SEE ALSO – Breathlessness, Sputum clearance

ACPRC/BTS GUIDELINES (2009) – Physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 64, suppl.i1-i52

Ayoub J (2001) Diaphragm movement before and after cholecystectomy. Anesth Analg, 92, 755-61
• effects of deep breathing

Bakow (1977) Sustained maximal inspiration - a rationale for its use. Respir.Care, 22, 379-82.
• explanation of the mechanism of the end-inspiratory-hold

Bianchi R (2004) Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest, 125, 2, 459-465

Borge CR, Hagen KB, Mengshoel AM et al (2016) Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC Pulm Med; 14:184. doi: 10.1186/1471-2466-14-184

Brasher PA, McClelland KH, Denehy L (2003) Does removal of deep breathing exercises from a physiotherapy programme alter patient outcomes? Austr.J.Physiother, 49, 165-73
• routine breathing exercises appear unnecessary after cardiac surgery

Button B, Boucher RC (2008) Role of mechanical stress in regulating airway surface hydration and mucus clearance rates. Respir Physiol Neurobiol; 163(1-3)189–201
• deep breathing helps mucociliary clearance

Collins EG, Jelinek C, O'Connell S et al (2014) Contrasting breathing retraining and helium-oxygen during pulmonary rehabilitation in COPD: a randomized clinical trial. Respir Med; 108(2):297-306. doi: 10.1016/j.rmed.2013.10.023

Critchley HD, Nicotra A, Chiesa PA et al (2015) Slow breathing and hypoxic challenge: cardiorespiratory consequences and their central neural substrates.
PLoS One; 10(5): e0127082. doi: 10.1371/journal.pone.0127082

Dallimore K, Jenkins S, Tucker B (1998) Respiratory and cardiovascular responses to manual chest percussion in normal subjects. Austr Physiother J, 44, 267-74
• deep breathing increases oxygen saturation

Davis D (1996) Neurological facilitation of respiration. ACPRC Journal, 28, 9-11.
• selective manual pressure to alter breathing patterns

De Araujo CL et al (2016) Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease. J Rehabil Med; 47(10):957-62.
• pursed-lips breathing may reduce dynamic hyperinflation, but do not improve functional capacity:

Dick TE, Mims JR, Hsieh Y-H et al (2014) Increased cardio-respiratory coupling evoked by slow deep breathing can persist in normal humans. Respir Physiol Neurobiol; 0: 99–111. doi: 10.1016/j.resp.2014.09.013

Drozdz T, Bilo G, Debicka-Dabrowska D et al (2016) Blood pressure changes in patients with chronic heart failure undergoing slow breathing training. Blood Press; 25(1):4-10. doi: 10.3109/08037051.2016.1099800
• slow breathing training shows a non-significant tendency to improve QoL

Fernandes M, Cukier A, Feltrim MIZ (2011) Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis, 8, 237-44
• diaphragmatic breathing reduces SOB and hypoxaemia in the majority of COPD patients, but in some patients with severe COPD it may cause asynchronous breathing thus worsening SOB

Fixley (1978) Flow dependence of gas distribution and the pattern of inspiratory muscle contraction. J Appl Phys, 45, 733-41.

Garrod R, Daly C, Hoarear C (2004) The effect of pursed lip breathing on exercise capacity and breathlessness in patients with COPD. ACPRC Journal, 36, 29-36
• pursed lip breathing during exercise may lower post-exercise respiratory rate

Garrod R (2014) Nonpharmacological interventions for refractory chronic cough patients: systematic review. Lung; 192:75-85. doi: 10.1007/s00408-013-9508-y

Gimenez MG (2010) Comprehensive directed breathing retraining improves exertional dyspnea for men with spirometry within normal limits. Am J Phys Med Rehabil, 89, 2, 90-98

Gosselink R (2004) Breathing techniques in patients with COPD. Chron Respir Dis, 1: 163-172
• evidence for the benefits of pursed lips breathing, forward leaning position, active expiration and inspiratory muscle training
• limited evidence for the transfer of the effects of breathing techniques during resting conditions to exercise conditions.

