Chronic obstructive pulmonary disease, commonly known as COPD, is a progressive disease that affects one’s quality of life. Perhaps the most serious and life-threatening symptom of it is shortness of breath. This is distressing and potentially dangerous because there is decreased airflow into and out of the airways. Fortunately, practicing breathing exercises is among the most invaluable treatments for managing this COPD symptom. 

Breathing exercises for COPD help1 you build up your breathing muscles, increase your oxygen intake, and breathe more easily. Breathing exercises work in the following ways:

  • Boost your body’s ability to utilize oxygen. This is significant because COPD patients require more effort to breathe than healthy individuals do
  • Relieve your symptoms and facilitate breathing
  • Increase circulation, reduce blood pressure, and strengthen your heart
  • Boost your energy to enable you to remain more active
  • Enhance your ability to sleep and make you feel more at ease
  • Assist you in keeping a healthy weight
  • Improve your emotional and mental perspective
  • Strengthen your bones

This article will describe certain common breathing exercises that can be used to control coughing and are especially beneficial for persons with COPD. The COPD exercise plan your healthcare practitioner has recommended for you should determine how much attention you give to each type. 

Deep Breathing

Deep breathing is a technique that requires you to relax your abdominal region while you take a deep breath. When you inhale deeply, your lungs are completely filled with air, and your lower belly expands.

Studies show that2 deep, slow, relaxed breathing increases pain tolerance by reducing the activity of your sympathetic nervous system (the one that controls your fight-or-flight response). Consequently, it may be helpful in managing chronic pain as well as calming you down.

To practice deep breathing:

  • Choose a comfortable and quiet position to stand or sit in, then relax your shoulders and chest
  • Slightly push your elbows back to widen your chest cavity and offer your lungs more room to expand
  • Inhale deeply through your nose, allowing your chest and lower belly to rise as you fill your lungs
  • Let your abdomen expand fully. Now exhale slowly for about five seconds through your mouth (or your nose, if that feels more natural). In order to maintain concentration, you can mentally count the seconds as they pass.

Exercise Tip:

  • Practice this technique regularly, as part of your daily routine. You can perform it while standing, sitting in a back-supporting chair, lying on a bed, or lying on a yoga mat on the floor. Studies show that deep,3 calm breathing in tandem with relaxation can control sympathetic nervous system arousal and pain perception. Consequently, it may be helpful in treating chronic pain.
  • Blend deep breathing with relaxing imagery and perhaps a focal phrase or concept while you sit comfortably with your eyes closed. Over time, you can adopt this technique as a regular practice of controlled breathing.


Pursed Lip Breathing

Pursed lip breathing allows you to breathe and keep your airways open for a longer period of time. The controlled way the air enters and exits your lungs means you can exercise more before getting out of breath because your lungs can accommodate more airflow. 

In other words, this exercise aids in slowing breathing, which allows for more air into and out of the lungs, rather than panting or gasping, which only allow a small amount of air into and out of the lungs at a time.

Pursed lip breathing4 can effectively relieve shortness of breath, decrease breathing frequency, increase how long you can breathe out for (important for getting all of the CO2 out), reduce how much air is left in your lungs after you breathe out, and increase exercise capacity5 (such as how far you can walk). 

To practice this technique:

  • Set yourself in a comfortable spot and relax your neck and shoulders
  • Breathe in slowly via your nose for three to four seconds, closing your mouth while you count to two
  • Purse your lips (as if whistling)
  • Steadily exhale air from the lungs through your pursed lips for five to seven seconds (you can count down to one)

Exercise Tip:

  • Practice pursed lip breathing while exercising – Studies6 reveal that COPD patients who use pursed-lips breathing while working out can enjoy longer exercise sessions, inhale more oxygen, and maintain steady breathing rates.

Diaphragmatic Breathing

Diaphragmatic breathing is a type of breathing technique that helps strengthen the diaphragm. It is sometimes called breath control, belly breathing, or abdominal breathing.

The diaphragm is a dome-shaped muscle located just below your chest, close to the bottom of your ribcage. The diaphragm and other respiratory muscles surrounding your lungs contract and relax during air inhalation and exhalation. When you inhale, the diaphragm performs a substantial role – it contracts as you inhale, to become flattened rather than dome-shaped; this allow your lungs to expand into the extra room and take in more air. If your diaphragm didn’t move, your lungs would only be able to expand sideways, where they would be restricted by the ribs.

