Breathlessness: Positions and Breathing Techniques That Help

Before you try anything

New or worsening breathlessness needs a cause. Heart failure, lung disease, anaemia, infection, a blood clot, anxiety and many other things can be responsible, and they are treated differently. If your parent is breathless at rest, or it came on suddenly, or is accompanied by chest pain, blue lips, confusion, fainting or a fast heartbeat, call 112 rather than trying techniques. Techniques help with the chronic breathlessness of known conditions and with the panic that accompanies it. See when breathlessness is an emergency.

Why these techniques help

• Positions use gravity and the support of furniture so that the shoulders and chest are held in place and the breathing muscles can work with less effort.
• Slow, pursed-lip breathing creates a slight pressure in the airways during breathing out, helping to keep small airways open and letting stale air escape, which is especially helpful in COPD.
• Relaxation reduces tension in neck and shoulders that wastes energy.
• Pacing matches activity to breathing capacity.
• Cool air from a fan on the face can reduce the sense of breathlessness through nerves in the cheeks.
• A sense of control reduces fear and panic.

Positions that ease breathing

Practise each when well, so that they are familiar when needed.

1. Forward-lean sitting. Sit on a firm chair, lean forward from the hips with the forearms resting on the thighs or on a table with a pillow, keeping the back straight and the neck and shoulders relaxed. This position supports the shoulders and allows the diaphragm to move.

2. Table-pillow position. Sit at a table, fold the arms on a pillow in front, and rest the head on the arms or hold it up. Good for resting after exertion.

3. Standing and leaning. Stand with the back against a wall, feet shoulder-width apart and about 30 cm from the wall, with arms hanging loose, or lean forward with hands on a counter, windowsill or the back of a chair.

4. Supported lying. In bed, lie on the side with pillows between and under the knees, or semi-recline with the head and shoulders raised on several pillows or an adjustable bed. Avoid lying flat if lying flat worsens breathlessness, which can be a sign of heart failure, and tell the doctor. Raising the head of the bed with blocks under the legs of the bed can also help; ask a nurse for safe methods.

5. Relaxed sitting back. Sit well back in a supportive chair with armrests, feet flat, shoulders dropped and hands resting on the thighs.

Make sure positions do not cause falls; keep furniture stable and the floor clear. See living room and seating setup.

Pursed-lip breathing

1. Sit or stand comfortably in one of the positions above, with shoulders relaxed. 2. Breathe in gently through the nose for about two counts, with the mouth closed. There is no need for a deep breath. 3. Purse the lips as if about to whistle or to blow out a candle gently. 4. Breathe out slowly through the pursed lips for about four counts, without forcing. Out-breath should be about twice as long as the in-breath. 5. Repeat, keeping a steady rhythm, until the breathing settles.

Use it while climbing steps, bending, lifting, walking and during moments of breathlessness. Breathe out on the effort: for example, breathe in before standing up, and breathe out while rising.

Diaphragmatic (belly) breathing

This can help in some people, but can be tiring in severe COPD; a physiotherapist should check suitability.

1. Sit or lie with knees bent, one hand on the upper chest and one on the belly. 2. Breathe in slowly through the nose, letting the belly rise while the chest stays still. 3. Breathe out through pursed lips, letting the belly fall gently. 4. Practise for a few minutes, two or three times a day when calm.

If it increases breathlessness, stop and ask the physiotherapist.

Fan technique

A small, handheld or desk fan blowing gently towards the cheeks and nose can ease the sensation of breathlessness for many people. It is cheap and safe, but:

• Keep it clean to avoid blowing dust.
• Do not use in very cold air or if it triggers cough or wheeze.
• Keep it away from oxygen equipment and any flame, and do not use electrical equipment with damaged wires near oxygen. See safe use of oxygen and electrical equipment.
• A fan does not replace oxygen, and breathlessness that does not ease needs medical help.

Pacing and energy conservation

• Plan the day: do demanding tasks when you feel best, often mid-morning, and spread heavy work across the day.
• Break tasks into steps with rests.
• Sit down for tasks like chopping vegetables, dressing, grooming and ironing.
• Slow down: moving at half pace takes less oxygen.
• Use aids: a shower stool, a trolley for carrying things, a long-handled sponge, a perching stool in the kitchen, and a walking aid with a seat if the doctor agrees; see daily living aids guidance.
• Avoid reaching and bending above the head or below the knees, which constricts the chest; keep things between hip and shoulder height.
• Bath and shower carefully: warm, not hot water; steam can worsen breathlessness; ventilate; sit down. Do not use a steamy bathroom if it makes breathing worse.
• Eat small, frequent meals, as a full stomach crowds the diaphragm.
• Wear loose clothing.
• Take medicines as prescribed, including the reliever before exertion if the doctor advises.

Calming the panic

• Stay with your parent and keep your voice calm and slow.
• Help into a supported position, open a window or use a fan.
• Coach the breathing: "In through the nose, and out slowly like a candle."
• Avoid crowding or fussing; too many people increase anxiety.
• Use the reliever as the doctor has prescribed.
• Check oxygen with an oximeter only if advised, bearing in mind its limits, and do not alter prescribed oxygen; see pulse oximeters: how they work and how to use one and oxygen flow rates and prescriptions: what families should know.
• After it eases, let your parent rest and drink water.

Anxiety and breathlessness feed each other. If panic attacks are frequent, tell the doctor; see anxiety in older adults.

Practising and teaching

Ask a physiotherapist or nurse to teach your parent and a family member, ideally in the home. Practise for a few minutes twice a day when calm. Use simple language and demonstrate; older adults learn well by copying. Write a one-page card with pictures of the positions and the breathing steps, in large print and the home language, and keep it by the chair and bed. For a broader programme, see pulmonary rehabilitation exercises at home and breathing exercises for seniors.

What to avoid

• Forcing deep breaths or breathing very fast, which can cause dizziness and tire the muscles.
• Holding the breath during effort.
• Lying flat when breathless.
• Hot, steamy rooms, smoke, incense and strong smells.
• Over-exertion and rushing.
• Paper bag breathing or breath-holding tricks.
• Taking extra doses of medicine without the doctor's guidance.
• Using oxygen without a prescription.

When to ask a professional

Ask the doctor to find the cause of breathlessness and review treatment. Ask a physiotherapist for a personal breathing programme. Ask an occupational therapist for equipment and energy-saving tips. Call the doctor if breathlessness is increasing, if your parent cannot do usual activities, if there is new swelling or weight gain, fever or change in sputum. Call 112 for severe breathlessness at rest, blue lips, chest pain, fainting or confusion.