Hillman DR (2013) The effect of diaphragm contraction on upper airway collapsibility. J Appl Phys; 115(2):337-345
• deep breathing reduces airway resistance

Holland AE (2009) Breathing retraining for individuals with chronic obstructive pulmonary disease - no role for clinicians. Chr Respir Dis, 6, 45-46
• interesting argument about breathing retraining being innecessary.

Hulme KM, Salome CM, Brown NJ et al (2013) Deep inspiration volume and the impaired reversal of bronchoconstriction in asthma. Resp Physiol Neurobiol; 189(3):506-512

Johnson MJ, Kanaan M, Richardson G et al (2015) A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease. BMC Medicine; 13:213. doi: 10.1186/s12916-015-0453-x

Kim K-s, Byun M-k (2012) Effects of breathing maneuver and sitting posture on muscle activity in inspiratory accessory muscles in patients with chronic obstructive pulmonary disease. Multidisciplin Respir Med, 7, 9, doi:10.1186/2049-6958-7-9

Lucas SJW (2013) Slow breathing as a means to improve orthostatic tolerance: a randomized sham-controlled trial. J Appl Phys; 115(2):202-211

McKeough ZJ, Alison JA (2003) Arm positioning alters lung volumes in subjects with COPD and healthy subjects. Austr J Physiother, 49, 133-7
• raising the arms above 90 degrees increases FRC but decreases inspiratory capacity

Nield MA, Hoo S, Guy W (2007) Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehab Prevention, 27, 4, 237-244
• PLB reduced SOBOE

Schnidrig S, Casaulta C, Schibler A et al (2013) Influence of end-expiratory level and tidal volume on gravitational ventilation distribution during tidal breathing in healthy adults. Eur J Appl Physiol, 113(3):591-8

Spahija J (2010) Factors discriminating spontaneous pursed-lips breathing use in patients with COPD. COPD, 7, 4, 254-261
• out of 57 patients, 6 spontaneously performed PLB at rest, exercise and recovery, 18 during exercise and recovery, 7 during recovery only and 20 not at all.

Tomich GM, Franηa DC, Diniz MTC et al (2010) Effects of breathing exercises on breathing pattern and thoracoabdominal motion after gastroplasty. Brazil J Pulmonol, 36(2):197-204

Valenza-Demet G, Valenza MC, Cabrera-Martos I et al (2014) The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial. Clin Rehabil; 28(11):1087-95. doi: 10.1177/0269215514530579
• for pleural effusion, deep breathing exercises, incentive spirometry and mobilisation improve radiological findings and shorten hospital stay

Westerdahl E (2015) Optimal technique for deep breathing exercises after cardiac surgery. Minerva Anestesiol; 81(6):678-83

Westerdahl E, Lindmark B, Eriksson T et al (2003) The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J, 37, 363-7
• a single session of 30 deep-breaths reduces atelectasis and increases oxygenation on the second postoperative day after CABG

Westerdahl E (2005) Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery Chest, 128: 3482-8.
• patients who performed 30 slow deep breaths (against a positive expiratory pressure of 10 cm H2O) hourly during daytime for the first 4 postoperative days after CABG had significantly smaller atelectatic areas and better pulmonary function.

Woo S-D, Kim T-H, Lim J-Y (2016) The effects of breathing with mainly inspiration or expiration on pulmonary function and chest expansion. J Phys Ther Science; 28(3):927-931. doi: 10.1589/jpts.28.927.

ACPRC = Association of Chartered Physiotherapists in Respiratory Care
CABG = coronary artery bypass graft.
FRC = functional residual capacity, i.e. resting lung volume
IPPB = intermittent positive pressure breathing, e.g. the Bird
PLB = pursed lips breathing
QoL = quality of life
SOB = shortness of breath
SOBOE = shortness of breath on exertion