Managing Breathlessness

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Leaflet code: 00134   Date of Publication: June 2009   Date of Review: June 2011
    Managing breathlessness
    People with Lung Disease will always suffer with some degree of breathlessness. This
    leaflet is designed to introduce you to different strategies, techniques and positions that
    you can use to alleviate this.
                                                                                                  High side lying
    When you are short of breath the priority is to relax the muscles of your shoulders, neck
                                                                                                  This position is particularly useful if you are
    and upper chest. This will make your breathing more efficient. Aim for relaxed gentle
                                                                                                  suffering with an exacerbation.
    breathing and be reassured in the knowledge that your breathing will always recover.
    Some people have a tendency to tense the muscles in their shoulders and arms when
    they are short of breath and try to take deep breaths, this can exacerbate the feelings of
    breathlessness and prolong recovery.

    When you are short of breath the first thing you should do is consider your position.         Supported sitting
    Adopting one of the following positions will help to decrease the work of breathing and       This is a good position to adopt between
    eliminate unnecessary muscular activity.                                                      activities.

    You should avoid:                                                                             Sitting in an upright chair with supported
                                                                                                  arms, leaning forward slightly. Ideally with
    • Fixing your arms with your shoulders raised                                                 your palms facing upwards.

    • Pushing down or gripping with the hands

    • Laying back

    Find a position which is comfortable for you

                                                                                                  Forward lean sitting
                                                                                                  This position is very similar to the position
                                                                                                  above but does not require arm support of a
                                                                                                  chair. It can be used as in the picture, when
                                                                                                  you are outside or it can be used when you
                                                                                                  are perched on the edge of the bed.

                                                                                                  Sitting leaning forward with arms resting on
                                                                                                  your thighs, palms facing upwards.

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                                                    Forward resting
                                                    This is another good position to use
                                                    when you are exacerbating.

                                                    Sitting leaning forward from the waist,
                                                    arms folded and resting on pillows on a    Side leaning
                                                    table, feet flat on the floor.
                                                                                               Standing relaxed, leaning sideways against
                                                                                               a wall, with either your hands in your pockets
                                                                                               or resting on a bag.

Forward lean standing

                                                                                               Supported standing
                                                                                               Standing relaxed, leaning back against
                                                                                               a wall with legs slightly apart, shoulders
                                                                                               relaxed and arms hanging loosely by your

Standing relaxed, leaning forwards with arms resting on a support of suitable height; such
as a window sill, kitchen worktop, walking aid or shopping trolley. Knees slightly bent, one
foot in front of the other.

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    Breathing control                                                                           Pursed-lip breathing
    Once you have adopted your chosen position you are now ready to practice your               Pursed-lip breathing can be used to aid recovery of your breathing. It can also be used to
    breathing control. This is a technique which helps to produce a more relaxed breathing      control your breathing during exertion. It is particularly useful for people with emphysema.
    pattern. It can be used at rest or during activities such as walking or climbing stairs.
                                                                                                How to do it:
                                                                                                • Breath in slowly for the count of 1 (ideally through your nose)
    Try to keep your shoulders and upper chest relaxed as you breathe gently in and out.
    If you find this difficult, ask someone to press gently down on your shoulders to relieve
    some of the tension.                                                                        • Purse your lips as if you were going to whistle

    How to do it:                                                                               • Breath out slowly through your pursed lips for the count of 2 (Breathe out twice as
                                                                                                  slowly as you breathe in)
    • Breathe in and out at your own rate
                                                                                                • Let the air escape naturally, don’t force the air out of your lungs
    • Put one hand on your upper chest, and the other on your belly just above your waist. As
      you breathe in, you should be able to feel the hand on your belly moving out (the hand    • Continue until your breathing slows and you feel back in control
      on your chest shouldn’t move)
                                                                                                Other Tips
    • If you give a little cough the muscle you feel under the hand on your belly is your
      diaphragm                                                                                 • Avoid sudden bursts of energy which can make you hold your breath

    • You should be able to feel the hand on your belly moving in as you exhale (breathe out)   • Try using a fan or sitting by an open window, this can really reduce your feelings of
    • Make your breath out twice as long as your breath in, but don’t force it out
                                                                                                • Using a stick when walking to aid the forward lean position when outside
    • Try breathing in through your nose if able and out through your mouth
                                                                                                • Using a delta frame when walking outside can increase the distance you cover and
    • Do this for about 1 minute                                                                  reduce your feelings of breathlessness

    Hints and Tips:                                                                             • Try to organise your time and day, so that you are able to perform tasks at the time of
                                                                                                  day when you have most energy. Plan rest periods into your day.
    • Don’t try and slow your breathing down straight away, this will happen naturally as you
      become more relaxed                                                                       • Prioritise and eliminate unnecessary tasks

    • Breaths that are too deep can make it harder to breathe, therefore avoid deep breaths     • Ask for assistance with difficult tasks, this does not make you dependent, it means you
      when you are breathless                                                                     can use your energy to its best advantage

                                                                                                It is important that you practice these techniques, strategies and positions when you are
                                                                                                not short of breath. This will allow you to get used to them and use them when you are
                                                                                                breathless. These techniques will allow you to gain a greater sense of control over your

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