Evidence suggests that how breathless you feel doesn’t always match up that well with the results of lung function tests and scans. This is because it’s not just lung function that affects how out of breath you feel.
How you think and feel about your breathing is important. For example, a worrying thought can make you feel anxious and make you feel breathless. This could perhaps make you feel panicky and bring on physical symptoms such as a tight chest or fast breathing.
When you have a long-term lung condition, you can feel anxious. Because being anxious interacts with your physical symptoms and can increase your feelings of breathlessness. It’s important to talk to your healthcare professional about what help is available for you. Read more about coping with anxiety and a lung condition.
Breathing habits
Unhelpful breathing habits will make you feel more out of breath.
When you’re out of breath, you may feel like you need more air. So you may start to take more air into your lungs or breathe faster. You might then not take the time to fully empty your lungs as you breathe out. This means you use the top of your chest more to breathe, instead of using your whole lungs. Breathing like this is more work – your muscles will get tired more quickly, and you’ll feel even more out of breath.
The good news is there are breathing techniques you can use to breathe more efficiently and to feel in control of your breathing. If you practise these techniques and use them every day, they’ll help you when you’re active or if you suddenly feel short of breath.
Breathing control
Breathing control means breathing gently, using the least effort. It will help when you’re short of breath or feeling anxious. The technique below is sometimes taught in yoga.
To get used to breathing control, it helps to practice when you are sitting, relaxed and not out of breath.
Breathing control is about the best use of your main breathing muscle - your diaphragm. The focus is on reducing tension and using your shoulder and neck muscles to get into the best position for you to breathe easily. Your diaphragm contracts when you breathe. This pulls the lungs down, stretching and expanding them. It relaxes back – into a dome position – when you breathe out, reducing the amount of air in your lungs.
Get into a comfortable position, with your arms supported on arm rests or your lap. Let your shoulders and body be relaxed and loose.
- Put one hand on your chest and the other on your stomach.
- Close your eyes to help you relax and focus on your breathing.
- Slowly breathe in through your nose, with your mouth closed. If you’re relaxed, the air will reach low in your lungs. Your stomach will move out against your hand. If your breathing is controlled, the hand on your chest will hardly move.
- Breathe out through your nose. Your stomach will fall gently. Imagine all the tension in your body leaving as you let the air out.
- Try to use as little effort as possible and make your breaths slow, relaxed and smooth. With every breath out, try to feel more relaxed. Gradually try to breathe more slowly.
When fully in control of your breathing, your out breath should take longer than your in breath. There should be a natural pause at the end of your out breath.
Remember the three Rs
Breathing control is sometimes known as relaxed tummy breathing. Try to remember the three Rs:
- Rise the tummy as you breathe in
- Relax the breath out
- Rest and wait for the next breath to come
Breathe a rectangle
Once you’ve mastered the relaxed tummy breathing technique, you might find it useful to imagine or look at a rectangle. Wherever you are, there is often a rectangle to be seen, whether this is a book, TV, computer, tablet screen, door, window, tabletop, or even a picture on the wall. Follow the sides of the rectangle with your eyes as you use relaxed tummy breathing. Gradually slow the speed at which your eyes move around the edge of the rectangle to slow your breathing.
Breathing techniques
Use breathing control combined with any of the breathing techniques below. Some people find some techniques suit them better than others. Give them all a go and see what works well for you.
| Breathing technique | How do I do it? |
|---|---|
| Pursed-lips breathing can be used at any time to help you control your breathing. This helps to empty all the air out of your lungs and is particularly useful for people with COPD as the narrowed airways can trap air in the lungs. | Breathe in gently through your nose, then purse your lips as though you’re going to blow out a candle. Blow out with your lips in this pursed position. Imagine blowing out a candle when you breathe out. Blow out only for as long as is comfortable – don’t force your lungs to empty. |
| Blow-as-you-go helps make tasks and activities easier. Use it while you’re doing something that makes you breathless. You can use it with pursed-lips breathing. | Breathe in before you make the effort. Then breathe out while you’re making the effort. For example, when standing up, breathe in before you step or stand up, and then blow out as you stand up. Try pursing your lips as you blow out. |
| Paced breathing 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. |
Count to yourself as you walk or move. For example, breathe in for one step and then take either one or two steps as you breathe out. Take more steps as you breathe in or as you breathe out, if that feels better for you. Try different combinations to find what works best for you - for example, two steps in, two steps out. |
Talk to a physiotherapist to find the best techniques for you. If you don’t already have one, ask your doctor to refer you.
Positions to help you recover from breathlessness
Use these positions to help you practise your breathing control, or to recover your breath when you get breathless.
Stand leaning backwards or sideways against a wall
Have your feet slightly apart, about one foot or 30cms away from the wall. Relax your hands down by your sides. If you prefer, rest your hands or thumbs in your waistband or belt loops, or across the shoulder strap of your handbag.
This position can be helpful for most people with a lung condition, and you can use this when you’re at home or out and about. Other helpful positions vary depending on whether you have an obstructive or a restrictive lung condition.
Obstructive and restrictive lung conditions
Obstructive or restrictive lung diseases both cause breathlessness, but they result from different processes in your lungs:
- obstruction refers to how quickly you can move air in and out of your lungs
- restriction refers to the total amount of air you can get into your lungs.
If a healthy person takes a big breath in and then blows out as hard, they will be able to get over 70% of the air out of their lungs in one second.
Obstructive lung diseases
In obstructive lung disease, such as COPD, asthma or bronchiectasis, it takes longer to empty your lungs. The airflow is slower because the disease makes your airways narrower or lungs less elastic. Because breathing out is slower, the person may need to breathe in again before they have emptied their lungs. This makes breathing uncomfortable.
Restrictive lung diseases
In restrictive lung disease, you cannot fill your lungs with air because your lungs are restricted from fully expanding. This happens when the lungs themselves are stiff or because there is a problem with the chest wall or breathing muscles.
The most common restrictive lung conditions are interstitial lung disease, such as IPF, others are obesity or a curved spine.
Some people find it difficult to breathe because they have lots of phlegm in their airways. This happens with lung conditions such as bronchiectasis. If you have lots of sputum, clearing your sputum may help you feel less out of breath.
There’s more information on managing breathlessness on the Association of Chartered Physiotherapists in Respiratory Care website.
Next: Living well with breathlessness
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