Impact of Breathlessness
Dyspnoea (breathlessness) associated with COPD, triggered by increased breathing effort with activity, negatively affects haemoglobin saturation (O’Donnell et al., 2020) and leads to physiological brain responses of fear and anxiety, often limiting activities (Hanania and O’Donnell, 2019). As part of the PR program, breathing exercises (BE) can improve QoL and respiratory muscle strength (Li et al., 2022). Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are beneficial in supporting Nola in her daily activities (Yang et al., 2022). Combining breathing techniques, such as respiratory training, is simple and easy to perform, improving compliance (Li et al., 2022), can positively strengthen respiratory muscles and increase oxygen exchange and lung function scores to improve breathing efficiency (Hanania and O’Donnell, 2019).
COPD Foundation (2024b).
COPD symptoms often affect the ability to eat and exercise (Collins et al., 2019). Eating smaller, frequent meals is advised to help Nola overcome breathlessness at mealtimes (Beek et al., 2023). All meals within Nola’s dietary plan are calorie-dense and in small volumes to ensure she consumes the nutrients required. Considering slower eating patterns, meals can be eaten either hot or cold, such as the Sushi bento box.
Sushi Bento Box.
Nola’s sitting position is imperative, sitting upright at a table, with feet flat on the floor to allow the lungs to expand fully, using pursed lip breathing (PLB) as support throughout the meal (COPD Foundation, 2024a). In support of Nola’s dietary requirements of increased calorie consumption, nutrient-dense snacks are advised between meals, placing less pressure to eat larger meals at mealtimes when Nola may feel more breathless (Kubala and Morales-Brown, 2020).
Breathing Exercises.
PLB would be a good strategy for Nola to release residual air (trapped) within the lungs (yang et al., 2022). This method slows breathing and helps the lungs absorb more oxygen, thereby expelling more carbon dioxide and reducing anxiety when breathing becomes difficult during daily activities (Yang et al., 2022).
Nola would relax her neck and shoulders, breathe through her nose with her mouth closed, and exhale longer and slower through pursed lips (like whistling) (Nguyen and Doung, 2023).
(Healthline, 2023a).
DB focuses on deep abdominal breathing, engaging the diaphragm (key respiratory muscle) to support breathing, promote relaxation, and enhance oxygen exchange. Hamasaki’s (2020) study indicates DB connections to physiological effects such as improved respiratory rate, tidal volume, and QoL. It is common for COPD patients to rely on using their back, neck, and shoulder muscles when breathing; DB is a helpful technique to strengthen the diaphragm muscles. (Yang et al., 2022). DB can lead to anxiety when first used; if this occurs, Nola should quicken breathing to reduce symptoms and try again later (Crumpler and Johnson, 2023).
Nola would relax her neck and shoulders while sitting or lying, place one hand on her chest and the other on her stomach, and breathe slowly through the nose with her mouth closed. She would focus on the stomach expanding with inhalation and minimum movement in the chest, breathing out at a slower rate than the inhale for six seconds, and then repeat (Hamasaki, 2020).
(Healthline, 2023b).
When BE are part of an intervention program of 5-10 minutes four times daily (Sachdev and Stuart, 2023), Nola will see enhancement in her breathing (Xiang et al.,2022); this will support her dietary consumption (COPD Foundation, 2024a), as PLB and DB work synergistically to improve pulmonary function, with positive results in several ventilatory-related outcomes (Ubolnuar et al., 2019).
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References
Beek, L,T., van dee Vaart, H., Wempe, J,B., Dzialendzik, A, O., Roonenburg, J, l, N., vander Schans, C, P., Keller, H, H. and Jager-Wittenaar, H. (2018). Dietary resilience in patients with severe COPD at the start of a pulmonary rehabilitation program. Available at: Dietary resilience in patients with severe COPD at the start of a pulmonary rehabilitation program – PMC (nih.gov) International Journal Chronic Obstructive Pulmonary disease. 13: 1317-1324. doi: 10.2147/COPD.S151720 (Accessed 18th April 2024).
Collins, P, F., Yang, I, A., Chang, YC. And Vaughan, A. (2019). Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. Available at: Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update – PMC (nih.gov) (17) s2230-S2237. Journal of Thoracic Disease. 11(Suppl 17). doi: 10.21037/jtd.2019.10.41 (Accessed 1st April 2024).
