BREATHING EXERCISES for INCREASING LUNG VOLUME, CLEARING SECRETIONS and REDUCING THE WORK OF BREATHING
SEE ALSO – Breathlessness, Sputum clearance


ACPRC/BTS GUIDELINES (2009) – Physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 64, suppl.i1-i52
thorax.bmj.com/cgi/content/full/64/Suppl_1/i1?HITS=10&sortspec=relevance&hits=10&FIRSTINDEX=0&resourcetype=HWCIT&fulltext=acprc&searchid=1


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.

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
chestjournal.chestpubs.org/content/125/2/459

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
www.ncbi.nlm.nih.gov/pmc/articles/PMC2645865/?tool=pmcentrez
• deep breathing helps mucociliary clearance

Chuter T A M (1990) Diaphragmatic breathing maneuvers and movement of the diaphragm after cholecystectomy. Chest, 97, 1110-14.

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

Fernandes M, Cukier A, Feltrim MIZ (2011) Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis, 8, 237-44
crd.sagepub.com/content/8/4/237.abstract?etoc
• 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

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

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
www.mrmjournal.com/content/7/1/9

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
www.physiotherapy.asn.au/AJP/vol_49/2/AustJPhysiotherv49i2McKeough.pdf
• 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
journals.lww.com/jcrjournal/Abstract/2007/07000/Efficacy_of_Pursed_Lips_Breathing__A_BREATHING.10.aspx
• PLB reduced SOBOE

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

Spahija J (2010) Factors discriminating spontaneous pursed-lips breathing use in patients with COPD. COPD, 7, 4, 254-261
informahealthcare.com/doi/abs/10.3109/15412555.2010.496820
• 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.

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
www.informaworld.com/smpp/content~db=all?content=10.1080/14017430310014984
• 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.
www.chestjournal.org
• 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.





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
SOB = shortness of breath
SOBOE = shortness of breath on exertion