How does pursed lip breathing work. What are the benefits of pursed lip breathing. Who can benefit from pursed lip breathing. What are the potential risks of pursed lip breathing. How is pursed lip breathing performed correctly. What is the clinical significance of pursed lip breathing. How does pursed lip breathing help COPD patients.

Understanding the Mechanics of Pursed Lip Breathing

Pursed lip breathing is a controlled breathing technique that involves inhaling through the nose and exhaling slowly through pursed lips. This method creates a back pressure, producing a small amount of positive end-expiratory pressure (PEEP). But how exactly does this technique work?

The respiratory drive is primarily controlled by central chemoreceptors in the brainstem, which respond to changes in pH caused by carbon dioxide accumulation. Peripheral chemoreceptors, located in the carotid and aortic bodies, are more sensitive to oxygen levels. In normal breathing, the central chemoreceptors usually override the peripheral ones.

Pursed lip breathing alters this balance by:

• Prolonging the expiratory phase compared to normal breathing
• Creating back pressure that produces PEEP
• Supporting airway patency during exhalation
• Increasing carbon dioxide excretion
• Improving gas exchange

The Physiological Effects of Pursed Lip Breathing

What happens in our bodies when we practice pursed lip breathing? This technique has several physiological effects:

1. Airway support: The PEEP created by pursed lip breathing acts as an artificial splint, supporting the patency of airways and alveoli.
2. Increased surface area: By recruiting more alveoli, the technique increases the surface area available for gas exchange.
3. Improved carbon dioxide excretion: The controlled exhalation helps prevent or relieve hypercapnia.
4. Reduced work of breathing: By supporting airway patency, pursed lip breathing can decrease the effort required to breathe.
5. Enhanced oxygenation: The improved gas exchange leads to better oxygenation of the blood.

Benefits and Therapeutic Applications of Pursed Lip Breathing

What are the main benefits of pursed lip breathing? This technique offers several advantages for individuals with respiratory issues:

• Relief of shortness of breath
• Decreased work of breathing
• Improved gas exchange
• Increased sense of control over breathing
• Enhanced relaxation

These benefits make pursed lip breathing particularly useful for patients with chronic obstructive pulmonary disease (COPD). In some COPD patients, pursed lip breathing may even become an involuntary compensatory mechanism to help keep airways open.

Proper Technique: How to Perform Pursed Lip Breathing Correctly

How should one perform pursed lip breathing for maximum benefit? Follow these steps:

1. Sit in a comfortable position with your neck and shoulder muscles relaxed.
2. Inhale slowly through your nose for about 2 seconds.
3. Purse your lips as if you’re going to whistle or gently blow out a candle.
4. Exhale slowly and gently through your pursed lips for about 4-6 seconds.
5. Repeat for 3-5 breaths, or as directed by your healthcare provider.

It’s crucial to maintain proper coordination and avoid prolonging the technique beyond recommended durations to prevent fatigue of respiratory muscles.

Potential Risks and Limitations of Pursed Lip Breathing

While pursed lip breathing can be highly beneficial, it’s important to be aware of its limitations and potential risks. What are the main concerns?

• Short-lived effects: The therapeutic benefits of pursed lip breathing are typically short-term.
• Risk of fatigue: Prolonged use can lead to fatigue of respiratory muscles.
• Potential for hyperventilation: Excessive use may lead to abnormally low levels of carbon dioxide, potentially causing syncope.
• Risk of exacerbation: Improper technique could worsen air trapping and carbon dioxide retention.

To mitigate these risks, it’s crucial to learn the correct technique from a trained professional and use it as directed.

Clinical Significance: Pursed Lip Breathing in Medical Settings

In clinical settings, pursed lip breathing has significant applications. How is this technique used in healthcare?

Medical professionals often teach pursed lip breathing to patients suffering from dyspnea and air trapping. It’s particularly beneficial for individuals with COPD, where it can help:

• Relieve symptoms of breathlessness
• Improve oxygenation
• Reduce anxiety associated with breathing difficulties
• Enhance overall respiratory function

Beyond its physiological effects, pursed lip breathing can also serve as a relaxation technique, helping patients regain a sense of control over their breathing during mild respiratory distress.

Pursed Lip Breathing and COPD: A Closer Look

How does pursed lip breathing specifically benefit COPD patients? In individuals with COPD, airways often become obstructed, leading to air trapping and increased work of breathing. Pursed lip breathing can help counteract these effects by:

• Creating positive pressure that helps keep airways open
• Promoting more efficient exhalation
• Reducing air trapping
• Improving ventilation-perfusion matching
• Decreasing the work of breathing

Interestingly, some COPD patients may adopt pursed lip breathing as an unconscious compensatory mechanism, highlighting its effectiveness in managing their condition.

The Role of Pursed Lip Breathing in COPD Management

In the context of COPD management, pursed lip breathing serves multiple purposes:

1. Symptom relief: It can provide immediate relief during episodes of breathlessness.
2. Exercise facilitation: The technique can help patients better manage their breathing during physical activity.
3. Anxiety reduction: By providing a sense of control over breathing, it can help reduce anxiety associated with respiratory distress.
4. Long-term management: Regular practice can contribute to improved overall respiratory function over time.

