Exercises to improve your breathing

Even if you can't manage to take active exercise, breathing exercises are essential to keep your lungs clear and free of infection. Practising breathing exercises can help you to:

  • breathe more efficiently and make better use of your lungs
  • control the unpleasant, panicky feeling of breathlessness
  • remove sputum from your chest.

Your physiotherapist can show you positions to help reduce your breathlessness when it is bad. However, here are two simple exercises that will help your general breathing: relaxed breathing control and deep breathing.

Make sure you discuss these with your doctor or physiotherapist.

Relaxed breathing control


This exercise will help you to control breathlessness, particularly after coughing, huffing or taking active exercise.

Follow these steps:

  1. Relax your head, neck and shoulders. Your physiotherapist can show you some exercises to achieve this.
  2. With your shoulders dropped, place your hands across your stomach just below your ribs.
  3. Breathe out gently through your mouth.
  4. After a long breath out, breathe in gently, keeping your shoulders relaxed.
  5. Repeat this exercise four to six times.

This exercise should not tire you. If it does, ask your physiotherapist for advice, as you might not be doing it correctly.

Huff

This is a forced breath out of an open mouth that helps to move the secretions upwards; for example, as if creating a mist on a window.

There are two types:

  1. Take a medium-sized breath in and try and ‘squeeze’ the breath out.
  2. Take a big breath in and do a shorter, sharper breath out.

You should start with the first type of huff and as the secretions move upwards then try the second type.

Always remember to allow for an essential short period for relaxation and gentle breathing control after every one or two huffs. Between 15 and 30 seconds should be enough.

This will prevent the feeling of tightness in the airways and chest, and allow you to relax and recover your breath comfortably. Remember, relaxed breathing control is also helpful after a bout of coughing.

Deep breathing


This exercise helps you make better use of the lower parts of your lungs.

Follow these steps:

  1. Relax your head, neck and shoulders and place your hands across your stomach, as in the previous exercise.
  2. Breathe out gently.
  3. Keeping your shoulders relaxed, take a deep breath in, feeling your ribs rising under your hands.
  4. Hold the deep breath for a second, then breathe out gently through your mouth.
  5. Repeat the exercise three or four times; then rest.

Children can be encouraged to take deep breaths through the use of blowing games, for example, blowing tissues, or even by playing a musical instrument.

Coughing and sputum

Sputum, the excessive sticky mucus present in your lungs, and coughing are common problems in people with lung damage.

Sputum has to be cleared from the chest so that you can breathe more easily. It becomes a problem when:

  • it is thick, sticky and difficult to cough up
  • it is infected
  • there is a lot of it.

Thick, sticky sputum can cause long, tiring and painful bouts of coughing, particularly in the early morning.

The colour of your sputum

In many people with bronchiectasis the sputum can be transparent with a white or greyish tinge when it is free from infection. Other people with bronchiectasis may have yellow or green sputum all the time. When you have an infection though it causes the sputum to thicken and turn yellow, creamy or green.

When you have an infection/bronchitis it is best treated as early as possible with an antibiotic prescribed by a doctor. The doctor may ask you to send a sputum sample to your GP or hospital. In the case of a child, a cough swab may be easier to obtain.

There are exercises to help clear sputum from your lungs.

Exercises to help clear sputum


Although it isn't possible to stop the production of excessive sputum, you can improve the way it is cleared from your chest.

The techniques used to clear the chest are:

  • relaxed breathing control to avoid tightness of the chest and exhaustion
  • deep breathing exercises to loosen the sputum
  • huffing.

If you produce only about two or three tablespoonfuls of sputum a day, you can do the exercises either sitting or lying down, first on one side and then on the other.

Postural drainage

However, if you have bronchiectasis and produce more than one cupful of sputum a day, you will need to lie in positions in which gravity helps to drain the affected areas of the lungs. This is often known as postural drainage.

A physiotherapist must advise you on the postural drainage positions that are most appropriate for you.

Clearing sputum in children


Babies and small children will swallow their sputum, but as soon as a child is old enough he or she should be encouraged to cough it up and spit it out (expectorate).

Postural drainage for small children is best performed across the parent's knee, before a feed. As the child grows older, postural drainage can be performed over a wedge of foam or pillows. It is often difficult to persuade a toddler to remain in one position for any length of time. However, running or jumping up and down between short sessions of postural drainage can actually help, as these activities often stimulate a cough.

Remember to seek advice from your physiotherapist before practising postural drainage on your child.

A programme for clearing sputum

Here we suggest a series of exercises for clearing your chest:

  1. Relax and breathe gently using the relaxed breathing control method.
  2. Take three or four deep breaths, breathing out quietly.
  3. Pause for some relaxed breathing control.
  4. Huff once or twice.
  5. Pause for some further relaxed breathing control.

Other useful ways to clear sputum include the flutter valve and the PEP mask. For more information, contact your physiotherapist.

This information has been kindly reviewed by Dr John Hurst, Senior Lecturer and Honorary Consultant, Centre for Respiratory Medicine, University College London Medical School and Royal Free London NHS Foundation Trust, London (March 2013) and approved by our Medical Advisory Panel, April 2013.