One of the biggest challenges of living with chronic obstructive pulmonary disease (COPD) is the shortness of breath that can happen each day.
If you have COPD, you also may notice that sometimes when you experience breathlessness, you become anxious, too.
Then, as your anxiety increases, your nervous system responds, increasing your respiratory rate and you find yourself breathing even faster. This makes you feel more out of breath. People start avoiding activities to avoid this feeling. This is the dyspnea cycle or inactivity cycle that slowly makes a person avoid activities and get further deconditioned.
Your Physiological & Psychological Response with Breathlessness
If you have COPD, breathlessness doesn’t just impact you physiologically, it also impacts your psychological well-being. When you start to feel breathless, you can start to avoid activities that make you feel that way.
But when you become less active, your muscles can become weaker over time. Your overall fitness level can decrease, and your body can become less efficient at handling the oxygen in your bloodstream and transporting it to muscles, explains Sharon Noelker, a Respiratory Therapist with nearly three decades of experience.
Specialized in both cardiac and pulmonary care, Sharon works in the Cardiopulmonary Rehabilitation program at UC Health, a healthcare system that provides advanced care for a variety of lung and other pulmonary-related diseases. Sharon helps patients with exercise training and counseling, education, clinical counseling, and more.
“Muscles need work—and they need work to run efficiently. When they don't run efficiently, they need more oxygen. And if you can't supply it, because your lungs aren't working efficiently, you do less,” explains Sharon. “So as you start to do less, and potentially those muscles weaken, you get more breathless. Eventually, psychologically, it can start to affect someone’s mood and they can even become depressed,” she explains.
As someone’s mood and demeanor change, it can make them more likely to miss out activities—both physical and social. “So it can become a vicious cycle,” explains Sharon.
Breathing Strategies Can Break the Dyspnea Cycle
To combat breathlessness and the anxiety that can come with it, people with COPD have a number of strategies they can practice. In terms of breathing strategies in particular, there are four key benefits, including helping to break the dyspnea cycle:
- Breathing exercises can promote relaxation.
- Breathing exercises can reduce shortness of breath.
- Breathing exercises slow down a person’s breathing.
- Breathing exercises can help to get rid of the trapped air that is a problem for people with COPD.
And, when practiced during daily activities, these strategies can also help people with COPD get back into the habit of more exercise, and that's hugely beneficial for their overall health. Let’s dig deeper into some of the top breathing strategies for people with COPD.
Breathing Strategies for COPD
Sharon shares a number of strategies that she shares with her COPD patients to improve lung function and reduce stress:
Pursed Lip Breathing
Pursed lip breathing is an extremely effective strategy that helps people reduce anxiety, calm down, and better regulate their breathing. “Pursed lip breathing can also release serotonin and reduce stress —so it promotes those feel-good messages in the body. Relaxing your whole body through pursed lip breathing can have so many benefits,” explains Sharon.
To practice pursed lip breathing:
- Start with your back straight.
- Inhale in through your nose for two seconds. Engage your diaphragm while breathing in.
- As you exhale, purse your lips, as if you are making soap bubbles. Your exhalation can last four seconds (or twice as long as the inhale). Breathe out slowly.
- Repeat 5 times, approximately 4-5 times per day.
Pursed lip breathing can be practiced whenever someone starts to feel short of breath, helping to provide an effective way to slow a person’s pace of breathing. That might be when going up the stairs, when going for a walk, or when doing laundry.
Sharon encourages many people with COPD to practice as much as 10 times a day, and especially before meals. Performing pursed lip breathing before meals reminds someone to practice the technique as a routine task. “I really encourage them to work on pursed lip breathing prior to eating so as to feel fully nourished and relaxed with their meal,” explains Sharon.
If your diaphragm becomes weak and/or flattened, it works less efficiently. Diaphragmatic breathing is an exercise that can be used to combat that, helping to promote strength in the diaphragm.
To practice diaphragmatic breathing:
- Make sure you are in a comfortable position to start. Your head, neck, and shoulders should start from a relaxed state.
- Start by putting one hand on the middle of your upper chest. Place your other hand beneath your rib cage and below your diaphragm (on the belly). Breathe in through your nose, drawing the breath down toward your stomach. The hand on your belly will rise as you let in air deeply. The hand on the chest will not move much but the hand on the belly should rise. This means you are using your diaphragm for that breath.
