Pursed-lips breathing technique improves inspiratory capacity in COPD patients

An abstract of new study published online ahead of print in the journal Respiration highlights the benefits of a breathing technique known as pursed-lips breathing (often referred to as PLB by respiratory care professionals). Specifically, the researchers reported that inspiratory capacity (the maximum of volume of air inhaled by the lungs from a fully expired state) increased significantly in the 35 severe COPD patients tested during the study. (Visser FJ, et al. Pursed-Lips Breathing Improves Inspiratory Capacity in Chronic Obstructive Pulmonary Disease. Respiration. 2010 July 17 [Epub ahead of print])

Pursed-lips breathing is a highly effective breathing technique taught by respiratory therapists and other pulmonology professionals in pulmonary rehabilitation programs to help COPD reduce the sensation of breathlessness before, during or after exercise or other strenuous activities. Despite its effectiveness, it is remarkable to me how many COPD patients have never used it or heard of it.

PLB has been shown in previous studies to help moderate to severe COPD patients improve pulmonary gas exchange, reduce hyperinflation of the lungs, improve physical function and reduce oxygen desaturation in the lungs. In one recent study, 32 COPD patients who used pursed-lip breathing immediately before walking boosted the time they were about to walk before fatiguing by 16%. (Faager G, et al. Influence of spontaneous pursed lips breathing on walking endurance and oxygen saturation in patients with moderate to severe chronic obstructive pulmonary disease. Clin Rehabil. 2008 Aug;22(8):675-83)

Pursed-lips breathing works like this - first, with your mouth closed you breathe in through your nose for 2-3 seconds. Then, you purse your lips (like you are blowing out candles on a birthday cake or blowing bubbles through the small opening of a bubble wand) and blow air out through your pursed-lips for about twice as long as you inhaled through your nose (approximately 4-6 seconds).

This technique works because narrowing the opening of your mouth when you exhale creates back pressure. Back pressure helps you blow out more used air from your lungs. And that’s the core of the issue when you feel short of breath. While it feels like you can’t breathe in fresh air, the real issue is that you have too much used air trapped in your lungs. Until you can get the used air out, it doesn’t matter how hard you try to breathe in. Your lungs don’t have the capacity to accept a large volume of fresh air when you have used air dominating your airway passages. PLB helps clear out the used air more quickly so that more fresh air (and hence, more oxygen) can be taken in by your lungs. In turn, PLB helps reduce shortness of breath related to walking, climbing stairs, exercising, and other vigorous activities. This is likely the mechanism that increased inspiratory capacity in the COPD patients in the Respiration study mentioned above. By clearing out more old/used air using PLB, the lungs are in a better position to absorb a greater maximum volume of fresh air when inhaling.

A simple example to demonstrate how PLB works – face the palm of one of your hands a couple of inches from the opening of your mouth and exhale for 3 seconds without pursing your lips. Now, exhale again on the palm of your hand using the pursed-lips breathing technique for 3 seconds. If you’ve executed PLB correctly, you should have noticed a significant difference in the force of air hitting your hand when using PLB versus exhaling normally from your mouth.

Though I don’t have COPD nor have I ever smoked cigarettes, I use the pursed-lips breathing technique frequently when I climb long flights of stairs and when I’m feeling short of breath when running or working out in the gym. I have to say I’ve been very impressed at two effects of PLB when I use it. First, I definitely believe it helps me reduce shortness of breath in a relatively short time frame. Second, and more surprising to me, is the sensation I get when using PLB that I am in greater control of my breathing rhythm during vigorous activity which to me has a calming/relaxing effect.

For a printable sheet demonstrating the pursed-lips breathing technique taken from our Breathe Better for Life CD-ROM, click here. For more information about our Breathe Better for Life guidebook and CD-ROM, visit www.breathebetterforlife.com.