Coping with breathlessness

Much of the information on this page has been taken from the Association of Chartered Physiotherapists in Respiratory Care

People with lung problems often feel short of breath. Many daily tasks can make you breathless, such as walking, getting dressed or doing jobs around the house. Being breathless can make you panic or feel frightened. It can sometimes feel as though your breathlessness controls you, but this doesn’t need to be the case. From our experience, we have seen very poorly and breathless people regain some control by following the techniques detailed below.

When you learn how to control your breathing these feelings of panic and fear will not trouble you as much and you will be able to do more. When you are breathless, do not panic. Your breathing will settle.

Positioning
The positions and breathing exercises below will help you control your breathing. Remember to take rests and use one of these positions before you get too short of breath.

What positions can I use when I am short of breath?
Choose a position from the suggestions below which suits what you are doing and where you are. When you are in any of these positions it is important to relax. Some of these positions will work better than others depending on your condition.

Sitting Leaning Forward
Sit leaning forward with your elbows resting on your knees. Make your wrists and hands go limp.

Sitting leaning forward at a table
Sit leaning forward with your elbows resting on a table. You can also put a few pillows or cushions on the table to rest your head on.

Sitting Upright
Sit upright against the back of a firm chair. Rest your arms on the chair arms or on your thighs. Make your wrists and hands go limp.

High side lying
Lie on your side, with a few pillows under your head and shoulders. Some people like to use a foam wedge instead. A pillow between your waist and armpit can stop you sliding down the bed. Make sure the top pillow supports your head and neck.

Your knees and hips should be slightly bent. Depending on your lung condition it may be better to bend both of your legs, or just your top leg.

When standing or out and about
Standing leaning forward
Lean forwards resting your elbows onto a wall, a windowsill, a railing or a countertop. You could lean on a walking stick or a long umbrella if you use one. You can lean on a trolley while you are out shopping. A walking frame with wheels can be helpful.

Standing leaning back or sideways
Lean back or sideways against a wall, with your feet slightly apart and about one foot (30cms) away from the wall. Let your hands hang loosely by your sides, or rest them in your pockets. You may prefer to rest your hands or thumbs on your belt loops or waistband, or across the shoulder strap of your handbag.

Breathing Exercises
When you feel short of breath, particularly if occurring during daily tasks, do not hold your breath when you do any of these things. This will make you feel more short of breath. Do not avoid doing things that make you breathless.

When you learn how to control your breathing these feelings will not trouble you as much and you will be able to do more. When you get breathless, do not panic. Your breathing will settle.

Breathing Control
Breathing control means breathing gently, using the least effort. It will help you to control your breathing when you are short of breath or feeling fearful, anxious or in a panic. By using breathing control the effort of breathing is reduced.

How do I do breathing control?
Get into a comfortable position so that you can relax your shoulders and body. Make sure that your arms are supported. Use one of the positions described above.

Breathe in gently through your nose and breathe out through your nose, if you can. If you cannot breathe out through your nose, breathe out through your mouth instead.
If you breathe out through your mouth you can use it with ‘pursed lips breathing’ (see below)
You could place one hand on your chest and the other on your abdomen. As you breathe in allow your abdomen to rise and move out against your hand, your chest should hardly move. As you breathe out your abdomen should fall gently
Try to let go of any tension in your body with each breath out
Gradually try to make the breaths slower
Closing your eyes may help you to focus on your breathing and relax
Do not force your breath

When fully in control of your breathing, your ‘out’ breath should be longer than your ‘in’ breath and there should be a natural pause at the end of your breath out.

Tip: Try holding a handheld battery fan near your face – this often helps people to feel less breathless.

Relaxed slow deep breathing
Relaxed slow deep breathing is very useful when you are active. It should be used from the start of an activity that makes you out of breath. For example, walking or making the bed. It is not helpful to use this exercise if you are already very breathless.

How do I do relaxed slow deep breathing?
As you start to exert yourself, slow down your breathing and breathe in more deeply. Breathe in through your nose if you can. Use it with pursed-lips breathing and /or ‘blow-as-you-go’.

Pursed-lips breathing
This exercise can be used at any time to help you control your breathing. You can also use it while you are doing something that makes you breathless and it will help you to feel less short of breath.

How do I do pursed lips breathing?
Breathe in gently through your nose, then purse your lips as though you were going to blow out a candle or whistle. Blow out with your lips in this pursed position. Imagine “blowing out a candle” or whistling when you breathe out. Try to blow out for as long as is comfortable; do not force your lungs to empty.

Blow-as-you-go
This exercise helps make tasks easier. You can use it while you are doing something that makes you breathless. You can use it with ‘pursed lips breathing’.

How do I do blow-as-you-go?
Breathe in before you make the effort. Then breathe out while making the effort. For example, when lifting a heavy bag, breathe in before you lift the bag and then breathe out through as you lift the bag - “blow as you go”!
It can be helpful to use pursed lips as you blow. Here are some other examples of when to use ‘blow as you go’:

As you stretch your arms above your head to reach for something
As you reach for something – such as a glass of water by your bed
As you reach or bend down
As you lift a heavy object or weight
As you step up
As you stand up
During the most difficult part of any action

Paced breathing
This is useful when you are active, for example, walking or climbing stairs. You pace your steps to your breathing. You can use it at the same time as pursed lips breathing and ‘blow as you go’.

How do I do paced breathing?
To use it when walking, count to yourself as you walk. For example, count 1 as you breathe in and then count either 2 or 3 as you breathe out. You can count for longer as you breathe in or as you breathe out if that feels better for you.

The right number for you will depend on you and your lung condition. Your counting should be in time with the steps you take.

To use paced breathing while climbing stairs, breathe in and out in time with the steps you take. Do this in a rhythm that suits you. Here are some examples of how you could pace your breathing:

breathe in when standing on the stair and breathe out as you go up a stair (blow-as-you-go!),or
breathe in as you go up one step and breathe out as you go up another step (in for 1, out for1)
breathe in as you go up one step and breathe out as you go up two steps (in for 1, out for 2) or
breathe in as you go up two steps and breathe out as you go up three steps (in for 2, out for 3)

When should I do my breathing exercises?
It is important to practice these exercises often so that you learn them. Then you will find you can use them more easily when you need them.
It is easier to practice them when you are not too short of breath. Practice them in one of the positions. You may find some of the breathing exercises are more helpful to you than others and different ones work better in different situations.