People with lung disease will always have some degree of breathlessness. This leaflet is designed to introduce you to different strategies, techniques and positions that you can use to alleviate this.

When you are short of breath, the priority is to relax the muscles of your shoulders, neck and upper chest. This will make your breathing more efficient. Aim for relaxed gentle breathing and be reassured in the knowledge that your breathing will always recover. Some people have a tendency to tense the muscles in their shoulders and arms when they are short of breath and try to take deep breaths, this can exacerbate the feelings of breathlessness and prolong recovery.

Positioning

When you are short of breath the first thing you should do is consider your position. Adopting one of the following positions will help to decrease the work of breathing and eliminate unnecessary muscular activity.

You should avoid:

• fixing your arms with your shoulders raised
• pushing down or gripping with the hands
• laying back.

Find a position which is comfortable for you. Images of each position are included at the back of this leaflet.

High side lying | A

This position is particularly useful if you are suffering with an exacerbation.

Supported sitting | B

This is a good position to adopt between activities. Sit in an upright chair with supported arms,

leaning forward slightly. Ideally with your palms facing upwards.

Forward lean sitting | C

This position is very similar to the supported one but does not require arm support of a chair. It can be used as in the picture, when you are outside or it can be used when you are perched on the edge of the bed. Sitting leaning forward with arms resting on your thighs, palms facing upwards.

Forward resting | D

This is another good position to use when you are exacerbating. Sitting leaning forward from the waist, arms folded and resting on pillows on a table, feet flat on the floor.

Forward lean standing | E

Standing relaxed, leaning forwards with arms resting on a support of suitable height – such as a window sill, kitchen worktop, walking aid or shopping trolley. Knees slightly bent, one foot in front of the other.

Side leaning | F

Standing relaxed, leaning sideways against a wall, with either your hands in your pockets or resting on a bag.

Supported standing | G

Standing relaxed, leaning back against a wall with legs slightly apart, shoulders relaxed and arms hanging loosely by your side.

Breathing control

Once you have adopted your chosen position you are now ready to practice your breathing control.
This is a technique which helps to produce a more relaxed breathing pattern. It can be used at rest or during activities such as walking or climbing stairs.

Preparation

Try to keep your shoulders and upper chest relaxed as you breathe gently in and out. If you find this difficult, ask someone to press gently down on your shoulders to relieve some of the tension.

How to do it

• Breathe in and out at your own rate.
• Put one hand on your upper chest, and the other on your belly just above your waist.
  As you breathe in, you should be able to feel the hand on your belly moving out – the hand on your chest shouldn’t move.
• If you give a little cough the muscle you feel under the hand on your belly is your diaphragm.
• You should be able to feel the hand on your belly moving in as you exhale (breathe out).
• Make your breath out twice as long as your breath in but don’t force it out.
• Try breathing in through your nose if able and out through your mouth.
• Do this for about one minute.

Hints and tips

• Don’t try and slow your breathing down straight away, this will happen naturally as you become
  more relaxed.
• Breaths that are too deep can make it harder to breathe, therefore avoid deep breaths when you
  are breathless.

Pursed-lip breathing

Pursed-lip breathing can be used to aid recovery of your breathing. It can also be used to control your breathing during exertion. It is particularly useful for people with emphysema.

How to do it

• Breath in slowly for the count of one – ideally through your nose).
• Purse your lips as if you were going to whistle.
• Breath out slowly through your pursed lips for the count of two – breathe out twice as slowly as you breathe in.
• Let the air escape naturally, don’t force the air out of your lungs.
• Continue until your breathing slows and you feel back in control.

Other tips

• Avoid sudden bursts of energy which can make you hold your breath.
• Try using a fan or sitting by an open window, this can really reduce your feelings of breathlessness.
• Using a stick when walking to aid the forward lean position when outside.
• Using a delta frame when walking outside can increase the distance you cover and reduce your feelings of breathlessness.
• Try to organise your time and day, so that you are able to perform tasks at the time of day when you have most energy. Plan rest periods into your day.
• Prioritise and eliminate unnecessary tasks.
• Ask for assistance with difficult tasks, this does not make you dependent, it means you can use your energy to its best advantage.

It is important that you practice these techniques, strategies and positions when you are not short of breath. This will allow you to get used to them and use them when you are breathless. These techniques will allow you to gain a greater sense of control over your breathing.

Positions