Breathe in, breathe out! Take slow, deep breaths; breathe in through your nose and breathe out through your mouth. Isn’t this what helps us relax? But, if you thought the role of breathing ends here, you are highly mistaken; it extends way beyond relaxation.
Do you know that breathing exercises help improve lung capacity, strengthen the respiratory muscles, and enhance the quality of life? For individuals with asthma, chronic obstructive pulmonary disease (COPD), or other respiratory/lung conditions, breathing exercises play a pivotal role.
The role of physiotherapy in respiratory conditions is not unknown. COVID-19 has acted as a catalyst to emphasize the importance of breathing exercises in physiotherapy for managing respiratory diseases.
Why are breathing exercises necessary?
We all have been in situations where we have climbed quickly or run a couple of meters and found ourselves gasping for air; this is what people with respiratory conditions experience in their day-to-day activities.
Breathing exercises help in:
clearing the airways,
improving the capacity of the lungs,
strengthening the muscles associated with breathing,
reducing breathlessness,
aiding in relaxation, and
improving the overall quality of life of individuals.
Types of Breathing Exercises
Diaphragmatic Breathing
This technique focuses on the diaphragm—the primary muscle for inspiration (inhalation).
The diaphragm contributes to 80% of breathing.
Steps:
Patient position: Semi-fowler’s position or can be performed in sitting.
Relax the accessory muscles, like the upper trapezius and the pectorals.
Inhale through the nose, allowing the abdomen to rise during each breath.
Gently breathe out through the mouth, allowing the abdomen to fall.
Pursed Lip Breathing
It is commonly advised for COPD patients as it helps to manage breathlessness.
Steps:
Take a slow and deep breath through the nose.
Breathe out gently through your mouth with pursed lips, like blowing out a candle. Exhale as slowly as possible.
Segmental Breathing
This technique focuses on increasing airflow in some segments of the lungs, which can reduce post-surgery, pregnancy, trauma to the chest wall, or pneumonia.
Segmental breathing techniques include:
Lateral costal expansion: Lateral aspect of lower ribs.
Posterior basal expansion: Posterior aspect of lower ribs.
Right middle lobe expansion.
Apical expansion: Apices of lungs.
Steps:
Patient position: Supine (lying on your back) or sitting.
Therapist places hands on the targeted lung segments, e.g., lateral aspect of lower ribs for lateral costal expansion.
Once the patient breathes out, the therapist applies a downward and inward stretch just before inspiration, which facilitates the external intercostal muscles.
Self-technique using a towel or belt can be taught to patients.
Active Cycle of Breathing (ACBT)
ACBT focuses on mucus clearance and improving ventilation.
The three main phases are:
a) Breathing control: Gentle breathing through the nose and exhaling through pursed lips. Breathing control is performed between the more active phases of the cycle.
b) Thoracic expansion exercises/deep breathing: Thoracic expansion focuses on inspiration.
Inspiration, followed by a 3-second hold, then relaxed expiration (repeat 3-5 times).
Therapist places hands on the thoracic cage for proprioception.
c) Huffing or Forced Expiratory Technique (FET): Huffing moves the secretions, mobilized through breathing control and thoracic expansion exercises, towards the upper airways.
Cycle: Breathing control → Deep breathing (3-4) → Breathing control → Deep breathing (3-4) → Huffing → Cough.
Incentive Spirometry
An incentive spirometer is a hand-held tool that helps to improve lung function and strengthen the inspiratory muscles.
Indications:
Post-surgery,
Prolonged immobility,
Patients with COPD.
Steps:
Patient position: Relaxed sitting. Exhale fully before starting.
The patient performs sustained, maximal inspiration, followed by a 3-5 second hold, and exhales slowly.
The ball present in the spirometer gives visual feedback to the patient.
Recreational Exercises
Blowing balloons.
Making water bubbles in a glass using a straw.
Blowing tiny pieces of paper.
The physiotherapist customizes an exercise protocol incorporating the breathing exercises with the frequency, duration, time, and type of exercises to be done. Breathing exercises not only help improve lung function but also help relieve breathlessness and enhance daily well-being.
ความคิดเห็น