Learning to control your breathing

Choose a position that will make it easier for you to breathe. It is important to try and relax in these positions. Focus on relaxing the muscles in your neck and shoulders.

Sitting leaning forward

Sit leaning forward resting your elbows on your knees or the arms of the chair.

Sitting leaning forward at a table

Sit leaning forward with your elbows resting on a table. You could put some pillows or cushions on the table for comfort.

Standing leaning forward

Lean forwards resting your elbows on a chair, a wall or a railing. You could use a walking stick or a frame if you have one.

Your nurse or physiotherapist can teach you some breathing techniques.

Breathing techniques

Learning some breathing techniques will help ease shortness of breath. It will also reduce the feelings of panic and anxiety that can come with shortness of breath.

Talk to your GP if you are finding it difficult to control your breathing or if you have feelings of panic or anxiety. They may refer you to a physiotherapist to help you to manage your shortness of breath.

Pursed-lips breathing

Using this method, you breathe out for twice as long as you breathe in. Practice this method several times a day so it becomes natural to you when you are short of breath.

To do pursed-lip breathing :

• breathe in slowly, if possible through your nose - as you inhale, count 1, 2
• purse your lips in a whistling position
• breathe out slowly for twice as long as you inhaled - as you exhale count 1,2,3,4,
• relax and keep breathing steady
• repeat these steps until you no longer feel short of breath

Rest for a few breaths if you get dizzy and then begin again when you are no longer dizzy.

Watch a video demonstration of pursed lip breathing

Deep breathing exercise

To practice deep breathing:

• keep your neck and shoulders relaxed
• take 3 to 4 deep breaths in through your nose or mouth, so that your lower rib cage expands
  
• at the end of the last breath in, hold the air in your lungs for 3 to 4 seconds
• let the air out gently through your mouth

Relaxed tummy breathing

This breathing technique can help if you are short of breath after any activity. It can also help you feel more relaxed if you are feeling anxious or panicky.

Taking slower, deeper breaths from your tummy helps to ease shortness of breath.

Breathing from the tummy does not come naturally. You should practice it when you are not short of breath. This will help you master the technique.

Practising tummy breathing

1. Make sure you are in a comfortable position.
2. Your head and back should be supported and shoulders and upper chest relaxed.
3. Place one hand on your tummy.
4. Feel the tummy rise and expand as you breathe in and relax down as you breathe out.
5. Breathe gently when practising; there should only be a slight movement of your tummy at rest.

Watch a video of the tummy breathing technique

Breathe a rectangle

When you practice relaxed tummy breathing, it might help to look at a rectangle. This could be a book, a TV, window, table top, or even a picture on the wall.

Controlling shortness of breath at night

Some people with COPD may suffer from breathing difficulties at night. This can be frightening and the anxiety can then make your shortness of breath worse.

Sleeping upright using 4 to 5 pillows can make you feel more comfortable and less short of breath. Being prepared for shortness of breath at night can also reassure you.

To help control your shortness of breath at night:

• use the pursed-lip breathing technique
• relax your shoulders and neck muscles
• keep your reliever inhalers beside your bed and use them if needed
• keep a fan beside you and turn it on if you are breathless - the sensation of moving air can help with shortness of breath

if you wake short of breath, sit up and lean forward - sit at the edge of the bed and lean on a bed table

Clearing mucus (phlegm) from your lungs

Some people with COPD produce a lot of mucus in their lungs. You may find it hard to clear it. This can cause extra distress and shortness of breath.

To help clear phlegm or mucus:

• drink lots of fluids to keep the phlegm or mucus loose
• use a reliever inhaler before trying to clear phlegm
• do ACBT or huff breathing
• exercise often if you are able to

Active cycle of breathing techniques (ACBT)

ACBT is a technique using breathing exercises to remove phlegm from your lungs.

You can do ACBT in sitting, lying or side-lying positions. But start in a sitting position until you are comfortable and confident to try different ones.

ACBT uses depth of breathing to move phlegm from the small airways at the bottom of your lungs to the larger airways near the top. The phlegm can then be cleared more easily with huffing or coughing.

When you do ACBT try to:

• maintain a good breathing pattern with relaxed shoulders and neck
• breathe in through your nose and out slowly through your mouth - this can help minimise any wheezing

Forced expiratory technique or huffing

The forced expiratory technique is sometimes referred to as a ‘huff’. It is used to help force phlegm up the throat so you can get rid of it through your mouth without coughing. It can help to imagine you are steaming up a mirror in front of you.

To do the forced expiratory technique:

• take half a deep breath in and blow or huff the air out quickly through an open mouth - keep your mouth open in an O-shape
• as the phlegm moves into the larger airways take a deep breath in and blow it out again through an open mouth, keeping your mouth open in an O-shape
• continue blowing or huffing to clear the phlegm out of the back of your throat

This breathlessness scale will help you to track how hard you are working in all the tasks you complete every day. For example, you might be doing a housework task and notice that you are becoming short of breath.

You are the expert on your body and know it best. It is important that you know how to check your own energy and activity levels often.

The breathlessness scale starts at the number 0 where your breathing is causing you no difficulty at all. It goes up to 10, where your breathing is at its most difficult. Use this scale to check and guide you as you exercise or do everyday activities. It’s important to take regular rests and stop before you get too short of breath.

Modified BORG Breathlessness Scale