Deep Breathing Exercise

Deep Breathing Exercise
Definition of Deep Breathing Exercise
Deep breathing exercise is breathing that is done by contracting the diaphragm,

a muscle located horizontally between the thoracic cavity and abdominal cavity.
Deep breathing involves slow and deep inhalation through the nose, usually to a
count of 10, followed by slow and complete exhalation for a similar count. The
process may be repeated 5 to 10 times, several times a day.
Goals Of Deep Breathing Exercise:
o Improve ventilation.
o Increase the effectiveness of cough and promote airway clearance.
o To prevent post-operative pulmonary complications.
o To improve the strength endurance coordination of the muscles of
ventilation.
o Maintain and improve chest and thoracic spine mobility.
o Promote relaxation and relive stress.
o To teach the patient how to deal with episodes of dyspnea.
o Assisting in removal of secretions.
o Correct abnormal breathing patterns and decrease the work of breathing.
o Aid in bronchial hygiene---Prevent accumulation of pulmonary secretions,
mobilization of these secretions, and improve the cough mechanism.
Principles of deep breathing exercise:
 Area of exercises
 Explanation & Instructions to the patient
 Patient’s position
 Evaluate the patient
 Demonstration of exercise
 Patient practice
Procedure
Steps of Procedure Yes No
Diaphragmatic Breathing
Diaphragm is the primary muscle for breathing (inspiration).

Diaphragm controls breathing at an involuntary level, a patient with
primary pulmonary disease like COPD can be taught breathing
control by optimal use of diaphragm and relaxation of accessory
muscles.
Diaphragmatic breathing ex: are also use to mobilize lung secretion.
Steps:
- Prepare the patient in relaxed and comfortable position in which

the gravity assists the diaphragm such as semi-fowlers position.
- If you notice any accessory muscle activation stop him and do
relaxation techniques (shoulder roll or shrugs coupled with
relaxation).
- Place your hands over the rectus abdominis just below the ant:
costal margin asks the patient to breath slowly and deeply via
nose by keeping the shoulder relaxed and upper chest quiet
allowing the abdominal to rise now ask him to slowly let all the
air out using controlled expiration through mouth.
- Have him to practice this for 2-4 times if he finds any difficulty
in using diaphragm have the patient inhale several times in
succession through the nose by using sniffing action this
facilitates the diaphragm.
- For self-monitor have the patient’s hand over the ant costal
margin and feel the most: (hand rise and fall) by placing one
hand over abdomen he can also feel the contraction of abdominal
muscles which occurs with controlled expiration or coughing.
- After patient understands and able to do the controlled breathing
using a diaphragmatic pattern keep the shoulder relaxed and
practice in verity of positions (supine sitting standing) and during
activity (walking and climbing stair).
Resisted diaphragmatic breathing:
- Use small weight, such as sandbag to strengthen and improve the

endurance of the diaphragm.
- Have the patient in a head up position.
- Place a small weight (1.30- 2.20 kg or 3-5 lb) over the epigastric
region of his abdomen.
- Tell the patient to breath in deeply while trying to keep the upper
chest quiet.
- Gradually increase the time that the patient breaths against the
resistance of weight.
- Weight can be increased when he can sustain diaphragmatic
breathing pattern without the use of any accessory muscles of
inspiration for 15minuts.
Glossopharyngeal breathing:
- It is a means of increasing a patient’s inspiratory capacity when

there is a severe weakness of the muscle of inspiration.
- It is taught to patients who have difficulty in deep breathing.
- It is used primarily for ventilatory dependent patients due to
absent or incomplete innervation of diaphragm because of high
cervical cord injury or neuromuscular disorders.
- Glossopharyngeal breathing with inspiratory action of neck
muscles can reduce ventilatory dependence or can be used as an
emergency procedure for malfunctioning of ventilator.
- Patient take several gulps of air (6 to 10), then by closing the
mouth the tongue pushes the air back and trap it in the pharynx
the air is then forced to lungs when the glottis is opened.
- This increases the depth of inspiration & patient’s inspiratory &
vital capacity.
Pursed Lip Breathing: Pursed-lip breathing is a strategy that

involves lightly pursing the lips together during controlled
exhalation.
Steps:
- Patient in a comfortable position and relaxed, explain the patent

about the expiration phase (it should be relaxed and passive).
- Abdominal muscle contraction must be avoided (therapist hand
over the patients abdominal to check for contraction).
- Ask the patient to breathe in slowly and deeply through the nose
and then breathe out gently through lightly pursed lips (blowing
on and bending the flame of a candle).
- By providing slight resistance an increased positive pressure will
generate with in the airway which helps to keep open small
bronchioles that otherwise collapse.
- It can be applied as 3-5 minutes “rescue exercise” or an
Emergency Procedure to counteract acute exacerbations or
dyspnea (shortage of air or breathlessness) in COPD and asthma.
Segmental Breathing:
It is performed on a segment of lung, or a section of chest wall that

