According to the World Health Organization (WHO), COPD is the seventh leading cause of poor health worldwide and the third leading cause of death.
Though this may sound bleak, COPD is preventable and treatable.
In this article we’ll discuss:
- What is COPD?
- Causes and risk factors of COPD
- Symptoms of COPD
- How breathing exercises can help COPD
- Breathing exercises for COPD
What is COPD?
COPD stands for Chronic Obstructive Pulmonary Disease.
As the name suggests, it is a chronic, progressive lung disease. With COPD, breathing is compromised due to the restricted the flow of air in and out of the body’s airways.
The most common types of COPD are chronic bronchitis and emphysema.
Chronic Bronchitis
Chronic bronchitis is caused by damage to the bronchial tubes in the lungs.
Bronchitis is usually characterized by coughing as well as dyspnea (the medical term for shortness of breath), but it becomes chronic when coughing lasts for a minimum of three months for two consecutive years.
The bronchial tubes are lined by cilia (tiny hair-like structures) that help to transport mucus in an upward direction through the bronchial tubes, allowing it to be coughed up.
With chronic bronchitis, not only are the bronchial tubes irritated, the cilia have also been lost which makes it difficult to cough up mucus. Consequently, this can lead to mucus build-up in the lungs and excessive coughing in an attempt to remove mucus.
This excessive coughing can be tiring and lead to further damage.
Emphysema
Emphysema is caused by damage to the alveoli (air sacs at the end of the bronchioles in the lungs).
The alveoli become larger and the lungs stretched out as the walls of the alveoli have broken down.
The result is that the lungs become less springy and becomes easier for air to get trapped in the lungs. This is why emphysema can be characterized by dyspnea.
COPD is usually diagnosed via pulmonary (lung) function testing, chest x-rays and / or scans. A positive diagnosis can mean that you have either chronic bronchitis or emphysema or both.
The type of COPD you have will likely have a bearing on how your symptoms impact you and the effectiveness of any treatment you may be undertaking.
Other health conditions alongside COPD such as diabetes, high blood pressure and heart disease, can also influence your COPD and how it is treated.
Causes of COPD
Though COPD can be inherited, it usually develops over time due to external factors.
A genetic condition that can be inherited called AATD (Alpha-1 Antitrypsin Deficiency) negatively impacts the body’s ability to produce the Alpha-1 protein. Alpha-1 protects the lungs and this deficiency is the most common form of genetic emphysema. A blood test would be required to diagnose this.
According to the American Lung Association, the leading external cause of COPD is smoking, though 1 in 4 people with COPD have never smoked.
The ALA also states that more women are living with COPD (and experiencing higher death rates) than men.
Some of the other external causes and risk factors may include:
- Exposure to pollutants (indoors and outdoors)
- Passive (second-hand) smoking
- A history of respiratory infections during childhood
- Underdeveloped lungs
- A history of asthma
Symptoms of COPD
How would you know if you might have COPD? Though symptoms can vary from person to person, a few common ones include:
- A continuous cough (with or without mucus)
- Dyspnea (shortness of breath)
- Wheezing
- A feeling of tightness in the chest
- Frequent nose / throat infections and colds
- Unexplained tiredness
If you suspect that you may have COPD, it’s important to seek medical guidance, as symptoms can become worse over time if left untreated.
Though COPD isn’t curable, lifestyle changes such as giving up smoking or vaping and reducing your exposure to airborne pollutants (such as smoke from wood burning stoves or coal) can improve symptoms.
As lung function also tends to decline as we get older, being physically active (especially if you’re over the age of 40) is also important to consider.
There are also ways of treating COPD to help improve the condition.
How Breathing Exercises can Help COPD
Breathing exercises on their own are not a cure all for COPD, but they are certainly among the tools that can be helpful in managing the symptoms of this condition day to day.