Integrating Pursed Lip Breathing into Daily Life

How can individuals incorporate pursed lip breathing into their daily routines? Here are some practical suggestions:

• Practice during rest: Start by practicing the technique while sitting comfortably, gradually increasing duration and frequency.
• Use during activities: Apply pursed lip breathing during activities that typically cause breathlessness, such as climbing stairs or walking.
• Combine with relaxation techniques: Use pursed lip breathing as part of broader relaxation or meditation practices.
• Set reminders: Use phone apps or alarms to remind you to practice regularly throughout the day.
• Teach family members: Educate family members about the technique so they can offer support and reminders when needed.

By making pursed lip breathing a regular part of daily life, individuals with respiratory issues can maximize its benefits and improve their overall quality of life.

Enhancing the Effectiveness of Pursed Lip Breathing

To get the most out of pursed lip breathing, consider these tips:

1. Maintain good posture: Proper posture can enhance the effectiveness of the technique by allowing for optimal lung expansion.
2. Stay relaxed: Tension in the neck, shoulders, or chest can interfere with effective breathing.
3. Practice consistently: Regular practice can help make the technique more natural and effective over time.
4. Combine with diaphragmatic breathing: Integrating pursed lip breathing with diaphragmatic breathing can further improve respiratory efficiency.
5. Monitor your progress: Keep track of how the technique affects your symptoms and overall well-being.

The Science Behind Pursed Lip Breathing: A Deeper Dive

What’s happening at a physiological level during pursed lip breathing? Let’s explore the scientific mechanisms in more detail:

Airway Dynamics

During normal exhalation, airways that lack cartilage support can collapse inward, increasing airway resistance and potentially trapping air. Pursed lip breathing counteracts this by:

• Creating positive pressure that helps maintain airway patency
• Reducing the velocity of exhaled air, which decreases the tendency for airway collapse
• Promoting more even distribution of air throughout the lungs

Gas Exchange

Pursed lip breathing improves gas exchange through several mechanisms:

1. Increased alveolar recruitment: The positive pressure helps open and maintain patency of alveoli, increasing the surface area for gas exchange.
2. Improved ventilation-perfusion matching: By promoting more even air distribution, it helps match ventilation with blood flow in the lungs.
3. Enhanced carbon dioxide elimination: The controlled, prolonged exhalation facilitates more efficient removal of carbon dioxide.

Respiratory Muscle Function

How does pursed lip breathing affect respiratory muscles?

• Reduced workload: By improving airway patency and gas exchange, the technique can decrease the work required by respiratory muscles.
• Improved efficiency: The controlled breathing pattern can help optimize the use of respiratory muscles.
• Prevention of fatigue: When used appropriately, pursed lip breathing can help prevent respiratory muscle fatigue during periods of increased demand.

Pursed Lip Breathing in Various Medical Conditions

While particularly beneficial for COPD, pursed lip breathing can be helpful in various other medical conditions. How does it apply to different respiratory issues?

Asthma

In asthma patients, pursed lip breathing can:

• Help control breathing during asthma attacks
• Reduce anxiety associated with breathlessness
• Improve overall breathing efficiency

Interstitial Lung Disease

For patients with interstitial lung disease, pursed lip breathing may:

• Help manage episodes of dyspnea
• Improve oxygenation
• Enhance exercise tolerance

Anxiety Disorders

In individuals with anxiety disorders, pursed lip breathing can serve as:

• A grounding technique during panic attacks
• A tool for managing chronic anxiety
• A method to prevent hyperventilation

Future Directions: Research and Applications of Pursed Lip Breathing

What does the future hold for pursed lip breathing research and applications? Several areas warrant further investigation:

• Long-term effects: More research is needed on the long-term impacts of regular pursed lip breathing practice.
• Combination therapies: Studies exploring the synergistic effects of pursed lip breathing with other respiratory therapies could yield valuable insights.
• Technology integration: Development of apps or devices to guide and monitor pursed lip breathing could enhance its effectiveness and accessibility.
• Personalized approaches: Research into how pursed lip breathing can be optimized for individual patients based on their specific conditions and needs.
• Application in other fields: Exploring the potential benefits of pursed lip breathing in areas such as sports performance or stress management.

As our understanding of respiratory physiology and the benefits of controlled breathing techniques grows, pursed lip breathing is likely to play an increasingly important role in both medical and wellness contexts.

Pursed-lip Breathing – StatPearls – NCBI Bookshelf

John D. Nguyen; Hieu Duong.

Author Information and Affiliations

Last Update: July 25, 2022.

Definition/Introduction

The major drive for respiration originates in the central and peripheral chemoreceptors. The central chemoreceptors are located anterior medulla in the brainstem and predominantly responds to a decrease in pH from the accumulation of carbon dioxide in the cerebral spinal fluid. The blood-brain barrier protects the central nervous system from external stimuli. Carbon dioxide is lipid-soluble, which allows it to quickly diffuse across the protective barrier and influence the respiratory drive.

Unlike the central chemoreceptors, the peripheral chemoreceptors are more sensitive to changes in oxygen levels. The peripheral chemoreceptors consist of the carotid and aortic bodies. The aortic bodies are located at the aortic arch while the carotid bodies are situated at the common carotid artery bifurcation. Hypoxia stimulates cranial nerve IX to send signals to the nucleus tractus solarius which triggers ventilation. However, the central chemoreceptors normally override the peripheral receptors as it originates from the central control system of the body.[1]

Purse-lip breathing is a technique that allows people to control their oxygenation and ventilation. The technique requires a person to inspire through the nose and exhale through the mouth at a slow controlled flow. The expiratory phase of respiration is going to prolonge when compared to inspiration to expiration ratio in normal breathing. The maneuver presents as a controlled breath directed through the nostril then exhalation directed through lips having a puckered or pursed appearance. This technique creates a back pressure producing a small amount of positive end-expiratory pressure (PEEP).

