Whether it is appropriate to teach pursed lip breathing to a patient is debatable.

1. Most therapist feel that gentle pursed lip breathing with a controlled expirations is a useful procedure, if it is performed appropriately, it is thought to keep airways open by creating a back pressure in the airways. It is taught to help a patient with chronic obstructive pulmonary disease (COPD) deal with attacks of shortness of breath. Studies suggest that pursed–lip breathing decreases the respiratory rate, increases the tidal volume, and improves exercise tolerance.
2. Some patients spontaneously develop this pattern of breathing. If so, they should not be discouraged from using it.
3. Precaution: The use of forced expiration during pursed lip breathing must be avoided. Forceful or prolonged expiration while the lips are pursed can increase the turbulence in the airways and cause further restriction of these small bronchioles. For this reason, some therapists have suggested that patients may perform pursed lip breathing inappropriately, therefore should not be taught this form of breathing.

Procedure

1. Have the patient assume a comfortable position and relax as much as possible.
2. The expiration must be relaxed (passive) and that contraction of the abdominals must be avoided.
3. Place your hand over the patient’s abdominal muscles to detect any contraction of the abdominals.
4. Instruct the patient to breathe in slowly and deeply.
5. Then have the patient loosely purse the lips and exhale.

Preventing and relieving shortness of breath attacks

1. Many patients with emphysema and asthma may suffer from periodic attacks of dyspnea (shortness of breath), particularly with physical exertion or when in contact with allergens. Whenever a patient’s normal breathing pattern is interrupted shortness of breath can occur. It is helpful to teach patients to try to prevent shortness of breath attacks with controlled breathing, by pacing activities, and by becoming aware of what activity or situation causes dyspnea.
2. Pacing is the performance of functional activities, such as walking, stair climbing or work related tasks, within the limits of a patient’s breathing capacity. Although some patients may intuitively understand to what limits functional activities can be pushed, other patients must be taught to recognize the early signs of dyspnea. If the patient becomes slightly short of breath, he or she must learn to stop an activity and use controlled, pursed lip breathing until the dyspnea subsides.
3. Procedure
   1. Have the patient assume a relaxed, forward bent posture (picture). This position stimulates diaphragmatic breathing (the viscera drops forward and the diaphragm descends more easily).
   2. Use bronchodilators as prescribed.
   3. Have the patient gain control of his or her breathing and reduce the respiratory rate by using pursed lip breathing during expiration. Be sure that the patient does not use forceful expiration. Have the patient emphasize the expiratory phase of breathing.
   4. After each pursed lip expiration, have the patient breathe in diaphragmatically, avoiding the use of accessory muscles.
   5. Have the patient remain in this posture and continue to breathe in as relaxed a manner as possible.