SEE ALSO – Breathlessness, Sputum clearance


ACPRC/BTS GUIDELINES (2009) – Physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 64, suppl.i1-i52


Ayoub J (2001) Diaphragm movement before and after cholecystectomy. Anesth Analg, 92, 755-61
• effects of deep breathing

Bakow (1977) Sustained maximal inspiration - a rationale for its use. Respir.Care, 22, 379-82.

Brasher PA, McClelland KH, Denehy L (2003) Does removal of deep breathing exercises from a physiotherapy programme alter patient outcomes? Austr.J.Physiother, 49, 165-73
• breathing exercises appear unnecessary after cardiac surgery

Bakow (1977) Sustained maximal inspiration - a rationale for its use. Respir.Care, 22, 379-82.
• explanation of the mechanism of the end-inspiratory-hold

Bianchi R (2004) Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest, 125, 2, 459-465
chestjournal.chestpubs.org/content/125/2/459

Bott J, Blumenthal S, Buxton M et al (2009) Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient, Joint BTS/ACPRC Guideline. Thorax, 64(Suppl.1):i1-i52
thorax.bmj.com/cgi/content/full/64/Suppl_1/i1?HITS=10&sortspec=relevance&hits=10&FIRSTINDEX=0&resourcetype=HWCIT&fulltext=acprc&searchid=1
• comprehensive evidence-base including breathing exercises

Cahalin LP (2002) Efficacy of diaphragmatic breathing in persons with COPD: a review of the literature. J Cardiopulm Rehab, 22, 7-21
• rationale of why diaphragmatic breathing may or may not be effective

Chuter T A M (1990) Diaphragmatic breathing maneuvers and movement of the diaphragm after cholecystectomy. Chest, 97, 1110-14.

Collins EG et al (2001) Breathing pattern retraining and exercise in persons with COPD. AACN Clin Issues, 12, 202-9.
• literature review

Dallimore K, Jenkins S, Tucker B (1998) Respiratory and cardiovascular responses to manual chest percussion in normal subjects. Austr Physiother J, 44, 267-74
• deep breathing increases oxygen saturation

Davis D (1996) Neurological facilitation of respiration. ACPRC Journal, 28, 9-11.
• selective manual pressure to alter breathing patterns

Davis (1984) The sustained maximal inspiration (SMI). Respir Ther, Mar/Apr.

Fernandes M, Cukier A, Feltrim MIZ (2011) Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis, 8, 237-44
crd.sagepub.com/content/8/4/237.abstract?etoc
• diaphragmatic breathing reduces SOB and hypoxaemia in the majority of COPD patients, but in some patients with severe COPD it may cause asynchronous breathing thus worsening SOB

Fixley (1978) Flow dependence of gas distribution and the pattern of inspiratory muscle contraction. J Appl Phys, 45, 733-41.

Garrod R, Daly C, Hoarear C (2004) The effect of pursed lip breathing on exercise capacity and breathlessness in patients with COPD. ACPRC Journal, 36, 29-36
• pursed lip breathing during exercise may lower post-exercise respiratory rate

Gimenez MG (2010) Comprehensive directed breathing retraining improves exertional dyspnea for men with spirometry within normal limits. Am J Phys Med Rehabil, 89, 2, 90-98

Gosselink RAAM (1995) Diaphragmatic breathing reduces efficiency of breathing in patients with COPD. Am J Respir Crit Care Med, 151, 1136-42

Gosselink R (2004) Breathing techniques in patients with COPD. Chron Respir Dis, 1: 163-172
• evidence for the benefits of pursed lips breathing, forward leaning position, active expiration and inspiratory muscle training
• limited evidence for the transfer of the effects of breathing techniques during resting conditions to exercise conditions.

Holland AE (2009) Breathing retraining for individuals with chronic obstructive pulmonary disease - no role for clinicians. Chr Respir Dis, 6, 45-46
• interesting argument about breathing retraining being unnecessary.

Jones A, Tse E, Cheung L (1997) Restoration of lung volume using the flutter or breathing exercise. Austr J Physiother, 43, 183-9
• deep breathing increases lung volume

McKeough ZJ, Alison JA (2003) Arm positioning alters lung volumes in subjects with COPD and healthy subjects. Austr J Physiother, 49, 133-7
www.physiotherapy.asn.au/AJP/vol_49/2/AustJPhysiotherv49i2McKeough.pdf
• raising the arms above 900 increases FRC but decreases inspiratory capacity

Nield MA, Hoo S, Guy W (2007) Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehab Prevention, 27, 4, 237-244
journals.lww.com/jcrjournal/Abstract/2007/07000/Efficacy_of_Pursed_Lips_Breathing__A_BREATHING.10.aspx
• PLB reduced SOBOE

Olsén MF (2000) Chest physiotherapy in open and laparoscopic abdominal surgery. Phys Ther Reviews, 5, 125-30
• review, including benefits of breathing exercises

Roberts SE, Stern M, Schreuder FM, Watson T (2009) The use of pursed lips breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence. Phys Ther Reviews, 14, 4, 240-6
www.ingentaconnect.com/content/maney/ptr/2009/00000014/00000004/art00004
• patients with moderate to severe COPD are most likely to benefit.

Smith A (2001) What are the effects of postoperative chest physiotherapy? Clin Evid, 6, 1078-80
• evidence for benefits of deep breathing, incentive spirometry and IPPB

Spahija J (2005) Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest, 128, 2, 640-650
chestjournal.chestpubs.org/content/128/2/640.full
• PLB has a variable effect on SOB in patients with COPD

Spahija J (2010) Factors discriminating spontaneous pursed-lips breathing use in patients with COPD. COPD, 7, 4, 254-261
informahealthcare.com/doi/abs/10.3109/15412555.2010.496820
• out of 57 patients, 6 spontaneously performed PLB at rest, exercise and recovery, 18 during exercise and recovery, 7 during recovery only and 20 not at all.

Stiller et al (1994) Are breathing and coughing exercises necessary after coronary artery surgery? Physiother.Theory & Practice, 10, 143-52.

Vitacca M, Clini E, Bianchi K et al (1999) Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency. Eur Respir J, 11, 2, 408-415
erj.ersjournals.com/cgi/reprint/11/2/408?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=vitacca&fulltext=COPD&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=11&firstpage=408&resourcetype=HWCIT
• deep diaphragmatic is associated with improved blood gases but increased work of breathing in people with severe COPD

Westerdahl E, Lindmark B, Eriksson T et al (2003) The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J, 37, 363-7
www.informaworld.com/smpp/content~db=all?content=10.1080/14017430310014984
• a single session of 30 deep-breaths reduces atelectasis and increases oxygenation on the second postoperative day after CABG

Westerdahl E (2005) Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery Chest, 128: 3482-8.
www.chestjournal.org
• patients who performed 30 slow deep breaths (against a positive expiratory pressure of 10 cm H2O) hourly during daytime for the first 4 postoperative days after CABG had significantly smaller atelectatic areas and better pulmonary function.





ACPRC = Association of Chartered Physiotherapists in Respiratory Care
CABG = coronary artery bypass graft.
FRC = functional residual capacity, i.e. resting lung volume
IPPB = intermittent positive pressure breathing, e.g. the Bird
PLB = pursed lips breathing
SOB = shortness of breath
SOBOE = shortness of breath on exertion