During exhalation, the forces cause the airways that lack cartilage to drag inward towards the lumen obstructing airflow by increasing airway resistance which could lead to carbon dioxide trapping. [2] When there is an increased in carbon dioxide levels the central chemoreceptors are triggered to immediately increase the rate of respiration in an attempt to bring the body’s pH back to a baseline range of roughly 7.4 in a normal individual.[3][4] While the increase in the rate of respiration is effective in clearing carbon dioxide, it can potentially cause more air trapping and fatigue of the respiratory muscles.[5] PEEP mitigates the increase in work by creating an artificial splint that supports the patency of the airways and alveoli, increasing surface area and recruiting more alveoli to participate in gas exchange.[6] 

The positive pressure created opposes the forces exerted on the airways from the flow of exhalation. As a result, pursed-lip breathing helps support breathing by the opening of the airways during exhalation and increasing excretion of volatile acids in the form of carbon dioxide preventing or relieving hypercapnia. Through purse-lip breathing, people can have relief of shortness of breath, decrease the work of breathing, and improve gas exchange. They also regain a sense of control over their breathing while simultaneously increasing their relaxation.

Issues of Concern

With purse-lip breathing, the action of breathing initiates voluntarily. For purse-lip breathing to be effective, the individual must be able to perform the technique correctly. The technique requires proper coordination to maintain prolonged exhalation. As for the therapeutic effects, they are short-lived. The technique is limited to 3 to 5 breaths since prolonging the duration of the technique causes fatigue of the respiratory muscles and significantly lower than normal levels of carbon dioxide in a normal individual potentially leading to a decrease perfusion pressure in the brain causing syncope. Without the proper use of purse-lip breathing, an individual could exacerbate air trapping and carbon dioxide retention.

Clinical Significance

Clinically, purse-lip breathing when done correctly, can be beneficial in individuals suffering from dyspnea and air trapping. With proper teaching and coaching the technique can be easily taught by a trained professional. The benefits of purse-lip breathing may extend beyond its effects on the relief of carbon dioxide retention and improvement in oxygenation. Patients in mild respiratory distress may be able to regain control of their respiration through the technique. It is also an excellent tool for relaxation.

Purse lip breathing commonly helps patients with chronic obstructive pulmonary disease (COPD). With these patients, purse-lip breathing may not be a voluntary action, but rather a compensatory mechanism to help splint open the airways.[7][8] COPD individuals may have chronic obstruction of their airways from mucus plugging, loss of integrity of the airways, or enlargement of the airways. These changes in the airways can prevent the appropriate driving pressure and flow of air to maintain an adequate clearance of carbon dioxide due to an increase in airway resistance.[9] The increase in airway resistance also affects inhalation preventing enough oxygen from reaching the alveoli to create a sufficient partial pressure of oxygen needed to drive the diffusion of oxygen across the alveoli-capillary interface adequately. The defected driving pressure for oxygenation is further exacerbated due to the retention of carbon dioxide, causing less carbon dioxide to diffuse from the blood into the alveoli for excretion. The blunting of the proper mechanism to excrete carbon dioxide and adequate oxygenation leads to a constant stimulus to the central chemoreceptors to increase respiration until the point of exhaustion. Chronic hypercapnia decreases the sensitivity of the central chemoreceptors, allowing peripheral receptors sensing oxygen levels to become the predominantly drive for respiration.[10][11] Increased purse lip breathing in these patients may be a sign of impending respiratory failure.

Nursing, Allied Health, and Interprofessional Team Interventions

When it comes to the proper teaching of a new technique such as purse-lip breathing the trained individual should explain the benefits and potential adverse effects. The physiology of the technique requires explanation, followed by a demonstration. After teaching, the trainer should ensure that the trainee has learned the technique properly by asking the trainee to perform the technique or explain the technique to the trainer; this can ensure proper technique and correction of any mistakes that may occur during the learning process.[12][13]

Physicians, nurses, and health care professionals can incorporate the technique to help calm the patient. Patients with COPD, congestive heart failure, or panic attack may use the technique to relieve their dyspnea. This method could help reduce the need for noninvasive mechanical ventilation.[14][15]

Nurses that can recognize COPD patients in respiratory distress through signs such as increase purse-lip breathing, dyspnea, and accessory muscles use will allow rapid initiation of a response team to assist the patient before they deteriorate.[16][17] [Level III]

Nursing, Allied Health, and Interprofessional Team Monitoring

When it comes to monitoring, nursing staff should be able to teach pursed-lip breathing and explain to the trainee when this technique would be useful. The risk and benefits of the technique should be thoroughly explained with all questions and concerns addressed.

The nursing staff often spends the most time with patients of all health professionals. Nurses should be able to identify any patients that are in respiratory distress. With the knowledge of the common signs and symptoms of respiratory distress, nurses can effectively alert the appropriate response team and physicians to intervene before they deteriorate. Since the compensatory pursed-lip breathing is common to COPD patients, nursing should monitor COPD for the fatigue of respiratory muscles. Promptly alerting the physician can prevent patients from requiring mechanical ventilation.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Pursed lip breathing. Image courtesy O.Chaigasame

References

1.

