This finding agreed with the conclusions of Jones et al 5 who evaluated the effects of diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing in 30 subjects with COPD.
The investigators also found a greater decrease in the breathing frequency when diaphragmatic breathing and pursed-lips breathing were combined compared with quiet breathing and with diaphragmatic breathing separately.
The decrease in expiratory flow leads to a lower drop in the pressure along the airways, which prevents the collapse of the airways and, therefore, reduces air trapping. Thus, it is suggested that subjects with minor lung elastic recoil pressure would benefit the most from this technique. Jones et al 5 also evaluated oxygen consumption during spontaneous breathing at rest and during breathing exercises diaphragmatic breathing and diaphragmatic breathing plus pursed-lips and found no changes in this variable among the 3 conditions.
However, this variable was not assessed in our study, which limits comparisons. Moreover, dynamic hyperinflation and diaphragmatic mobility were not directly analyzed, which limits a possible distinction among subjects who may have responded differently to the breathing exercises. Future studies should include these parameters in the analysis of the effects of combined breathing exercises to determine subjects who may receive the most clinical benefit.
This study supported the positive acute effects of diaphragmatic breathing and the diaphragmatic breathing plus pursed-lips breathing exercises for individuals with COPD. Moreover, it adds to the knowledge base regarding the effects of the combination of the exercises that had been previously assessed only for the outcomes of breathing frequency and oxygen consumption.
The addition of pursed-lips breathing to diaphragmatic breathing provided greater changes in breathing parameters, especially for time variables. In addition, the results of this study have important clinical implications for symptom management in individuals with COPD. The assessed breathing exercises were demonstrated to improve chest wall volumes and oxygenation, and to reduce breathing frequency without increasing dyspnea.
Therefore, these exercises might be helpful for individuals who feel anxious and tense when it is difficult to breathe, as well as for individuals trying to manage sudden COPD symptoms. The exercises may play a role in care and symptom management, and thus may be taught in pulmonary rehabilitation and nursing care programs, and be included in routine care of individuals with COPD.
Despite the benefits described regarding breathing exercises, this study had some limitations. One was a mismatch between the number of men and women in the sample.
When considering that it was a nonprobabilistic sample, the first subjects who showed interest in participating in the study were included, and those were mainly men.
Therefore, it was not possible to control for sex disparity. In addition, this study evaluated the effects of breathing exercises at rest. We can wonder whether the benefits of breathing exercise, such as improved oxygenation and chest wall volumes, would be more favorable, for example, during exercise performance because that is when dyspnea symptoms appear.
Our results showed that diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing improved chest wall volumes and oxygenation as well as reduced the breathing frequency, which provided more volume for hematosis without increasing dyspnea. Therefore, this study supported the positive acute effects of these breathing exercises for subjects with COPD.
These breathing exercises are low cost and do not require special instrumentation or continuous assistance of a health care provider, which can improve adherence of the patients to their routine. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
We do not capture any email address. Skip to main content. Research Article Original Research. Liliane PS Mendes. Introduction COPD is a treatable disease characterized by chronic air-flow limitation and persistent symptoms, such as dyspnea, cough, weight loss, and fatigue.
What this paper contributes to our knowledge We found that diaphragmatic breathing with and without pursed-lips breathing improved chest wall volumes and oxygenation, reduced breathing frequency, and provided more volume for hematosis without increasing dyspnea. Intervention Data were collected over 2 d, with a maximum interval of 1 week between them. Outcome Variables The breathing pattern variables analyzed were chest wall tidal volume, end-inspiratory chest wall volume, end-inspiratory rib-cage volume, end-inspiratory abdomen volume, end-expiratory chest wall volume, end-expiratory rib-cage volume, end-expiratory abdomen volume, minute ventilation, breathing frequency, inspiratory time, expiratory time, and duty cycle.
Sample Size Calculation Sample size calculation was determined after a pilot study with the first 10 participants. Data Reduction The intermediate minute from each of the 3 series registered was used to determine the breathing pattern, chest wall motion, and chest wall asynchrony variables of quiet breathing and also of the breathing exercises.
