Positions to ease breathlessness: sitting, standing and lying

Why does your position matter?

Your diaphragm works best when it is dome-shaped. In COPD, and whenever you are very breathless, your lungs stay over-full and push the diaphragm flat, so each contraction moves less air. You then lean on the muscles of your neck, shoulders and upper chest, which tire quickly.

The positions on this page help in two ways. Leaning forward lets your tummy press gently up under the diaphragm and restore some of its dome. Resting your arms on something steadies your shoulders, so the muscles that run from your shoulders to your ribs can lift the chest instead of lifting your arms. Many people with COPD find these positions on their own; you will often see someone leaning on a shopping trolley or a wall to get their breath back.

When should you use them?

• To recover after walking, stairs, washing or dressing.
• During a flare-up, while you wait for your reliever or other medicines to work.
• At night, if lying down makes you breathless.
• When you are out: a wall, railing, bus shelter or trolley will do.

Once you are in position, slow your breathing with pursed-lip breathing or gentle diaphragmatic breathing.

What the research shows

The idea goes back to physiology studies in the early 1980s, which found that many people with severe COPD were less breathless leaning forward, and that their diaphragms worked more efficiently in some positions than others.

A 2024 study measured the activity of the breathing muscles in 16 people with COPD across eight positions. Sitting and leaning forward, with forearms on the thighs or on a table, needed the least muscle effort. Lying flat on the back needed the most. Standing leaning forward, leaning back against a wall, sitting upright and lying propped up all came in between.

These are small studies that measured muscle effort over minutes, not trials of how people fared over months, so we grade the evidence as weak. But the positions are free, safe and standard NHS advice, and many people find them the quickest way to get their breath back.

Common mistakes

• Hunching your shoulders. Let them drop away from your ears. If your shoulders are up, you are holding tension, not resting.
• Gripping hard. Rest your arms on the support; don’t push down on it.
• Lying flat. Lying on your back usually makes breathlessness worse. Prop yourself up.
• Only trying them in a crisis. Practise each position when you are well, so you can use it without thinking.

When breathlessness is an emergency

Call 999 if you are breathless and also have chest pain, blue or grey lips or skin, confusion or sudden drowsiness, or can’t speak in full sentences, or if your breathing doesn’t ease with rest and your usual medicines. See breathlessness: when to get help.