Evidence suggests that diaphragmatic breathing may reduce stress,7 as measured by physiological biomarkers, like the levels of the stress hormone cortisol in people’s saliva, and psychological self-report metrics.

The COPD foundation8 recommends sitting or lying down when you use this approach for the first time when you are feeling rested and at ease.

To practice diaphragmatic breathing:

  • Start by placing one hand over your belly and one over your heart
  • Inhale using your nose, deliberately pushing out your belly; the hand here is to help you feel this
  • Keep your hands on your heart and stomach, and notice how the stomach one is moved out whereas the heart one should remain stationary
  • Exhale as if blowing balloons, drawing your navel toward your spine
  • Feel as the belly hand comes back in as you exhale
  • Do this for five to 10 minutes, two to three times a day, monitoring how you feel after each round. In the beginning, start by reclining on your back. Then attempt it while seated. After that, try it standing up

Exercise tip:

  • Once you have the hang of it, try using diaphragmatic breathing while engaging in a task.

Controlled Coughing

Coughing that is controlled has precisely the right amount of force to break up and move mucus through the airways without making them constrict and close. This helps conserves energy for those who cough a lot due to COPD.

To effectively cough with control:

  • Sit in a comfortable position on a chair or the edge of your bed – put both of your feet on the ground, lean a little to the front, and relax
  • Fold your arms across your stomach as you inhale softly through your nose until your lungs feel full and your stomach muscles push outwards
  • Hold your breath for three seconds
  • Lean further forward and press your arms against your abdomen; cough with your lips slightly open two to three times – short, sharp coughs are recommended 
  • The first cough allows the mucus to loosen and move through the airways. You can cough the mucus up and out with the second and third coughs
  • Breathe again slowly and gently through your nose. By taking slow, deep breaths, you can stop mucus from returning to your airways
  • Repeat more coughing cycles if necessary

The best way to practice controlled coughing is to carefully go over the instructions in the office with your doctor first, then practice them at home. This approach can be very helpful for people with COPD when used carefully since it helps to maintain energy and reserve oxygen.

Exercise Tip: 

  • Remember to cough from the lungs and not from the throat
  • After coughing, refrain from taking a rapid, deep breath in via your mouth – rapid mouth breathing can restrict the flow of mucus out of the lungs and contribute to uncontrollable coughing
  • Stay hydrated; drink six to eight glasses of liquids per day. Coughing is easier when you are well hydrated as the mucus is thin
  • Use the controlled coughing technique whenever you feel mucus (congestion) in the airways, especially after using a bronchodilator

Coordinated Breathing

Have you ever noticed that when you’re doing some activities, such as when you’re moving a heavy box, you tend to hold your breath? Your regular breathing pattern is disrupted when you hold your breath, which prevents the portions of your body that require oxygen from receiving enough of it. Consequently, you become more exhausted and out of breath.

Coordinated breathing helps to ensure that your working muscles receive enough oxygen and keeps you from holding your breath most especially during activity or exercise. It builds upon the pursed lip breathing explained above.

The key points of coordinated breathing are:

  • Breathe *in* before each portion of effort within the activity – such as bending your knees to crouch before the box
  • Breathe *out* during each effortful part – such as standing up holding the box
  • Breathe *in* again after this strenuous part to ensure you get oxygen to your muscles – such as when you are successfully standing with the box, before you start to walk

Keep this pattern in your mind and consciously hold to it; by maintaining steady breathing throughout activities you can ensure your muscles get enough oxygen and you won’t be out of breath.

Exercise tip:

  • You can use this technique practically during everyday exercises and activities such as when climbing stairs:
    • Take a couple of seconds to inhale deeply to start
    • Then, climb one to four steps while gently exhaling through pursed lips (roughly four seconds of activity)
    • Relax, then do it again

Huff Cough

Huff coughing is a gentle way of coughing that assists in clearing mucus from the lungs.

To practice a huff cough:

  • Draw a big breath in
  • Keep your throat open
  • Breathe out swiftly as possible through your mouth, as if you’re attempting to make a mirror foggy

Puffing moves the phlegm can be moved closer to the center of the lungs and it can then be expelled with a strong cough. 