needs increased ventilation or movement.
Hypoventilation occur in certain areas of the lungs because of chest
wall fibrosis, pain after surgery, atelectasis, trauma to chest wall,
pneumonia and post mastectomy scar.
Therefore, it will be important to emphasize expansion of such areas
of the lungs and chest wall
Techniques:
 Lateral costal expansion
 Posterior basal expansion
 Right middle lobe or lingula expansion
 Apical expansion
Lateral costal expansion:
- This is sometimes called lateral basal expansion and may be

done unilaterally or bilaterally.
- The patient may be sitting or in a hook lying position.
- Place your hands along the lateral aspect of the lower ribs.
- Ask the patient to breathe out, and feel the rib cage move
downward and inward.
- As the patient breathes out, place firm downward pressure into
the ribs with the palms of your hands.
- Just prior to inspiration, apply a quick downward and inward
stretch to the chest. This places a quick stretch on the external
intercostals to facilitate their contraction. These muscles move
the ribs outward and upward during inspiration.
- Apply light manual resistance to the lower ribs to increase
sensory awareness as the patient breathes in deeply and the chest
expands.
- When the patient breathes out, assist by gently squeezing the rib
cage in a downward and inward direction.  The patient may
then teach to perform the maneuver independently, ask him to
apply resistance with his hand or with a towel.
Posterior basal expansion:
This form of segmental breathing is important for the post-surgical

patients who is in bed in a semi-reclining position for an extended
period of time.
Secretion often accumulates over the posterior segments of lower
lobes.
Steps:
- Have the patient sit and lean forward on a pillow, slightly

bending the hips.
- Place the PT hand over the posterior aspect of the lower rib and
do the same procedure in lateral costal expansion.
Right middle lobe or lingula expansion:
While the patient in sitting place your hand at either the right or left
side of the patient’s chest just below the axilla, and follow the same
procedure in lateral costal expansion.
Alternate-Nose Breathing Technique:
- Sit with spine straight and feet flat on the floor

- Close the right nostril with your right thumb, and inhale through
the left nostril. Inhale into the belly, for a count of 4.
- After inhaling, hold your breath for 4 seconds.
- Exhale through your right nostril while closing the left with your
ring and pinky finger of your right hand for 4 counts.
- Repeat steps 1 to 3, but this time start inhaling through the
RIGHT nostril (while you close the left nostril with your ring
and pinky finger).
- Start off practicing this breathing exercise for 2 minutes at a time
and then increase to 10 minutes for maximum benefits
Abdominal Breathing Technique:
- Place one hand on your chest and the other on your abdomen.
- When you take a deep breath in, the hand on the abdomen should
rise higher than the one on the chest. This ensures that the
diaphragm is pulling air into the bases of the lungs.
- After exhaling through the mouth, take a slow deep breath in
through your nose imagining that you are sucking in all the air in
the room and hold it for a count of 7 (or as long as you are able,
not exceeding 7)
- Slowly exhale through your mouth for a count of 8.
- As all the air is released with relaxation, gently contract your
abdominal muscles to completely evacuate the remaining air
from the lungs.
- It is important to remember that we deepen respirations not by
inhaling more air but through completely exhaling it.
- Repeat the cycle four more times for a total of 5 deep breaths and
try to breathe at a rate of one breath every 10 seconds (or 6
breaths per minute).
- At this rate our heart rate variability increases which has a
positive effect on cardiac health.
Precautions:
 Never allow the patient to force expiration-it may increase the turbulence in
the air way which leads to bronchospasm and airway resistance.
 Avoid prolonged expiration-it cause the patient to gasp with the next
inspiration and the breathing pattern become irregular and inefficient.
 Do not allow the patient to initiate inspiration with accessory muscles and
upper chest ,advise him that upper chest should be quiet during breathing.
 Allow the patient to perform deep breathing only for 3-4 times (inspiration
and expirations) to avoid Hyperventilation.

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Deep Breathing Exercise

Definition of Deep Breathing Exercise

Deep breathing exercise is breathing that is done by contracting the diaphragm,

Goals Of Deep Breathing Exercise:

Principles of deep breathing exercise:

Steps of Procedure Yes No

Diaphragm is the primary muscle for breathing (inspiration).

- Prepare the patient in relaxed and comfortable position in which

- Use small weight, such as sandbag to strengthen and improve the

- It is a means of increasing a patient’s inspiratory capacity when

Pursed Lip Breathing: Pursed-lip breathing is a strategy that

- Patient in a comfortable position and relaxed, explain the patent

It is performed on a segment of lung, or a section of chest wall that

Lateral costal expansion:

- This is sometimes called lateral basal expansion and may be

Posterior basal expansion:

This form of segmental breathing is important for the post-surgical

- Have the patient sit and lean forward on a pillow, slightly

Right middle lobe or lingula expansion:

Alternate-Nose Breathing Technique:

- Sit with spine straight and feet flat on the floor

Abdominal Breathing Technique:

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