Breathing Retraining

Breathing Retraining

Breathing retraining teaches a calmer, more efficient breathing pattern. It is one of the most useful tools for breathlessness, an over-fast or upper-chest breathing pattern, and the breathing-pattern disorders that can occur even when the lungs themselves are healthy.

Pursed-lip breathing

Breathe in gently through the nose, then out slowly through pursed lips — as if blowing out a candle — making the breath out about twice as long as the breath in. The light back-pressure holds the airways open, slows the breathing rate, and reduces the air-trapping and breathlessness of COPD.¹ It is a simple, portable rescue strategy for moments of breathlessness.

Diaphragmatic (relaxed, lower-chest) breathing

Many breathless people over-use the neck and shoulder muscles and breathe high in the chest. Diaphragmatic breathing shifts the effort back to the diaphragm — "nose, low and slow" — with the lower ribs and abdomen doing the work and the shoulders relaxed. It lowers the work of breathing and the sense of effort.²

Positions of ease and the handheld fan

Forward-lean positions — leaning on a table, on your knees, or against a wall — fix the shoulder girdle and let the breathing muscles work more efficiently, easing breathlessness quickly. A handheld fan directing a stream of cool air across the face genuinely reduces the sensation of breathlessness through stimulation of facial (trigeminal) nerves, and is a cheap, evidence-supported tool.

Breathing-pattern disorders

Sometimes breathlessness, sighing, dizziness, air hunger and chest tightness arise from a disordered breathing pattern rather than the lungs — often fast, shallow, upper-chest breathing that lowers carbon dioxide. Retraining restores nose breathing, a diaphragmatic pattern and a slower rate, normalising the chemistry.³ Structured methods such as the Papworth approach, and the Buteyko technique in asthma, formalise this.⁴ See our guide to dysfunctional breathing.

Evidence

Breathing exercises improve breathlessness and quality of life in COPD and asthma, and resolve symptoms in dysfunctional breathing.⁵ They complement — and never replace — prescribed inhaled treatment.

References & evidence base

1. Holland AE, Hill CJ, Jones AY, McDonald CF. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012;(10):CD008250.
2. Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 2009;64(Suppl 1):i1–i52.
3. Jones M, Harvey A, Marston L, O'Connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev 2013;(5):CD009041.
4. Vagedes J, Helmert E, Kuderer S, et al. The Buteyko breathing technique in children and adults with asthma: a systematic review. Complement Ther Med 2021;60:102745.
5. Santino TA, Chaves GS, Freitas DA, et al. Breathing exercises for adults with asthma. Cochrane Database Syst Rev 2020;(3):CD001277.

References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.