Breathing Exercises

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, decreases 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.
• The benefits of purse-lip breathing
• Relieves shortness of breath
• relief of carbon dioxide retention
• improvement in oxygenation.
• an excellent tool for relaxation.
• Improves breathing patterns by moving old air out of your lungs and
allowing new air to enter.
Deep breathing
• The following will facilitate this :

• relief of pain, nausea, dry mouth, discomfort, fatigue, anxiety or

tension

• avoidance of distractions

• minimum breathlessness, e.g. patients need time to get their breath

back after turning
• When ready, patients are asked to breathe in deeply and slowly
through the nose, then sigh out through the mouth.

• Breathing through the nose warms and humidifies the air but doubles
resistance to airflow, and patients may prefer to mouth-breathe if they
are breathless or have a nasogastric tube.

• After every few breaths, the patient should relax and regain his/her
rhythm.

• Patients should not be engaged in conversation between cycles.

• Deep breathing has shown the following benefits :

• increase lung volume

• Increase ventilation and reduceses airways resistance
• improves lung compliance
• increases VA/Q matching
• Increase oxygen
End-inspiratory hold
• An inspiratory hold technique involves prolonged holding of the breath
at maximum inspiration followed by a relaxed exhalation.
• Air can be coaxed into poorly ventilated regions by interspersing every
few deep breaths with breath-holds for a few seconds at full inspiration.
• This distributes air more evenly between lung segments and boosts
collateral ventilation
• The end-inspiratory hold is unsuitable for breathless people, who should
not be asked to hold their breath.
• It should be used with caution in patients with a tendency to
bronchospasm.
• Abdominal breathing Emphasis on abdominal movement during
inspiration
• The term 'diaphragmatic breathing' is sometimes used
• Abdominal breathing usually increases the lung volume but does not
alter the distribution of ventilation
• slow deep breathing favours peripheral distribution.
• The patient is asked to get comfortable in a symmetrical position such
as upright sitting.
• The manoeuvre is first explained and demonstrated unhurriedly,
avoiding words like 'push', 'pull', 'try' and 'harder’.
• Rest the dominant hand on your abdomen, with elbows supported,
and, keeping your shoulders relaxed, allow your hand to rise gently while
visualizing air filling your abdomen like a balloon.
• Sigh the air out.
• Check that shoulders remain relaxed and heavy.
• Gradually increase the depth of breathing while maintaining relaxation.
• If appropriate, progress to side-lying and relaxed standing.
Thoracic expansion exercises
• These are also known as deep breathing exercises. They help the
lungs to expand more effectively and allow air to get behind any
secretions so that they can then be “pushed” up the airways towards
the mouth.
• The breath in should be slow and deep.
• At the end of the breath in, the breath is held for a few seconds.
• Breathing out is relaxed and “quiet”.
• TEE are sometimes accompanied by percussion or vibrations
 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.

• Indications: Hypoventilation, atelectasis, ineffective cough, pain,

uncoordinated breathing pattern
Sniff
• Even after a full inspiration, it is often possible to squeeze in a wee bit
more air and further augment collateral ventilation by taking a sharp
sniff at end-inspiration.
• It increases lung volume
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.
Airshift breathing
• Position: supine/hook-lying
• Pt to take deep breath and hold. While holding breath ask pt
to tuck the abdomen so that air will move from lower to
upper part of chest.
• Uses: increase ROM of chest and intercostals
• Can be used for generalised collapses
Glossopharyngeal Breathing
• Glossopharyngeal breathing (GPB) is a technique useful in patients with a
reduced vital capacity owing to respiratory muscle paralysis.
• It was this gulping action that gave the technique the name 'frog
breathing’.
• it helps to maintain or improve lung and chest wall compliance.
• It is used primarily by patients who are ventilator-dependent because of
absent or incomplete innervation of the diaphragm as the result of a high
cervical-level spinal cord lesion or other neuromuscular disorders.
• Procedure Glossopharyngeal breathing involves taking several
“gulps” of air, usually 6 to 10 gulps in series, to pull air into the
lungs when action of the inspiratory muscles is inadequate.
• After the patient takes several gulps of air, the mouth is closed,
and the tongue pushes the air back and traps it in the pharynx.
• The air is then forced into the lungs when the glottis is opened.
• This increases the depth of the inspiration and the patient’s
inspiratory and vital capacities.
Segmental Breathing