Brinkman JE, Toro F, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 8, 2022. Physiology, Respiratory Drive. [PubMed: 29494021]

2.

Seadler BD, Toro F, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2022. Physiology, Alveolar Tension. [PubMed: 30969647]

3.

Hopkins E, Sanvictores T, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 12, 2022. Physiology, Acid Base Balance. [PubMed: 29939584]

4.

Keir DA, Duffin J, Millar PJ, Floras JS. Simultaneous assessment of central and peripheral chemoreflex regulation of muscle sympathetic nerve activity and ventilation in healthy young men. J Physiol. 2019 Jul;597(13):3281-3296. [PubMed: 31087324]

5.

Lomax M, Kapus J, Webb S, Ušaj A. The effect of inspiratory muscle fatigue on acid-base status and performance during race-paced middle-distance swimming. J Sports Sci. 2019 Jul;37(13):1499-1505. [PubMed: 30724711]

6.

Gonçalves-Ferri WA, Jauregui A, Martins-Celini FP, Sansano I, Fabro AT, Sacramento EMF, Aragon DC, Ochoa JM. Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study. Braz J Med Biol Res. 2019;52(7):e8585. [PMC free article: PMC6644527] [PubMed: 31314854]

7.

Vatwani A. Pursed Lip Breathing Exercise to Reduce Shortness of Breath. Arch Phys Med Rehabil. 2019 Jan;100(1):189-190. [PubMed: 30033163]

8.

Sakhaei S, Sadagheyani HE, Zinalpoor S, Markani AK, Motaarefi H. The Impact of Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in COPD Patients. Open Access Maced J Med Sci. 2018 Oct 25;6(10):1851-1856. [PMC free article: PMC6236030] [PubMed: 30455761]

9.

Haghighi B, Choi S, Choi J, Hoffman EA, Comellas AP, Newell JD, Lee CH, Barr RG, Bleecker E, Cooper CB, Couper D, Han ML, Hansel NN, Kanner RE, Kazerooni EA, Kleerup EAC, Martinez FJ, O’Neal W, Paine R, Rennard SI, Smith BM, Woodruff PG, Lin CL. Imaging-based clusters in former smokers of the COPD cohort associate with clinical characteristics: the SubPopulations and intermediate outcome measures in COPD study (SPIROMICS). Respir Res. 2019 Jul 15;20(1):153. [PMC free article: PMC6631615] [PubMed: 31307479]

10.

Docio I, Olea E, Prieto-LLoret J, Gallego-Martin T, Obeso A, Gomez-Niño A, Rocher A. Guinea Pig as a Model to Study the Carotid Body Mediated Chronic Intermittent Hypoxia Effects. Front Physiol. 2018;9:694. [PMC free article: PMC5996279] [PubMed: 29922183]

11.

Benner A, Lewallen NF, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 19, 2022. Physiology, Carbon Dioxide Response Curve. [PubMed: 30844173]

12.

Feinberg I, Ogrodnick MM, Hendrick RC, Bates K, Johnson K, Wang B. Perception Versus Reality: The Use of Teach Back by Medical Residents. Health Lit Res Pract. 2019 Apr;3(2):e117-e126. [PMC free article: PMC6610032] [PubMed: 31294313]

13.

Yen PH, Leasure AR. Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes. Fed Pract. 2019 Jun;36(6):284-289. [PMC free article: PMC6590951] [PubMed: 31258322]

14.

Sha J, Worsnop CJ, Leaver BA, Vagias C, Kinsella P, Rahman MA, McDonald CF. Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital. Intern Med J. 2020 Apr;50(4):453-459. [PubMed: 31157943]

15.

Avdeev SN, Truschenko NV, Gaynitdinova VV, Soe AK, Nuralieva GS. Treatment of exacerbations of chronic obstructive pulmonary disease. Ter Arkh. 2018 Dec 30;90(12):68-75. [PubMed: 30701836]

16.

Charlton PH, Pimentel M, Lokhandwala S. MIT Critical Data. Secondary Analysis of Electronic Health Records [Internet]. Springer; Cham (CH): Sep 10, 2016. Data Fusion Techniques for Early Warning of Clinical Deterioration; pp. 325–338. [PubMed: 31314272]

17.

Cui L, Liu H, Sun L. Multidisciplinary respiratory rehabilitation in combination with non-invasive positive pressure ventilation in the treatment of elderly patients with severe chronic obstructive pulmonary disease. Pak J Med Sci. 2019 Mar-Apr;35(2):500-505. [PMC free article: PMC6500851] [PubMed: 31086540]

Disclosure: John Nguyen declares no relevant financial relationships with ineligible companies.

Disclosure: Hieu Duong declares no relevant financial relationships with ineligible companies.

Pursed-lip Breathing – StatPearls – NCBI Bookshelf

John D. Nguyen; Hieu Duong.

Author Information and Affiliations

Last Update: July 25, 2022.

Definition/Introduction

The major drive for respiration originates in the central and peripheral chemoreceptors. The central chemoreceptors are located anterior medulla in the brainstem and predominantly responds to a decrease in pH from the accumulation of carbon dioxide in the cerebral spinal fluid. The blood-brain barrier protects the central nervous system from external stimuli. Carbon dioxide is lipid-soluble, which allows it to quickly diffuse across the protective barrier and influence the respiratory drive.