Statistical Analysis Data are presented as measures of central tendency and dispersion, and the normality was verified by using the Shapiro-Wilk test. Results Initially, 18 participants with COPD were selected to participate in the study; 1 participant was excluded from data analysis due to irregularities on data recording. View this table: View inline View popup Download powerpoint. Table 1. Characteristics of the Participants. Table 2. Table 3. Discussion The main results of this study were the following: 1 the diaphragmatic breathing and the diaphragmatic breathing plus pursed-lips breathing resulted in significant increases in chest wall tidal volume compared with quiet breathing, 2 there was no difference in the abdominal contribution among the conditions quiet breathing, diaphragmatic breathing, and diaphragmatic breathing plus pursed-lips breathing , 3 there was a significant increase in chest wall asynchrony during breathing exercises, 4 there was no significant change in dyspnea among the evaluated conditions, 5 significant decreases were observed in breathing frequency for both breathing exercises, and 6 diaphragmatic breathing plus pursed-lips breathing provided greater changes in breathing parameters, especially for time variables.
Conclusions Our results showed that diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing improved chest wall volumes and oxygenation as well as reduced the breathing frequency, which provided more volume for hematosis without increasing dyspnea.
The authors have disclosed no conflicts of interest. References 1. Chest ; 4 : — Pulmonary rehabilitation for chronic obstructive pulmonary disease. Comparison of the oxygen cost of breathing exercises and spontaneous breathing in patients with stable chronic obstructive pulmonary disease. Phys Ther ; 83 5 : — Dechman G , Wilson CR.
Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease. Phys Ther ; 84 12 : — Breathing exercises for chronic obstructive pulmonary disease. OpenUrl PubMed. The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients' respiratory muscle activation. J Phys Ther Sci ; 29 3 : — A modified breathing exercise program for asthma is easy to perform and effective.
J Asthma ; 54 2 : — Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease COPD.
Chron Respir Dis ; 1 3 : — Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews.
BMC Pulm Med ; 14 : Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease: a review of the literature. J Cardiopulm Rehabil ; 22 1 : 7 — Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis ; 8 4 : — Patterns of chest wall kinematics during volitional pursed-lip breathing in COPD at rest. Respir Med ; 7 : — Pursed-lips breathing improves inspiratory capacity in chronic obstructive pulmonary disease.
Respiration ; 81 5 : — Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis. Physiotherapy ; 1 : 9 — As the lungs are not working normally, the body starts to use muscles in the back and chest to breathe. This irregular muscle use can be tiring and cause discomfort.
With regular practice, pursed lip breathing can get rid of stale air in the lungs. It can also help the lungs and diaphragm work better to get more oxygen into the body. The technique involves breathing in and out in a specific way. A person with COPD will often take lots of shallow breaths. Pursed lip breathing keeps the airways in the lungs open for longer. As a result, a person will take fewer breaths, but these breaths will be more efficient. A person should try to relax before starting pursed lip breathing.
They can take a minute to drop the shoulders and release the tongue from the roof of the mouth, both of which are common ways to hold tension in the body. It may help to close the eyes when trying pursed lip breathing for the first few times. A person can use pursed lip breathing during any activity that causes shortness of breath. Such activities can include exercise, standing up from a seat, or lifting something.
More air can flow in and out of the lungs to help the body during these activities. It may take some time before the technique feels natural, but with regular practice, it can become comfortable. Pursed lip breathing is one of the techniques that experts most commonly recommend for people with COPD. However, other techniques can also help slow breathing and fill the lungs properly.
For example, belly breathing or diaphragmic breathing can retrain the diaphragm, helping this muscle do more work in the breathing process. To do belly breathing, a person should sit in a chair or lie on their back before breathing in through the nose and noticing how the belly expands with the breath. It can help to place the hands on the belly to feel this happening. As well as helping the lungs work better, pursed lip breathing can have several other health benefits.
Pursed lip breathing can be particularly beneficial as part of a pulmonary rehabilitation program. A healthcare professional will supervise this program, which may include exercises, information, and support. As well as helping with breathing, it may reduce stress and make it easier for a person to exercise or socialize. Pursed lip breathing is a low risk practice. However, a person with a respiratory condition, such as COPD, should consider seeking advice from a healthcare professional before trying it.
These breathing exercises have the added benefit of helping you relax when you are anxious or stressed. Three types or breathing techniques are pursed lip breathing, coordinated breathing with exercise and diaphragmatic breathing.
Learn more about our pulmonary rehabilitation program. The purpose of pursed lip breathing is to help keep your airways open. This helps your airways to remain open. Pursed lip breathing also slows down your breathing rate and calms you down. The purpose of coordinated breathing is to help assure adequate oxygen to your working muscles and to prevent you from holding your breath. If coordinating your breathing with exercise is difficult, as you perform the movement, count out loud.
This helps prevent you from holding your breath. If you become very short of breath, stop the exercise, use pursed lip breathing to help control your breathing, then start exercising again.
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