Alternatively, you could attempt puffing to expel the mucus from various lung regions, depending on where it is lodged.

Exercise Tip

  • Only do two or three huff coughs before taking a proper breath, otherwise, you will become light-headed

Yoga Breathing

Yoga stretches and deep breathing can help in relaxation,9 agility, and mind-body wellness. 

Breathing is an important part of yoga. Yoga practitioners use the Sanskrit term “pranayama”– it is frequently translated as “breath control.” These techniques are often taught to people with COPD as part of their pulmonary rehabilitation10 program.

According to a 2014 study,11 practicing yoga for three to nine months may assist people with COPD to improve their capacity to exercise and lung function. Additionally,  a 2019 review of multiple studies12 concluded that yoga can be an effective long-term intervention for patients with COPD; however, its safety needs to be assessed in more depth by future studies.

Because there is a need for further research to determine the safety, long-term impacts, and implications on the quality of life of yoga if you have COPD, it is recommended that you discuss its safety and suitability with a doctor before enrolling in a class. 

Final Thoughts

To sum up, having COPD makes it harder to breathe. And when it’s hard to breathe, it’s normal to get anxious. So, take a few slow, deep breaths in and out between attempts if you experience any wooziness or lightheadedness when using these methods.

While these breathing exercises can help you manage your cough symptoms associated with COPD, tracking each and every cough is also vital. This is because COPD can be exacerbated by infection, being around someone who is smoking, or pollutants. In these incidents, you may suddenly feel short of breath or your cough may get worse. 

References

  1. Lu, Y., Li, P., Li, N., Wang, Z., Li, J., Liu, X., & Wu, W. (2020). Effects of Home-Based Breathing Exercises in Subjects With COPD. Respiratory care, 65(3), 377–387. https://doi.org/10.4187/respcare.07121
  2. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing–an experimental study. Pain medicine (Malden, Mass.), 13(2), 215–228. https://doi.org/10.1111/j.1526-4637.2011.01243.x
  3. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing–an experimental study. Pain medicine (Malden, Mass.), 13(2), 215–228. https://doi.org/10.1111/j.1526-4637.2011.01243.x
  4. Spahija, J., de Marchie, M., & Grassino, A. (2005). Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest, 128(2), 640–650. https://doi.org/10.1378/chest.128.2.640
  5. Bhatt, S. P., Luqman-Arafath, T. K., Gupta, A. K., Mohan, A., Stoltzfus, J. C., Dey, T., Nanda, S., & Guleria, R. (2013). Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity. Chronic respiratory disease, 10(1), 5–10. https://doi.org/10.1177/1479972312464244
  6. Cabral, L. F., D’Elia, T., Marins, D., Zin, W. A., & Guimarães, F. S. (2015). Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. European journal of physical and rehabilitation medicine, 51(1), 79–88.
  7. Hopper, S. I., Murray, S. L., Ferrara, L. R., & Singleton, J. K. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI database of systematic reviews and implementation reports, 17(9), 1855–1876. https://doi.org/10.11124/JBISRIR-2017-003848
  8. COPD Foundation. (2022). Breathing Techniques. COPD Foundation. https://www.copdfoundation.org/Learn-More/I-am-New-to-COPD/Breathing-Techniques.aspx
  9. Fulambarker, A., Farooki, B., Kheir, F., Copur, A. S., Srinivasan, L., & Schultz, S. (2012). Effect of yoga in chronic obstructive pulmonary disease. American journal of therapeutics, 19(2), 96–100. https://doi.org/10.1097/MJT.0b013e3181f2ab86
  10. American Lung Association. (2020, July 13). The Basics of Pulmonary Rehabilitation. American Lung Association. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/pulmonary-rehab
  11. Liu, X. C., Pan, L., Hu, Q., Dong, W. P., Yan, J. H., & Dong, L. (2014). Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Journal of thoracic disease, 6(6), 795–802. https://doi.org/10.3978/j.issn.2072-1439.2014.06.05
  12. Cramer, H., Haller, H., Klose, P., Ward, L., Chung, V. C., & Lauche, R. (2019). The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clinical rehabilitation, 33(12), 1847–1862. https://doi.org/10.1177/0269215519860551
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