Unlike the central chemoreceptors, the peripheral chemoreceptors are more sensitive to changes in oxygen levels. The peripheral chemoreceptors consist of the carotid and aortic bodies. The aortic bodies are located at the aortic arch while the carotid bodies are situated at the common carotid artery bifurcation. Hypoxia stimulates cranial nerve IX to send signals to the nucleus tractus solarius which triggers ventilation. However, the central chemoreceptors normally override the peripheral receptors as it originates from the central control system of the body.[1]

Purse-lip breathing is a technique that allows people to control their oxygenation and ventilation. The technique requires a person to inspire through the nose and exhale through the mouth at a slow controlled flow. The expiratory phase of respiration is going to prolonge when compared to inspiration to expiration ratio in normal breathing. The maneuver presents as a controlled breath directed through the nostril then exhalation directed through lips having a puckered or pursed appearance. This technique creates a back pressure producing a small amount of positive end-expiratory pressure (PEEP).

During exhalation, the forces cause the airways that lack cartilage to drag inward towards the lumen obstructing airflow by increasing airway resistance which could lead to carbon dioxide trapping.[2] When there is an increased in carbon dioxide levels the central chemoreceptors are triggered to immediately increase the rate of respiration in an attempt to bring the body’s pH back to a baseline range of roughly 7.4 in a normal individual.[3][4] While the increase in the rate of respiration is effective in clearing carbon dioxide, it can potentially cause more air trapping and fatigue of the respiratory muscles. [5] PEEP mitigates the increase in work by creating an artificial splint that supports the patency of the airways and alveoli, increasing surface area and recruiting more alveoli to participate in gas exchange.[6] 

The positive pressure created opposes the forces exerted on the airways from the flow of exhalation. As a result, pursed-lip breathing helps support breathing by the opening of the airways during exhalation and increasing excretion of volatile acids in the form of carbon dioxide preventing or relieving hypercapnia. Through purse-lip breathing, people can have relief of shortness of breath, decrease the work of breathing, and improve gas exchange. They also regain a sense of control over their breathing while simultaneously increasing their relaxation.

Issues of Concern

With purse-lip breathing, the action of breathing initiates voluntarily. For purse-lip breathing to be effective, the individual must be able to perform the technique correctly. The technique requires proper coordination to maintain prolonged exhalation. As for the therapeutic effects, they are short-lived. The technique is limited to 3 to 5 breaths since prolonging the duration of the technique causes fatigue of the respiratory muscles and significantly lower than normal levels of carbon dioxide in a normal individual potentially leading to a decrease perfusion pressure in the brain causing syncope. Without the proper use of purse-lip breathing, an individual could exacerbate air trapping and carbon dioxide retention.

Clinical Significance

Clinically, purse-lip breathing when done correctly, can be beneficial in individuals suffering from dyspnea and air trapping. With proper teaching and coaching the technique can be easily taught by a trained professional. The benefits of purse-lip breathing may extend beyond its effects on the relief of carbon dioxide retention and improvement in oxygenation. Patients in mild respiratory distress may be able to regain control of their respiration through the technique. It is also an excellent tool for relaxation.

Purse lip breathing commonly helps patients with chronic obstructive pulmonary disease (COPD). With these patients, purse-lip breathing may not be a voluntary action, but rather a compensatory mechanism to help splint open the airways.[7][8] COPD individuals may have chronic obstruction of their airways from mucus plugging, loss of integrity of the airways, or enlargement of the airways. These changes in the airways can prevent the appropriate driving pressure and flow of air to maintain an adequate clearance of carbon dioxide due to an increase in airway resistance.[9] The increase in airway resistance also affects inhalation preventing enough oxygen from reaching the alveoli to create a sufficient partial pressure of oxygen needed to drive the diffusion of oxygen across the alveoli-capillary interface adequately. The defected driving pressure for oxygenation is further exacerbated due to the retention of carbon dioxide, causing less carbon dioxide to diffuse from the blood into the alveoli for excretion. The blunting of the proper mechanism to excrete carbon dioxide and adequate oxygenation leads to a constant stimulus to the central chemoreceptors to increase respiration until the point of exhaustion. Chronic hypercapnia decreases the sensitivity of the central chemoreceptors, allowing peripheral receptors sensing oxygen levels to become the predominantly drive for respiration.[10][11] Increased purse lip breathing in these patients may be a sign of impending respiratory failure.

Nursing, Allied Health, and Interprofessional Team Interventions

When it comes to the proper teaching of a new technique such as purse-lip breathing the trained individual should explain the benefits and potential adverse effects. The physiology of the technique requires explanation, followed by a demonstration. After teaching, the trainer should ensure that the trainee has learned the technique properly by asking the trainee to perform the technique or explain the technique to the trainer; this can ensure proper technique and correction of any mistakes that may occur during the learning process. [12][13]

Physicians, nurses, and health care professionals can incorporate the technique to help calm the patient. Patients with COPD, congestive heart failure, or panic attack may use the technique to relieve their dyspnea. This method could help reduce the need for noninvasive mechanical ventilation.[14][15]

Nurses that can recognize COPD patients in respiratory distress through signs such as increase purse-lip breathing, dyspnea, and accessory muscles use will allow rapid initiation of a response team to assist the patient before they deteriorate.[16][17] [Level III]

Nursing, Allied Health, and Interprofessional Team Monitoring

When it comes to monitoring, nursing staff should be able to teach pursed-lip breathing and explain to the trainee when this technique would be useful. The risk and benefits of the technique should be thoroughly explained with all questions and concerns addressed.

