O6.7 Breathing exercises

A variety of breathing exercises are used in people with COPD. The aim of these exercises is to reduce dyspnoea by altering respiratory muscle recruitment, reducing lung hyperinflation, improving the functioning of the respiratory muscles and optimising thoraco-abdominal motion.

A Cochrane Review of 16 studies involving a total of 1233 individuals with stable COPD (Holland 2012) evaluated the effects of a variety of breathing exercises alone, or together with other interventions, on the primary outcome measures of dyspnoea, exercise capacity and health-related quality of life (HRQoL). The review found some evidence that breathing exercises (pursed lip breathing, diaphragmatic breathing, yoga involving pranayama timed breathing techniques) performed for between 4 and 15 weeks when compared to no breathing exercises improved exercise capacity as measured by 6-minute walking distance [evidence level I/II] but had inconsistent effects on dyspnoea or HRQoL. Mixed results were found when breathing exercises were compared with other techniques, namely inspiratory or expiratory muscle training, or whole body exercise training, or when combined with another intervention. Computerised ventilation feedback was less effective than exercise training for improving exercise endurance [evidence level III-2] and when combined with exercise training did not confer any additional benefits in dyspnoea compared to exercise training alone [evidence level III-2]. No significant adverse effects were reported in the studies. A major limitation of the studies was that assessor blinding could only be determined in two studies. In a systematic review of 15 randomised control trials (1098 people with COPD), daily pursed lip breathing combined with deep breathing (2-5 times a day for 5-30 minutes) compared to usual care, showed statistically significant improved pulmonary function (FEV₁, FVC, FEV₁/FVC) and 6-minute walk distance (mean difference 29m, 95% CI 19-38, p<0.001) compared to control (Yang 2022) [evidence level I].

Breathing exercises practiced daily may have a role to improve exercise capacity in people with COPD who are unable to undertake exercise training, and their use during daily living activities can be beneficial for breathlessness management by reducing respiratory rate at rest and shortening time taken to recover from breathlessness.