• hypoventilation occurs in certain areas of the lungs because of chest

wall fibrosis, pain, and muscle guarding after surgery, atelectasis, and
pneumonia.

• Lateral Costal Expansion: Lateral costal expansion, sometimes called

lateral basal expansion, can be carried out unilaterally or bilaterally.
• Procedure
• Have the patient begin in a hook-lying position; later progress to a sitting
position. Place your hands along the lateral aspect of the lower ribs to
direct the patient’s attention to the areas where movement is to occur
(Figs. 25.11 and 25.12)
• Ask the patient to breathe out, and feel the rib cage move downward
and inward. As the patient breathes out, place pressure into the ribs
with the palms of your hands.
• Just prior to inspiration, apply a quick downward and inward stretch to
the chest. This places a quick stretch on the external intercostals to
facilitate their contraction.
• Apply light manual resistance to the lower ribs to increase sensory
awareness as the patient breathes in deeply and the chest expands and
ribs flare. Then, as the patient breathes out, assist by gently squeezing
the rib cage in a downward and inward direction.
• Teach the patient how to perform the maneuver independently by
placing his or her hand(s) over the ribs (Fig. 25.13) or applying
resistance with a towel or belt around the lower ribs (Fig. 25.14A&B).
Posterior Basal Expansion
• Procedure
• Have the patient sit and lean forward on a pillow, slightly bending the
hips (see Fig. 25.15). Place your hands over the posterior aspect of the
lower ribs, and follow the same procedure just described for lateral
costal expansion.
Active cycle of breathing
• The active cycle of breathing techniques (ACBT) is used to mobilize and
clear excess bronchial secretions and to improve lung function.

• It is a cycle of breathing control, thoracic expansion exercises and the

forced expiration technique (FET).

• Each component of this technique plays a key role in the movement of

secretions.
• The first phase is the breathing control phase, which consists of relaxed
breathing at tidal volume with emphasis on diaphragmatic and lower rib cage
expansion.

• The patient is encouraged to relax the upper chest and shoulders until s/he is
relaxed and ready for the next phases, usually 5 to 10 seconds.

• It allows recovery from fatigue, oxygen desaturation or signs of

bronchospasm, and relieves breathlessness
• TEEs are deep breathing exercises (DBEs) with an emphasis on slow,
controlled inspiration through the nose.
• Inspiration is active, with larger than normal tidal volume breaths which
are often combined with a 3-second end inspiratory breath hold.
• The active and deeper volume inspiration is believed to facilitate
collateral channel ventilation.
• Expiration is passive and relaxed.
• Alternatively, a patient may take a tidal volume breath in between each
TEE or may eliminate the breath hold.
• The third phase consists of the forced expiration technique, which consists
of huffing alternating with breathing control.

Huffing is performed at two different volumes:

1. first the patient performs one or two medium-volume huffs to mobilize
secretions from the peripheral airways followed by a period of breathing
control, (will move peripherally situated secretions towards the mouth)
2. and then the patient does a high-volume huff to clear secretions that have
reached the larger, proximal/upper airways.

• The huffing phase of the cycle is interspersed with deep breathing or relaxed
abdominal breathing to reduce risks of bronchospasm, coughing or
desaturation
Avoid :
• huffing at too high a lung volume at first, by taking a deep breath
before the huff
• taking too sharp a deep breath, thus forcing the secretions back or
stirring up bronchospasm
• not relaxing between cycles
• coughing before secretions are accessible.