COPD Foundation. (2024a). Nutrition for someone with COPD. Available at: Nutrition for Someone with COPD | COPD Foundation (Accessed 19th April 2024).
COPD Foundation. (2024b). Breathing Techniques. Available at: https://www.copdfoundation.org/Learn-More/I-am-New-to-COPD/Breathing-Techniques.aspx (Accessed 26th April 2024).
Crumpler, C. and Johnson, J. (2023). What to know about diaphragmatic breathing. Available at: What is diaphragmatic breathing? Benefits and how-to (medicalnewstoday.com) Medical News Today. (Accessed 1st May 2024).
Hamasaki, H. (2020). Effects of Diaphragmatic Breathing on Health: A Narrative Review. Available at: Medicines | Free Full-Text | Effects of Diaphragmatic Breathing on Health: A Narrative Review (mdpi.c om) Medicines. 7.65 https://doi.org/10.3390/medicines7100065 (Accessed 1st April 2024).
Hanania, N, A. and O’Donnell, D, E. (2019). Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Available at: Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions – PMC (nih.gov) The Journal Of Chronic Obstructive Pulmonary Disease. 14: 1127-1138. doi: 10.2147/COPD.S188141 (Accessed 25th April 2024).
Healthline. (2023a). Breathing Exercises with COPD. [Pursed lip breathing] Available at: https://www.healthline.com/health/copd/breathing-exercises#pursed-lip-breathing (Accessed 26th April 2024).
Healthline. (2023b). Breathing Exercise with COPD. [Diaphragmatic breathing] Available at: https://www.healthline.com/health/copd/breathing-exercises#diaphragmatic-breathing (Accessed 26th April 2024).
Kubala, J. and Morales-Brown. (2020). What to do about COPD and diet. Available at: COPD diet: Foods to eat, foods to avoid, and diet plan (medicalnewstoday.com) Medical News Today. (accessed 1st May 2024).
Li, Y., Ji, Y., Li, X. and Xie, Y. (2022). Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews. Available at: Full article: Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews (tandfonline.com)17: 3075-3085. International Journal Chronic Obstructive Pulmonary Disease. doi: 10.2147/COPD.S385855 (Accessed 30th March 2024).
Nguyen, J, D. and Doung, H. (2023) Pursed-lip Breathing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545289/ StatPearls publishing [internet]. (Accessed 2nd April 2024).
O’ donnell, D, E., Milne, K, M., James, M, D., de Torres, J, P. and Neder, J, A. (2020). Duspnea in COPD: New Mechanistic Insights and Management Implications. Advances in Therapy Journal. 37(1): 41-60. doi: 10.1007/s12325-019-01128-9 (Accessed 4th May 2020).
Sachdev, P. and Stuart, A. (2023). COPD and Exercise: Breathing and Exercise Programs for COPD. Available at: Breathing Exercises for COPD Patients (webmd.com) Lung Disease and Respiratory Health. (Accessed 1st May 2024).
Ubolnuar, N., Tanisuwat, A., Thaveeratitham, p., Lartmaharit, S., Kruapanich, C. and Mathiyakom, W. (2019). Effects of Breathing Exercises in Patients with Chronic Obstructive Pulmonary disease: Systematic Review and Meta Analysis. Available at: Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis – PMC (nih.gov) 43(4): 509-523. doi: 10.5535/arm.2019.43.4.509 (Accessed 2nd April 2024).
Xiang, X., Huang, L., Fang, Y., Cai, S and Zhang, M. (2022). Physical activity and chronic obstructive pulmonary disease: a scoping review. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354440/ Pulmonary medicine. 5;22(1): 301. doi: 10.1186/s12890-022-02099-4 (Accessed 2nd April 2024).
Yang, Y., Wei, L., Wang, S., Ke, L., Zhao, H., Mao, J., Li, J. and Mao, Z. (2022). The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity on patients with COPD: a systematic review and meta-analysis. Available at: The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis – PubMed (nih.gov) Physiotherapy theory and practice. 38:7, 847-857. https://doi.org/10.1080/09593985.2020.1805834 (Accessed 2nd April 2024).