Pursed lip breathing, yoga and co: Effective breathing exercises and positions for COPD

You have probably heard of the breathing exercises and positions such as pursed lip breathing, breathing in a forward leaning position or diaphragm breathing. No wonder: the first breathing exercises were developed in Japan in the 1950s and have been an important part of the treatment of lung diseases ever since. [1]

More than half of those affected by COPD suffer from respiratory distress every day. This makes it the most common symptom of COPD patients and can occur regardless of the severity of the disease.

Most of the breathing exercises are designed to reduce dyspnea. [2]

Breathing exercises have many other positive effects on the course of the disease: [3]

  • They can relieve or strengthen the respiratory muscles
  • They improve the elimination of secretions
  • They increase the mobility of the chest to increase
  • They improve gas exchange

In Germany, breathing exercises are traditionally taught in rehabilitation centers, in respiratory physiotherapy or in lung sports. [4]

Many breathing exercises can help patients with lung diseases: Pursed lip breathing, the breath stimulus exercise, diaphragm breathing, yoga and breath easing postures such as the forward leaning position or the goalkeeper position. In addition, there are more modern methods such as computer-supported breathing feedback devices and alternative methods such as playing the didgeridoo or specific COPD singing exercises[5].

 Depending on intention and personal preference, everyone can learn the technique best suited for him/her. 
Breathing exercises and breathing gymnastics can help in case of shortness of breath.

But how effective are breathing exercises for the treatment of COPD? Which techniques have proven successful? And how can you implement them yourself? This article provides answers.

Understanding the causes of shortness of breath: This is why respiratory gymnastics can help

Respiratory distress is a common symptom of COPD. It occurs both in the normal state and in the case of acute deterioration of the disease and also in chronic bronchitis as well as in pulmonary emphysema. [5]

Respiratory distress is not always based on a deteriorated lung function; the severity of the perceived respiratory distress can even vary independently of changes in lung function. Respiratory distress always has a physical, but also a psychological part.  [6]

How does shortness of breath occur in COPD?

Patients with COPD can exhale all the air much more slowly than healthy people. This may be because the respiratory tract is narrowed by inflammation and/or secretion (chronic bronchitis). Less air flows through the lungs and patients feel breathlessness.  [7]

Breathing Exercises can help open obstructed airways
Inflammation and constriction causes less air to flow through the bronchial tubes.

In so-called emphysema, the other important part of COPD, the small alveoli can wilt. In healthy lungs, the walls of the alveoli are flexible and mobile. They function like a balloon and contract automatically when you want to exhale.

In patients with emphysema, this automatic contraction no longer works properly because the walls of the alveoli lose their flexibility. This means that patients need more strength to inhale and exhale.

The airways, i.e. the tubes leading to the alveoli, can collapse when the air is exhaled from the lungs – similar to a plastic bag from which the air is sucked out.

This flaccid lung is more difficult to empty and more air remains in the lungs even after exhalation. This so-called air trapping means that less air can be inhaled, as part of the lung is already filled with air.  [8]

The result can be increased lung volume or bloating, which in turn increases the feeling of shortness of breath. [9]

In addition, the body perceives an imbalance due to the poorer exchange of oxygen and CO2 between blood flow and breathing air as well as due to the residual air in the lungs: although one breathes quickly, not enough oxygen enters the bloodstream. This imbalance leads to a feeling of lack of breathing effort and increased difficulty in breathing. [10]

Shortness of breath has several causes

  • Inflammation and secretion reduce the size of the bronchi
  • A smaller surface of the alveoli, which means that oxygen and CO2 are less easily exchanged between the blood and the breathing air.
  • Less elastic pulmonary alveoli, which no longer contract on their own to transport the air out of the lungs
  • Less stable respiratory tracts that may collapse when exhaled
  • The last two symptoms often cause residual air to get trapped in the lungs, which means that less new air can be inhaled.
  • The symptoms are exacerbated because the body is not supplied decisively better with air despite greater effort during breathing. This imbalance leads to an unpleasant feeling and increases the perceived shortness of breath.

In case of respiratory distress, support the respiratory tract with respiratory gymnastics

An important goal of respiratory gymnastics must therefore be to support the lungs when exhaling. This can reduce overinflation of the lungs and promote gas exchange.

The described causes of shortness of breath cause many patients to move less and thus to reduce shortness of breath by avoiding situations with increased exertion of breath. [11]

However, it has been shown that precisely this avoidance is bad for the course of the disease. The exact opposite is the case:

 More exercise and the right breathing exercises lead to a long-term reduction in respiratory distress and improvement of symptoms

The positive effects of exercise are put on the same level by experts as the use of the right medication.