The nursing staff often spends the most time with patients of all health professionals. Nurses should be able to identify any patients that are in respiratory distress. With the knowledge of the common signs and symptoms of respiratory distress, nurses can effectively alert the appropriate response team and physicians to intervene before they deteriorate. Since the compensatory pursed-lip breathing is common to COPD patients, nursing should monitor COPD for the fatigue of respiratory muscles. Promptly alerting the physician can prevent patients from requiring mechanical ventilation.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Pursed lip breathing. Image courtesy O.Chaigasame

References

1.

Brinkman JE, Toro F, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 8, 2022. Physiology, Respiratory Drive. [PubMed: 29494021]

2.

Seadler BD, Toro F, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2022. Physiology, Alveolar Tension. [PubMed: 30969647]

3.

Hopkins E, Sanvictores T, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 12, 2022. Physiology, Acid Base Balance. [PubMed: 29939584]

4.

Keir DA, Duffin J, Millar PJ, Floras JS. Simultaneous assessment of central and peripheral chemoreflex regulation of muscle sympathetic nerve activity and ventilation in healthy young men. J Physiol. 2019 Jul;597(13):3281-3296. [PubMed: 31087324]

5.

Lomax M, Kapus J, Webb S, Ušaj A. The effect of inspiratory muscle fatigue on acid-base status and performance during race-paced middle-distance swimming. J Sports Sci. 2019 Jul;37(13):1499-1505. [PubMed: 30724711]

6.

Gonçalves-Ferri WA, Jauregui A, Martins-Celini FP, Sansano I, Fabro AT, Sacramento EMF, Aragon DC, Ochoa JM. Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study. Braz J Med Biol Res. 2019;52(7):e8585. [PMC free article: PMC6644527] [PubMed: 31314854]

7.

Vatwani A. Pursed Lip Breathing Exercise to Reduce Shortness of Breath. Arch Phys Med Rehabil. 2019 Jan;100(1):189-190. [PubMed: 30033163]

8.

Sakhaei S, Sadagheyani HE, Zinalpoor S, Markani AK, Motaarefi H. The Impact of Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in COPD Patients. Open Access Maced J Med Sci. 2018 Oct 25;6(10):1851-1856. [PMC free article: PMC6236030] [PubMed: 30455761]

9.

Haghighi B, Choi S, Choi J, Hoffman EA, Comellas AP, Newell JD, Lee CH, Barr RG, Bleecker E, Cooper CB, Couper D, Han ML, Hansel NN, Kanner RE, Kazerooni EA, Kleerup EAC, Martinez FJ, O’Neal W, Paine R, Rennard SI, Smith BM, Woodruff PG, Lin CL. Imaging-based clusters in former smokers of the COPD cohort associate with clinical characteristics: the SubPopulations and intermediate outcome measures in COPD study (SPIROMICS). Respir Res. 2019 Jul 15;20(1):153. [PMC free article: PMC6631615] [PubMed: 31307479]

10.

Docio I, Olea E, Prieto-LLoret J, Gallego-Martin T, Obeso A, Gomez-Niño A, Rocher A. Guinea Pig as a Model to Study the Carotid Body Mediated Chronic Intermittent Hypoxia Effects. Front Physiol. 2018;9:694. [PMC free article: PMC5996279] [PubMed: 29922183]

11.

Benner A, Lewallen NF, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 19, 2022. Physiology, Carbon Dioxide Response Curve. [PubMed: 30844173]

12.

Feinberg I, Ogrodnick MM, Hendrick RC, Bates K, Johnson K, Wang B. Perception Versus Reality: The Use of Teach Back by Medical Residents. Health Lit Res Pract. 2019 Apr;3(2):e117-e126. [PMC free article: PMC6610032] [PubMed: 31294313]

13.

Yen PH, Leasure AR. Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes. Fed Pract. 2019 Jun;36(6):284-289. [PMC free article: PMC6590951] [PubMed: 31258322]

14.

Sha J, Worsnop CJ, Leaver BA, Vagias C, Kinsella P, Rahman MA, McDonald CF. Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital. Intern Med J. 2020 Apr;50(4):453-459. [PubMed: 31157943]

15.

Avdeev SN, Truschenko NV, Gaynitdinova VV, Soe AK, Nuralieva GS. Treatment of exacerbations of chronic obstructive pulmonary disease. Ter Arkh. 2018 Dec 30;90(12):68-75. [PubMed: 30701836]

16.

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Disclosure: John Nguyen declares no relevant financial relationships with ineligible companies.

Disclosure: Hieu Duong declares no relevant financial relationships with ineligible companies.

Mental health: Taking care of yourself: Lenta.ru

Psychotherapist Nurdaev: abdominal, box and resonant breathing will help with anxiety

Photo: Avrielle Suleiman / Unsplash

service “SberHealth” Viktor Nurdaev. He suggested these and other breathing practices that help to pull himself together in an interview with Lenta.ru.