Some of the benefits of breathing exercises for COPD include, (but are not limited to) in no particular order:
- More comfortable breathing
- Better control of your breathing
- Moving excess mucus from the lungs and airways
- Releasing trapped air from the lungs
- Stress reduction
- Improved ability to exercise and engage in physical activity
- Better quality of life
Breathing Exercises for COPD
Here are some COPD breathing exercises to try.
If in any doubt, it is important to speak to your doctor before doing any of these exercises to ensure they are suitable for you.
#1: Pursed Lip Breathing
If you’re experiencing dyspnea (the medical term for shortness of breath), pursed lip breathing is one of the simplest ways to get your breathing back under control.
With its ability to encourage airflow to the lungs, this breathing technique can also be helpful while engaging in physical activity.
In addition, pursed lip breathing (particularly with its lengthened exhale) encourages a parasympathetic (calm and relaxed) nervous system state that combats the anxiety that can understandably arise when dyspnea occurs.
This is important as feeling out of control of our breath can send us into a sympathetic nervous system (heightened stress) state, which is the last thing one needs under these circumstances.
Here’s how to do pursed lip breathing:
- Inhale through your nose – not deeply, just a regular breath
- Purse your lips together as though you’re about to blow out birthday candles
- Exhale in a slow and controlled manner through your pursed lips, aiming for your exhale to be about twice as long as your inhale
- Continue at this pace until you feel that you have your breathing back under your control
Tips for practice:
Practice pursed lip breathing several times a day when you are feeling calm in order to familiarize yourself with this technique.
Closing your eyes (if it’s safe to do so) may help you focus on your breathing more easily.
As you are aiming for your exhale to be twice as long as your exhale, you may find it helpful to internally count as you breath. For instance, you might count as follows:
“Inhale, 1, 2. Exhale, 1, 2, 3, 4.”
Reduce or increase the duration of the count to suit your breath capacity.
Also, if you are feeling particularly short of breath, you might find it more comfortable to lean your upper body slightly forward when practicing pursed lip breathing. To do so, try tripod posture as a way of encouraging more air into your lungs.
To perform tripod posture:
- Lean your upper body forward by approximately 45 degrees
- If you are standing, rest your hands or forearms on something in front of you such as a table
- If you are sitting, rest your hands or forearms on your thighs
Research from 2017 examining the effectiveness of different positions on abdominal muscle activity found that tripod position and kneeling on all fours lead to improved breathing.
#2: Diaphragmatic Breathing
The diaphragm is the dome-shaped muscle located underneath the lungs at the base of the rib cage. Its role is an important one when it comes to breathing well because it is the main muscle associated with breathing.
When you inhale, the diaphragm contracts by moving down, helping to bring air into the lungs. At the same time, this downward movement of the diaphragm causes the belly to rise.
When you exhale the diaphragm moves upwards (relaxing back to its original shape) allowing the belly to fall. (When you hear references to ‘belly breathing’ or ‘breathing into your belly’ it’s really a way of encouraging this up and down movement of the diaphragm to bring more air into the lungs.)
Like any muscle, the diaphragm can become weaker if not properly utilized. Lung conditions such as COPD tend to mean that the diaphragm has become less effective than it otherwise would be.
When we become short of breath or panicky, it’s common for the body to naturally resort to accessory breathing. This recruits muscles in the neck, shoulders, upper back and upper chest resulting in a shallow breath, which is not helpful to us.
By practicing diaphragmatic breathing, it’s possible to help this muscle work better and, in turn, aid the quality of your breathing by encouraging air to move deeper into the lungs.
Like the pursed lip breathing technique, diaphragmatic breathing also helps to regulate your nervous system, encouraging a calmer state.
Here’s how to do it:
- Diaphragmatic breathing can be practiced seated, though often this can be easier to do lying down with your knees bent and your head supported
- Allow your abdomen to be relaxed
- Rest one hand on the center of your chest and the other hand just below your ribs – this with allow you to feel the movement of your breath via your hands
- Inhale through your nose as slowly and deeply as is comfortably possible for you. The hand on your chest should be moving very little, while the hand under your ribs should rise (along with your belly)
- Exhale through your nose as slowly and as steadily as possible. The hand on your chest again, should move very little, while the hand under you ribs should fall (along with your belly.)
