 trials found it improved strength, walking distance, breathlessness and quality of life, though it adds less on top of a full rehabilitation programme.

Pulmonary rehabilitation

The breathing techniques above are usually taught as part of pulmonary rehabilitation, a programme of exercise and education run by the NHS, typically twice a week for at least six weeks. A Cochrane review of 65 trials with 3,822 people found it eases breathlessness and fatigue, improves quality of life and helps people do more. NICE recommends it for people with COPD who are limited by breathlessness, usually those who have to walk more slowly than others or stop for breath on the flat. NICE also recommends that people with COPD who have a lot of phlegm are taught the active cycle of breathing or a positive expiratory pressure device.

If you haven’t been offered pulmonary rehabilitation, ask your GP. We grade breathing exercises for COPD as moderate, and pulmonary rehabilitation as a whole has strong evidence.

When to get help

Use your COPD self-management plan and rescue medicines for flare-ups as your GP or nurse has advised. Call 999 if you are very breathless and it isn’t easing with rest and your medicines, or you have chest pain, blue or grey lips or skin, or new confusion or drowsiness. See breathlessness: when to get help.