Breathing with COPD

Tips for pursed lip breathing and pulmonary rehabilitation

By Katherine Kam

WebMD Feature Reviewed by Brunilda Nazario, MD

source:  Breathing With COPD

When you have chronic obstructive pulmonary disease, or COPD, shortness of breath may be a daily and unwelcome fact of life. Perhaps your doctor is urging you to enter a pulmonary rehabilitation program to help you manage your disease better. Or maybe you’ve heard about various breathing techniques, such as pursed lip breathing or diaphragmatic breathing.

What can help you to cope with breathlessness and improve your quality of life? Two lung experts spoke to WebMD about useful measures that you can take.

Diaphragmatic Breathing: New Thinking on an Old Standby

Many COPD patients have been taught to do diaphragmatic breathing by using one's abdominal muscles to empty the lungs. Patients lie on their backs, place their hands on their abdomens and practice breathing with their diaphragms.

But experts told WebMD that no evidence supports the value of diaphragmatic breathing. Once patients stop doing the exercise, they revert back to their usual way of breathing.

"Trying to teach someone to diaphragmatic-breathe or breathe with their belly probably doesn't work because your mind will take you back to a way that's less taxing for your abdominal muscles," says Gerard Criner, MD, a pulmonologist and professor of medicine at Temple University.

Pursed Lip Breathing: A Technique That Helps

However, another common technique, pursed lip breathing, has more merit, Criner says. The technique can ease shortness of breath. 

To do pursed lip breathing:

Relax your neck and shoulder muscles.

Breathe in for two seconds through your nose, keeping your mouth closed.

Breathe out for four seconds through pursed lips. If this is too long for you, simply breathe out twice as long as you breathe in.

Pursed-lip breathing can be particularly useful to COPD patients who have emphysema, a common scenario.

"People with emphysema have very collapsible airways," says Norman H. Edelman, MD, chief medical officer at the American Lung Association and professor of preventive medicine and internal medicine at the State University of New York at Stony Brook.

"If you teach them to breathe in normally but breathe out through a narrow orifice of their lips, they keep the pressure up in their airways and it tends to prevent the large airways from collapsing."

In COPD patients with advanced emphysema, pursed lip breathing can also open up airways enough to release more air, Criner says. "That may allow some air that's trapped in the lungs to exhale out, so it decreases the amount of gas trapped in your chest," Criner says.

When shortness of breath occurs, other tactics can help, too. Patients should try putting cold water on the face or flowing cold air over the face with a fan. Such measures will stimulate body responses that decrease the sensation of breathlessness, according to Criner.

While diaphragmatic breathing may not work well, other techniques taught through a pulmonary rehabilitation program may be more effective, Criner says. Some pulmonary rehab programs use breathing devices, called inspiratory muscle trainers, that train patients to increase the pressure that breathing muscles have to generate per breath.

"You can't really train the lungs, but you could train your respiratory muscles to be stronger or to have greater endurance," Criner says. Training the respiratory muscles may make them stronger by about 20% to 25%, he says.

"It's hard to show, though, if you make them stronger, that it relates to an improvement in your ability to do work. But you can make them stronger and that may be helpful in clearing secretions and coughing," as well as giving the breathing muscles greater reserves from which to draw, he says.

It's important to get good advice from a pulmonary rehab program about effective devices, Criner says. Lung trainers and other devices promoted on the Internet often don't work.

"They're like kazoos," he says. "Rather than searching the Web and buying things out of pocket that may not be useful, go to a pulmonary rehab program. They can tell you about the best things and approaches. They'll customize it to you to make you feel better and do more."

Pulmonary rehab programs also teach patients exercises to strengthen their arms and legs, a therapy that Edelman says is valuable to COPD patients. Typically, patients do aerobic and isotonic exercises, the latter designed to strengthen muscles.

"Old-fashioned exercise training -- the evidence for that is pretty good," Edelman says. "You can make the muscles and the circulatory system more efficient so that it delivers oxygen to the exercising muscles better. And of course, that reduces the burden on the lungs because you need to deliver less oxygen to the blood."

COPD Symptoms: When to Call Your Doctor

If you have COPD, you may have an episode in which shortness of breath worsens quickly to the point that it's difficult to catch your breath. Other symptoms may crop up, too, including chest tightness, increased coughing, more mucus, or a fever. Call your doctor immediately to discuss whether you need treatment, perhaps for a lung infection or other problem that has developed.

According to the National Heart, Lung and Blood Institute, you must get emergency help if you have these symptoms:

You're having an unusually hard time walking or talking, such as difficulty in finishing a sentence.

Your heart is beating rapidly or irregularly.

Your lips or fingernails look gray or blue.

Your breathing is fast and hard, even when you are using your medication.