- You may wish to use your lower hand to gently press down on your belly as you exhale to assist the movement of your diaphragm
Tips for practice:
If you have COPD this may be a bit more challenging than pursed lip breathing. Try to develop a habit of practicing diaphragmatic breathing regularly at times when you are not feeling breathless (e.g. 5 to 10 minutes daily).
If exhaling through your nose is difficult here, then exhale through pursed lips.
As you become more adept at diaphragmatic breathing you will be able to incorporate this into your pursed lip breathing technique.
#3: Deep Breathing
With COPD, dyspnea can occur when air can becomes trapped in the lungs. This deep breathing exercise, which involves some breath retention, can be helpful for addressing this and allowing you to breathe more efficiently.
Here’s how to do it:
- Sit comfortably with your neck, shoulders and chest relaxed
- Move your elbows back slightly to help broaden across your chest
- Inhale through your nose – try to make this a slightly bigger inhale if possible
- Hold your breath for 2 to 5 counts
- Exhale slowly through your nose until it feels like your lungs are empty
Tips for practice:
If holding your breath causes any discomfort or light-headedness, then practice pursed lip breathing instead.
Placing your hands on your rib cage may help you tune into your breathing more easily.
Work up to practicing this for 10 minutes daily.
#4: Forced Expiratory Technique (Huff Coughing)
This technique may be particularly helpful if you have chronic bronchitis and suffer from excess mucus (phlegm/sputum) build-up.
The huffing aids the movement of mucus from the small airways to the larger airways. This is important because coughing alone does not remove mucus from the smaller airways. Once in the larger airways, coughing can effectively remove it.
That said, excessive coughing is tiring to the body and not advised. Huff coughing is a known to be a technique that helps to move mucus without causing strain.
There are two kinds of huff:
Medium volume – to help move mucus in the lower airways
High volume – to help move mucus in the upper airways
To perform the medium volume huff:
- Sit in a comfortable upright position. Begin by taking a few pursed lipped breaths.
- With your abdominals relaxed, inhale through your nose
- Exhale through your mouth as slowly as possible making a “haaa” sound, until if feels like you’ve expelled the air from your lungs.
- The sound and force of your exhale here should be as though you’re trying to fog up the glass on a mirror in front of you.
To perform the high volume huff:
- Follow the first two steps for the medium volume huff, as above
- Use your abdominal muscles to expel the air from your lungs with 1 to 3 short huffs (“ha, ha, ha”) through your mouth
Tips for practice:
When performing huff coughing, you might find it easier to lean forward slightly while expelling air.
Avoid huffing too often in one go, as this may lead to chest tightness.
You may find that huffing alone clears mucus effectively. However, if your hear crackling sounds while you are huffing, this can be a sign that you need to cough up (and spit out) the mucus that has now moved to your larger airways.
Have tissues or similar to hand if you do need to spit. Also, remember that excess coughing can be tiring, so it’s advisable to avoid this.
#5: Controlled Coughing
This is similar to huff coughing in its effectiveness in loosening mucus and moving it through the airways. Controlled coughing uses less oxygen to do this in comparison to regular coughing.
To perform controlled coughing:
- Sit in a chair with your feet flat on the ground
- Breathe in through your nose
- Cross your forearms over your abdomen and lean forward
- On your exhale, in 2 to 3 short bursts, cough through your mouth sharply
Inhale through your nose and perform your controlled coughing again if necessary. Avoid doing so repeatedly as this may reduce its efficacy and become tiring.
Suggested further reading:
COPD for Dummies by Kevin Felner, MD and Meg Schneider
The Complete Guide to Understanding and Living with COPD: From A COPDer’s Perspective by R.D. Martin