Patients who do regular physical training can exert themselves physically (e.g. running or housework) significantly longer before they get out of breath than patients whose therapy consists only of inhalers. [12]

Breathing exercises also help with physical activity and sport.
Breathing exercises also help with physical activity and sport.

In addition, breathing exercises can reduce over-inflation of the lungs and thus not only increase performance in everyday life, but also improve respiratory rate and increase the oxygen content in the blood. [13]

With these breathing therapy techniques you can reduce shortness of breath and improve the quality of life  

In the following we would like to present some scientifically proven techniques which can be part of respiratory gymnastics in lung disease.

Pursed lip breathing

The pursed lip breathing is the basis of all breathing exercises. It can be used both under physical strain and breathlessness and is relatively easy to learn. It is therefore no wonder that experts recommend learning and regular use of the pursed lip breathing in almost all patients.

With the pursed lip breathing, exhalation is slow, with the lips compressed and almost closed. This increases the pressure within the airways. [14]

The increased pressure prevents the respiratory tracts from collapsing. More air can flow through the respiratory tract, reducing lung bloating. [15]

Furthermore, the purses lip breathing leads to slower and controlled breathing. In this way, the exchange of oxygen and CO2 between breathing air and blood can take place more effectively in the lungs. This reduces shortness of breath. The feeling of peace and control can be regained. [16]

Breathing exercises can help achieve a more relaxed stat.
The pursed lip breathing can help bring back the feeling of relaxation and calmness.

The pursed lip breathing also makes sense during physical activity: it can reduce the speed of breathing and the load of breathing. This has a calming effect and allows you to train longer and more effectively. [17]

Diaphragmatic breathing

In addition to the pursed lip breathing, diaphragmatic breathing is also a promising breathing exercise. The two can be combined very well.

The main purpose of diaphragmatic breathing is to perform the breathing movement mainly with the diaphragm. The most important effect is the relief of the many muscles that help with breathing. [18]

Diaphragm breathing is particularly suitable for people with an increased breathing rate and a relatively small volume of air during inhalation and exhalation.

The technique can be performed in a lying, sitting or standing position.

Breathing in forward leaning position

The forward leaning position itself is not a breathing exercise, but a breathing facilitating position in which both the pursed lip breathing and diaphragm breathing can be applied.

The changed position allows the back muscles to relax, as shoulders and arms do not put additional weight on the ribs. As a result, less energy is required and therefore less oxygen is consumed. [19]

By sitting in a forward leaning position and by quiet, controlled breathing, the gas exchange can be enhanced and the over-inflation of the lungs can be reduced. [20]

There are many other breath-relieving positions based on similar principles. The lung information service, for example, provides a good overview.


Yoga Pranayama

Yoga Pranayama (the guided breath during the yoga exercises) has also proven to be an effective tool that can be easily performed by patients at home: The technique can reduce shortness of breath and general fatigue, increase performance and improve lung function. Intensive yoga programs even lead to a higher oxygen level in the blood and to a higher physical performance. [21, 22]

Yoga can help with COPD
Yoga can also help with COPD – there are also easier exercises 😉


Other therapies can also have very positive effects. For example, singing in groups of patients is not only perceived as positive for the symptoms of the respiratory tract, but also brings social and emotional benefits for motivated participants. [23]

Motivation: How to integrate breathing exercises into everyday life

Besides the physical effects, the aim of all exercises is to bring about a state of inner peace. This reduces fears and cramps – also in the respiratory muscles.

Breathing techniques should be practiced as regularly and as painlessly as possible – because then they are most effective and can also be used correctly in acute respiratory distress. [24]

The pursed lip breathing, for example, can be used as an exercise itself and can even help you sleep.

So don’t hesitate to incorporate breathing exercises into everyday life. These help in case of shortness of breath as well as in everyday work and are therefore also recommended by common guidelines for treatment! [4]

The video of the respiratory league on YouTube offers a good introduction to the techniques. You can also learn breathing exercises in lung sports, from respiratory physiotherapists or in pneumatic rehabilitation.

The Kaia App for COPD therapy is also a good aid for practicing breathing, relaxation and movement exercises. It shows you daily the best exercises to treat COPD effectively even at home. The app can be tested here free of charge for 7 days.



Important notice:

This article contains general information only and may not be used for self-diagnosis or self-treatment. It cannot replace a visit to the doctor.


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