Leaflet 3: Breathing techniques to ease breathlessness

The information given below is designed to help you manage your stable long-term breathlessness. If you feel your breathing is getting worse, or you are experiencing breathlessness as a new feeling, it is important to seek advice from your GP.

Muscles involved in breathing

The diaphragm

The main muscle of breathing is the diaphragm. This is a large flat sheet of muscle sitting in a dome shape at the base of your rib cage. As you breathe in, it flattens downward drawing the air into your lungs, and your tummy expands. When you breathe out, it relaxes upwards, to return to its natural dome shape, and your tummy flattens. The diaphragm muscle does not tire easily.

Breathing accessory muscles

There are many smaller muscles around your neck, upper chest and shoulders which move your neck and arms. However, when you are breathless, these muscles can pull on your ribs to help with breathing. These muscles are therefore called breathing accessory muscles.

It is normal to use these muscles for short periods when very breathless. However, when they are used unnecessarily they may focus the breathing to the upper chest, causing breathing to feel tight and uncomfortable. Prolonged overuse can make these muscles become tight and sore. It can therefore feel more comfortable to breathe from your tummy (diaphragm) and keep your accessory muscles 'in reserve’ for when you really need them.

Breathing techniques

Tummy breathing (breathing control)

Breathing from the tummy can make breathing feel easier as there is more room to breathe at the base of the lungs and less muscles are used. It can also aid relaxation and reduce panic. Tummy breathing can be used with the handheld fan (leaflet 2 in this series) and positions of ease (leaflet 4 in this series).

Breathing from the tummy does not always come naturally. It can therefore help to practice for 10 minutes, twice a day, when you are not breathless. Find a comfortable, supportive position, perhaps on your bed in side lying, or supported upright with pillows on your bed or in an armchair. Place one hand on your tummy and relax your upper chest and shoulders. As you breathe in, allow your tummy expand under your hand. As you breathe out, relax and let the tummy rest inwards. This is not a big movement; you do not need to take deep breaths.

You can then progress to practicing tummy breathing in other positions, such as sitting and standing. Aim to create a habit of breathing from the tummy, as this is the most efficient way to breathe.

‘Breathe low and slow, relax, let go’

When breathless, try to calm your breathing by taking longer, slower breaths from your tummy. This is diaphragmatic breathing. It can ease breathlessness and reduce anxiety or panic. Think: ‘Breathe low and slow, relax, let go’.

Breathe a rectangle

Breathing round a rectangle may help if you are feeling breathless, anxious or panicky. Wherever you are, there is often a rectangle to be seen, whether this is a book, a TV, computer or tablet screen, a mobile phone, a door, a window or a picture on the wall.

Follow the sides of the rectangle with your eyes as you tummy breathe. Gradually slow the speed at which your eyes move around the edge of the rectangle to slow your breathing.

Some people find counting helps, such as breathing in for 2 and out for 3; or in for 4, out for 6. Others like to feel around the edge of a rectangle, such as their phone, with their finger.

Pursed lips breathing

Pursed lips breathing involves breathing in through the nose and then gently out through pursed, narrowed lips, as if flickering a candle, not blowing it out. Some people imagine this as smell the rose, then flicker the candle. Pursed lip breathing supports the airways and slows the breath out, allowing more time for the air to leave the lungs, therefore creating more space for the next breath in. If you find it too difficult to breathe in through your nose then just breathing out through pursed lips should still help. This technique tends to help people with chronic obstructive pulmonary disease (COPD), emphysema or asthma. It can be used to ease breathlessness during or after activity.

Recovery breathing

Recovery breathing may help when you feel breathless or panicky.

People with chronic obstructive pulmonary disease (COPD), emphysema or asthma may prefer long breaths out, perhaps through pursed lips, in a forward lean position with their arms supported. People with other conditions may find relaxed breaths out suit them better, while relaxing their shoulders in an upright position. However there is no right or wrong. Try different variations and see what helps you the most.

Remember: Focus on the out breath; the in breath will take care of itself.

General advice

• Avoid breath holding during activities eg climbing stairs or bending.
• Try to ‘blow as you go’, which means breathing out on effort, eg blow out when bending, lifting, reaching or standing up from a chair.
• Try to avoid rushing.
• When climbing stairs, take a breath in for one step, out for two steps. If very breathless, stop on each step and take a gentle breath in and out. Breathing out through pursed lips may help.

Further information

For further help or advice contact the Breathlessness Intervention Service on 01223 274404 09:00 (9am) to 17:00 (5pm) Monday to Friday.