According to Nurdaev, taking a break and breathing can be useful, for example, when stressed by work or doomscrolling. He suggested practicing abdominal breathing. According to the American Stress Institute, 20-30 minutes of abdominal (diaphragmatic) breathing can reduce stress and anxiety. To do this, you need to find a quiet place to sit or lie down in a comfortable position, and then put one hand on your chest and the other on your stomach under the chest.

“Then relax your stomach: don’t pull it in and don’t tense your muscles. Slowly inhale through the nose with the help of the stomach and make sure that the hand under the chest rises, and the hand on the chest remains motionless, ”Nurdaev said. Then, while inhaling, you need to scan the body, the therapist continued. “You can feel tension where you didn’t notice it before. Exhale through slightly pursed lips and try to tighten your abdominal muscles a little to push all the air out. As you exhale, try to relax those parts of the body in which you noticed tension, ”he suggested.

To help focus and cope with stress, the specialist added, maybe box breathing, or 4-4-4-4 breathing.

For example, US Navy SEALs use this technique. If you have ever noticed that you breathe to the rhythm of the song you are listening to, you are familiar with this exercise in absentia ; inhale, counting to four, hold your breath again for four counts, and then exhale and repeat the exercise.

Pursed-lip breathing, Nurdaev pointed out, helps not only to fight anxiety, but also to cope with shortness of breath in chronic obstructive pulmonary disease (COPD). To perform this technique, you need to sit comfortably, relaxing your neck and shoulders. “Inhale slowly through your nose for a couple of seconds, trying to keep your mouth closed. Through pursed lips, slowly exhale all the air in your lungs for four seconds. Repeat the exercise several times, ”the psychotherapist described the exercise, adding that if shortness of breath after the exercise does not go away or gets worse, you need to seek medical help.

Finally, resonant breathing, according to the specialist, helps to relax and improve the work of the heart and mood. “Lie down or sit down and close your eyes, inhale slowly through your nose for six seconds and make sure that the air does not completely fill your lungs. Just exhale slowly for six seconds without making any effort, ”Nurdaev concluded, emphasizing that the practice can be repeated for 10 minutes.

Related materials:

Previously, the therapist Nadezhda Chernyshova spoke about the benefits of stress for the body. According to the expert, stress is an adaptive reaction of the body, without which a person could not survive.

Breathing exercises for calmness, concentration and health – I Love Supersport Blog

Breathing exercises are a powerful tool for training the lungs and finding inner peace. In this article, we will talk about the most common breathing techniques for different purposes.

Why you need breathing exercises:

🌿 Breathing exercises will help you relieve tension and become more focused.

🌿 Among the most effective breathing exercises are deep breathing, pursed-lip breathing and the 4-7-8 method.

🌿 Breathing practices improve attention, help to cope with anxiety and insomnia.

🌿 Breathing exercises should be practiced 1-2 times a day or more often with increased anxiety.

🌿 Breathing practices have a positive impact not only “here and now”, but also work for the future – reduce anxiety, improve sleep quality and help with chronic obstructive pulmonary disease (COPD).

Whether your goal is to relieve the symptoms of an illness or seek peace and tranquility, any of the nine breathing techniques suggested will help you achieve this. Each of them is doable at home, does not require special devices and is suitable for any level of physical fitness.

Deep Belly Breathing

Deep Belly Breathing or Diaphragmatic Breathing is a simple and safe exercise. It teaches proper breathing using the Diaphragm , not the chest muscles. Deeper, slower diaphragmatic breaths have been scientifically proven to help improve focus and reduce stress .

Hint: with proper diaphragmatic breathing, the shoulders remain motionless, movements occur at the level of the abdomen – in and out.

Breathing technique:

🌬 Find a comfortable position, sitting or standing.
🌬 Place one hand on the stomach, just below the ribs, the other on the chest.
🌬 Inhale deeply through your nose, pressing your hand to your stomach.
🌬 Exhale with pursed lips, as if blowing out a candle.
🌬 Use your hand to push all the air out of your stomach.
🌬 Repeat 3 to 10 times.

The 4-7-8 Technique

The 4-7-8 Technique, also known as the Relax Breathing Technique, relieves stress and anxiety and helps you fall asleep quickly, says Trisha Smith, Breathing Coach, sports chiropractor and founder of Expand Your Human, a lifestyle medicine. Anyone who is experiencing anxiety or just wants to regain their peace of mind should try this technique.

Throughout the exercise, keep your tongue on the roof of your mouth behind your upper teeth and exhale through pursed lips. This will slow down the exhalation, and you can easily make it longer than the inhalation.

Smith recommends doing the 4-7-8 technique as follows:

🌬 Inhale deeply through your nose for 4 counts.
🌬 Hold your breath at the peak of inhalation for 7 counts.
🌬 Exhale through pursed lips for 8 counts.
🌬 Repeat this cycle up to 4 times, twice a day.

The Wim Hof ​​Method

The Wim Hof ​​exercise focuses on holding deep breaths longer than most other breathing practices.

According to Smith, prolonged breath-holding enhances the body’s defense response to stress , which in turn increases resistance to adverse external conditions. With this technique, Wim Hof ​​was able to climb Mount Kilimanjaro in shorts and stand covered in ice cubes for nearly two hours. The Wim Hof ​​method will be useful to everyone, and especially to those who want to increase the physical endurance of their body.

Warning: Wim Hof’s website has a warning about the potential risk of loss of consciousness due to the intensity of the exercise. In this regard, this exercise should only be performed while sitting or lying down in a safe environment.

