# Pursed-lip breathing for breathlessness: step by step

Source: https://breathingexercises.uk/exercises/pursed-lip-breathing/
Author: Nell Avery · Updated 2026-11-04

**Short answer:** Pursed-lip breathing means breathing in gently through your nose and breathing out slowly through lips shaped as if to whistle, with the out-breath about twice as long. It slows your breathing and helps you empty your lungs, so you feel less breathless. It is one of the main techniques taught in NHS pulmonary rehabilitation for COPD.

**Evidence grade:** Moderate evidence. Trials point the same way but are small or few, or large long-term studies agree but cannot prove cause and effect.

## What is pursed-lip breathing?

When you are breathless, it is natural to breathe fast and shallow. In COPD that makes things worse: the narrowed airways close before the air is out, so stale air gets trapped and each new breath is harder. Pursed-lip breathing slows the out-breath and keeps the airways open a little longer, so you empty your lungs better. Many people with COPD discover it on their own.

## When should you use it?

- During anything that makes you breathless: walking, stairs, getting dressed, carrying shopping.
- To recover when you are out of breath, ideally in one of the [positions that ease breathlessness](/exercises/positions-for-breathlessness/).
- With [blow as you go](/exercises/blow-as-you-go/): breathe out through pursed lips during the effort.

## What the research shows

A Cochrane review of breathing exercises in COPD (16 studies, 1,233 people) found that breathing exercises over 4 to 15 weeks improved how far people could walk in six minutes. In a single study of pursed-lip breathing, 60 people improved their walking distance by about 50 metres. Effects on breathlessness and quality of life were inconsistent across trials. The review suggested breathing exercises may be most useful for people who can't do exercise training.

Pursed-lip breathing is now usually taught as part of pulmonary rehabilitation, the NHS exercise and education programme for COPD. Pulmonary rehabilitation as a whole has strong evidence: a Cochrane review of 65 trials found it improves breathlessness, fatigue, quality of life and exercise capacity. If you have COPD and haven't been offered it, ask your GP. See [breathing exercises for COPD](/conditions/copd/).

## Common mistakes

- **Blowing hard.** The out-breath should be gentle and slow, like cooling soup, not blowing out birthday candles in one go.
- **Breathing in through pursed lips.** Breathe in normally, through your nose if you can.
- **Only using it when exhausted.** It works best if you start before you get very breathless.

## Make it easier or harder

- **Easier:** practise sitting, at 2 in and 3 out, then 2 in and 4 out.
- **Harder:** use it while walking, timing your breaths to your steps, then on stairs with [paced breathing](/exercises/paced-breathing/).

## Frequently asked questions

### How does pursed-lip breathing help?

Breathing out against slightly pursed lips slows the out-breath and keeps a little back-pressure in the airways, which helps stop them narrowing too early. You empty your lungs more fully, breathe more slowly and the next breath in is easier.

### When should I use pursed-lip breathing?

Whenever you feel breathless, and during anything that makes you breathless, such as walking, climbing stairs, bending or carrying. Combine it with blow as you go and the positions that ease breathlessness.

### Does pursed-lip breathing help anxiety?

It slows your breathing and can help you feel more in control, which eases the panic that often comes with breathlessness. For anxiety without breathlessness, other slow breathing exercises are more commonly used.

## References

1. [Holland AE et al. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2012.](https://pubmed.ncbi.nlm.nih.gov/23076942/)
2. [McCarthy B et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015.](https://pubmed.ncbi.nlm.nih.gov/25705944/)
3. [NHS. Chronic obstructive pulmonary disease (COPD): treatment.](https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/)
4. [Asthma + Lung UK. Breathlessness.](https://www.asthmaandlung.org.uk/symptoms-tests-treatments/symptoms/breathlessness)