Breathing Exercises

Breathing Exercises
SUMMARY
They are fundamental interventions for
improving pulmonary status, with prevention or
comprehensive management of impairments
related to acute or chronic pulmonary disorders.
Such exercises are designed to retrain the
muscles of respiration, improve ventilation,
lessen the work of breathing, and improve
gaseous exchange and patient’s overall function
in daily living activities.
Indications
1. Cystic fibrosis
2. Bronchiectasis
3. Atelectasis
4. Lung abscess
5. Neuromuscular diseases
6. Pneumonias in dependent lung regions.
7. COPD
8. For patients with a high spinal cord lesion/
spinal cord injury, myopathies .
9. Prophylactic care of preoperative patient with
history of pulmonary problems
10. After surgeries (thoracic or abdominal surgery)
11. For patients who must remain in bed for an
extended period of time.
Pursed-lip breathing
Pursed-lip breathing is used to decrease a

patient’s symptoms of dyspnea. It has been
shown to slow a patient’s respiratory rate,
decreasing the resistive pressure drop across the
airways, thus decreasing airway collapse during
expiration.
Airway collapse during exhalation presents in
the advanced stages of COPD.
To employ pursed-lip breathing, a patient is
instructed to inhale through the nose for several
seconds with the mouth closed and then exhale
slowly over 4 to 6 seconds through lips held in a
whistling or kissing position. This can be done
with or without abdominal muscle contraction.
Paced Breathing
Paced breathing is defined as “volitional

coordination of breathing during activity.”
During rhythmic activities, breathing can be
coordinated with the rhythm of the activity.
During nonrhythmic activities, the patient can
be instructed to breathe in at the beginning of
the activity and out during the activity.
This can be combined with pursed-lip breathing
or diaphragmatic breathing.
In the acute care setting, this technique can

help the patient control his or her respiratory
rate and associated feelings of dyspnea.
Inspiratory Hold Technique
An inspiratory hold technique involves

prolonged holding of the breath at maximum
inspiration.
It can be used in conjunction with vibration
techniques to aid in airway clearance.
It can also improve the flow of air into poorly

ventilated regions of the lungs.
The patient is instructed to hold his or her
breath (without using a valsalva maneuver) at
the height of inspiration for 2 to 3 seconds
followed by a relaxed exhalation.
Stacked Breathing
Stacked breathing is a series of deep breaths

that build on top of the previous breath without
expiration until a maximal volume tolerated by
the patient is reached. Each inspiration is
accompanied by a brief inspiratory hold.
Diaphragmatic Controlled Breathing
Diaphragmatic controlled breathing can be used

to manage a patient’s
Dyspnea,
Reduce Atelectasis, and
Increase oxygenation.
This technique has been described as
“facilitating outward motion of the abdominal
wall while reducing upper rib cage motion
during inspiration.”
Diaphragmatic breathing can be achieved
through a series of activities designed to
decrease accessory muscle use and increase
recruitment of the diaphragm.
Positioning the patient with a posterior pelvic

tilt can help facilitate use of the diaphragm. In
the acute care setting, simply placing a towel roll
under the patient’s ischial tuberosities.
 Sniffing can be added to help engage the
diaphragm. The patient is positioned to
eliminate gravity, either in the side-lying or semi-
Fowler position.
 It is often easiest for patients to achieve a

diaphragmatic breathing pattern while in the
supine position.
Lateral Costal Breathing
Unilateral costal expansion or bilateral costal

exercises address one side or both sides,
respectively, of the rib cage and corresponding
intercostal muscles.
Unilateral costal expansion exercises may be

more useful in the treatment session with a
patient who has a large incision from surgery on
one side of the thorax.
This may lead to decreased expansion on the
respective side and prevent full alveolar
ventilation.
In addition, as incisions heal, they can bind to
the underlying tissue and further limit chest wall
expansion.
SUMMARY
TECHNIQUE :
Pursed lip breathing
INDICATIONS
Dyspnea at rest and/or with exertion, wheezing
DESIRED EFFECT:
Relief of dyspnea, improved activity tolerance,
reduced wheezing
TECHNIQUE :
Diaphragmatic breathing
INDICATIONS
Hypoxemia, tachypnea, atelectasis, anxiety,
excess pulmonary secretions
DESIRED EFFECT:
Eupnea, improved oxygen saturation, resolution
of atelectasis, lower anxiety, mobilization of
secretions
TECHNIQUE :
Lateral costal breathing
INDICATIONS
Asymmetrical chest wall expansion, localized
lung consolidation or secretions, asymmetrical
posture
DESIRED EFFECT:
Symmetrical chest wall expansion, mobilization of
secretions, proper posture
TECHNIQUE :
Inspiratory hold technique
INDICATIONS
Hypoventilation, atelectasis, ineffective cough
DESIRED EFFECT:
resolution of atelectasis, improved cough
effectiveness
TECHNIQUE :
Stacked breathing
INDICATIONS
Hypoventilation, atelectasis, ineffective cough,
pain, uncoordinated breathing pattern
DESIRED EFFECT:
Improved ventilation and perfusion matching,
resolution of atelectasis, reduced pain,
improved cough effectiveness
TECHNIQUE :
Paced breathing
INDICATIONS
Low endurance, dyspnea on exertion, fatigue,
anxiety, tachypnea
Desired effect
Increased activity tolerance, reduced dyspnea,
reduced fatigue, lower anxiety, eupnea

Breathing Exercises

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Breathing Exercises

Pursed-lip breathing is used to decrease a

Paced breathing is defined as “volitional

In the acute care setting, this technique can

An inspiratory hold technique involves

It can also improve the flow of air into poorly

Stacked breathing is a series of deep breaths

Diaphragmatic controlled breathing can be used

Positioning the patient with a posterior pelvic

 It is often easiest for patients to achieve a

Unilateral costal expansion or bilateral costal

Unilateral costal expansion exercises may be

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