Smith, Wim Hof ​​instructor, describes the following breathing technique:

🌬 Take 30-40 deep breaths.
🌬 Inhale for the last time as deeply as you can, and then exhale through your open mouth.
🌬 Hold this exhalation as long as you can, the duration of the delay will depend on your fitness level.
🌬 Take another deep restorative breath.

Pursed lip breathing

Pursed lip breathing is a technique that slows down breathing and results in more controlled breathing. , teacher of breath with 20 years of experience, author of The Power of Breath, and CEO and founder of the Breath Hub app.

Medical term: Chronic obstructive pulmonary disease (COPD) is a disease that causes inflammation of the lungs. It restricts airflow and makes breathing difficult.

A 2019 study examined the effects of breathing exercises on COPD patients. The participants who practiced pursed-lip breathing improved their breathing rate (i.e., the number of breaths per minute) compared to those who did not.

Fidan Karamehmet recommends the following pursed-lip breathing technique:

🌬 Inhale as usual through the nose.
🌬 Pause and purse your lips as if you are about to whistle.
🌬 Exhale through your mouth.
🌬 Your pursed lips will control the speed of exhalation.

Lion’s breath

Lion’s breath probably got its name from the wide open mouth, protruding tongue and lion-like sigh.

This practice exercises the vocal cords more than other breathing exercises and is therefore ideal for singers and people with speech impediments.

According to Sandy Abrams, breathing instructor and author of Breathe To Succeed, lion breathing is done like this:

🌬 Stand or sit in a safe place, close your eyes.
🌬 Look inside yourself and imagine that emotional negativity that you would like to get rid of.
🌬 Take a long, slow, deep breath through your nose.
🌬 As you exhale, stick out your tongue, bulge your eyes and exhale loudly with the sound “haa”.
🌬 Repeat the exercise one to three times a day.

Alternate nostril breathing

Alternate nostril breathing is a common breathing technique used in yoga. And Hillary Clinton even practiced it during the 2016 election.

“It was designed to increase airflow to both hemispheres of the brain,” says Abrams. This activates both the logical and creative hemispheres. Studies have proven that this method suppresses anxiety . For example, in a small 2017 study, participants performed alternating nostril breathing for 15 minutes before simulating public speaking. Compared to the control group, people who performed the breathing technique had a lower level of anxiety.

Abrams outlines the following steps for alternate nostril breathing:

🌬 Close the right nostril securely with your thumb and take a slow, deep breath through the left nostril.
🌬 At the peak of inhalation with the ring finger, securely close the left nostril, pausing for a second, then release the thumb of the right hand and exhale through the right nostril.
🌬 Then repeat with the other side.
🌬 Do this exercise for 2-3 minutes.

Deep yoga breathing

Deep yogic breathing is a technique that teaches you to use the entire volume of your lungs. Beginners do this practice in the supine position. Once deep breathing becomes comfortable, it can be practiced in any position.

Warning: The first time you do this exercise, you may experience dizziness. In case of rapid breathing, it is necessary to slow down breathing and slowly rise.

Breathing technique:

🌬 Put one hand on the stomach, the other on the chest.
🌬 Inhale through your nose and exhale through your mouth 8-10 times.
🌬 While breathing, try to fill your lungs so that the stomach expands and the chest remains motionless.
🌬 After 8-10 breaths, begin to inhale first from the lower and then from the upper part of the chest. The hand on the stomach should drop slightly.
🌬 As you exhale, make a soft whistling sound with your mouth and lower your arms from your stomach and chest to your side.
🌬 Do this for three to five minutes.

Box breathing

Box breathing is a relaxation technique that involves inhaling, holding the breath and exhaling at regular intervals. The symmetry of this practice is unique among breathing exercises, as methods such as 4-7-8 usually emphasize longer exhalations than inhalations.

According to Fidan Karamehmet, box breathing is performed as follows:

🌬 Inhale slowly through your nose for 4 counts.
🌬 Hold your breath for 4 counts.
🌬 Exhale through your nose for 4 counts.
🌬 Hold your breath for 4 counts.
🌬 Repeat as often as you like.

Kapalbhati (Fire Breath)

Kapalbhati, also known as Fire Breath , is a breathing technique that can make you blush due to increased blood circulation due to muscle tension, says Fidan Karamehmet.

This is a key aspect of Kundalini Yoga, a branch of yoga designed to balance the chakras, or “energy centers” of the body. According to Fidan Karamehmet, although there are few scientific studies on the benefits of fire breathing, anecdotal evidence suggests an improvement in blood circulation and digestion.

Warning: Don’t practice Breath of Fire on a full stomach, says Fidan Karamehmet, as you’ll tighten your abdominal muscles, which can cause nausea or cramps.

Fidan Karamehmet highlights the following stages of kapalabhati:

🌬 Sit or stand straight, in a comfortable position, close your eyes.
🌬 Place your hands on your knees or hips, palms up.
🌬 Exhale completely in short bursts before inhaling.
🌬 Inhale through the nose, and then exhale sharply, straining the body.
🌬 Be sure to contract the lower abdomen so that during each exhalation, forcefully push all the air out of the diaphragm and lungs.
🌬 Focus on exhaling and the inhalation will happen naturally.

As a result

Despite the fact that each of the above exercises differs in execution technique, they all allow to direct all attention to breathing .