- As you exhale, your abdominal muscles will fall inward, tightening in the process. Now your hand on your belly will return to where it started.
- Repeat this exercise 5 times, 3-4 times a day
In people with COPD, the lungs are less effective at expelling secretions, and in those with chronic bronchitis, there can also be an increase in secretions in the lungs. Controlled coughing is one way to help people get rid of as much mucus as possible. “It can also help people conserve a bit of energy as they don’t have to become too exhausted with excessive coughing,” explains Sharon.
To practice controlled coughing:
- Sit with both feet on the floor. Lean slightly forward as you start the technique.
- Fold your arms across your abdomen and breathe in through your nose.
- Now you will exhale. Lean forward, and press your arms against your abdomen. Cough 2-3 times through a slightly opened mouth. Your coughs will be short.
- Next, breathe in—and do so very gently and slowly through the nose. You will “sniff” as you do so, to prevent mucus from getting back into your airways.
- Rest and repeat as needed.
Sharon emphasizes how the benefits of controlled coughing exercise are not just physiological. “There is the physiological reason it can be practiced, but also the psychological reason that they need to know they can control their cough, too,” she explains.
Deep breathing can decrease stress and promote a sense of calm. Deep breathing offers people the ability to follow a different breathing rhythm, when desired. Whereas pursed lip breathing follows a pattern of inhale for two and exhale out for four counts, deep breathing may or may not involve as long of an inhalation and/or exhalation.
To practice deep breathing:
- Find a place where you can get comfortable, such as on the bed or in a comfortable seat. Remember to relax your shoulders. Again place one hand on your abdomen and the other on your chest. Focus on only moving the hand that is on your abdomen. Try to keep your chest hand still.
- Breathe in through your nose to a count of three, filling your belly with air.
- Exhale through your nose to a count of three, allowing your belly to deflate, as if you are watching a balloon deflate. You can even say the word “calm” when exhaling.
- Repeat this technique 5 times, practicing it 3-4 times per day.
Coordinated breathing helps to foster a breathing cycle that can be tied to movement. Although it can also be used when feeling anxious, this is ideally used with movement or exercise.
To practice coordinated breathing:
- Inhale through your nose before you start activity.
- Now, as you perform the movement or exercise, exhale through pursed lips.
- Now, as you rest, take in another inhalation.
- As you perform the next movement or exercise, exhale again.
- Repeat this coordinated cycle as you continue your activity.
An example would be if you are lifting a box. You would inhale through your nose first, before doing any movement. Then, you would breathe out through your mouth as you lift the box.
Stair Climbing Strategy
As a more advanced form of coordinated breathing, you can take your coordinated breathing exercise and apply it when going up the stairs. After all, going up the stairs can be one of the most challenging or anxiety-inducing tasks for someone with COPD.
To practice the stair climbing strategy:
- Inhale at the bottom of the steps, while at rest.
- Walk up approximately two steps (or what you can do), and exhale while doing so. Be sure to support yourself as needed with the banister.
- Pausing at the step you are on, now rest and inhale.
- Repeat the process at the right pace for you.
Huff Coughing Technique
Huff Coughing is another technique that helps to move mucus out of the lungs, helping a person to not become so physically exhausted as they clear their airways each day. “One of its major benefits is that it can help someone reduce the excessive coughing that can happen with COPD,” adds Sharon.
To practice the huff coughing technique:
- Sitting up in a straight position, tilt your chin up slightly in order to help open your throat.
- Start with three diaphragmatic breaths.
- On your third diaphragmatic breath, hold for three seconds.
- Then exhale with a quick forced exhalation through an open glottis (the opening between the vocal cords). Try whispering the word “HA” while breathing out.
- Perform three huff cough maneuvers and then rest. This will help to move mucus through the airways and promote a gentler way to cough.
Don’t Forget Peer Support
While these techniques may be done on your own after getting guidance from your provider, don’t forget the importance of having a support group of some kind which can help to engage and empower you through your health journey.
Doing so can greatly impact your well-being, explains Sharon. This may involve class time in a cardiopulmonary rehab setting or dedicated support groups. “These interactions are effective ways to find healing through fellowship and friendships formed,” explains Sharon.
Does Your Breathing Make Day-to-Day Activities Difficult?
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This blog is for educational purposes only; talk to your provider to understand recommendations specific to you.