Breath is life, supporting you in each moment of every day. When your lungs are healthy, it’s easy to take this automatic process for granted. But when you’ve been diagnosed with a chronic obstructive pulmonary disease (COPD) like emphysema or chronic bronchitis, you devote more of your focus — and literal and metaphorical space in your body and mind — to the simple act of breathing.
While COPD doesn’t have a cure yet, it’s highly treatable with support from your primary care provider or pulmonologist. Because COPD care isn’t one-size-fits-all, your trusted clinician will work with you to recommend the right treatment plan to manage your symptoms effectively. They may suggest breathing exercises for COPD, such as pursed-lip breathing and diaphragmatic breathing, to strengthen your main breathing muscle and ultimately boost your quality of life.
To better understand diaphragmatic breathing and how it can help people with COPD, we sat down with Lung Health Program Coordinator Gloria Bailey, MPH, RRT, CHES, CTTS. “First, if you have a chronic lung condition like COPD, ask your healthcare provider or respiratory therapist which breathing techniques are best for your unique needs. They’ll be able to explain diaphragmatic breathing for COPD, techniques and benefits to make sure this practice is right for you,” Gloria says.
What Is Diaphragmatic Breathing?
“Diaphragmatic breathing, also called belly breathing, strengthens your diaphragm,” Gloria says. “It’s a simple, free technique that can help many people breathe more comfortably and feel more relaxed.”
How the Diaphragm Works
Your diaphragm is the dome-shaped muscle at the base of your lungs that separates the chest from the abdomen. It’s your body’s main muscle for breathing, and it works hard to support your lungs.
Each time you inhale, the diaphragm contracts, pulling down the bottom of the lungs to create more space for fresh air. When you exhale, the diaphragm relaxes, expanding upward into the chest cavity as the lungs return to their normal shape as well.
With COPD, your diaphragm may become flatter, reducing its normal mechanical ability to move the lungs, making it harder to breathe. The good news is that your diaphragm is a muscle, and like all muscles, it can be trained and strengthened, even if you have COPD.
Chest Breathing vs. Belly Breathing
Chest breathing uses the chest to help you inhale and exhale, and most people fall into this familiar rhythm of the chest rising and falling daily without realizing it. Chest breathing may feel easier and more natural, but it’s also shallower and less satisfying, especially if you have COPD.
Ultimately, your chest, neck and shoulders aren’t meant to handle all the work of breathing. Your diaphragm is designed to support every breath you take, and the more you strengthen this muscle, the less effort your other muscles will devote to breathing.
Deeper and more calming than chest breathing, diaphragmatic breathing uses the diaphragm muscle to support a full exchange of oxygen — inhaling oxygen, exhaling carbon dioxide — to help rid the lungs of accumulated air and increase your body’s oxygen levels. It can take practice, but it’s a key part of strengthening your diaphragm.
Why People With COPD May Benefit From Diaphragmatic Breathing
In people with COPD, shallow chest breathing may become more of a daily habit (think gasping for air or huffing and puffing) as the body works harder to inhale and exhale enough air. Air may also become trapped in the lungs due to weakened lung tissue, which keeps the diaphragm pressed down. Over time, this weakens the diaphragm and reduces its efficiency.
Diaphragmatic breathing helps you breathe more easily by training your diaphragm to do what it was designed to do. “By strengthening your diaphragm muscle, you reduce the work of using the muscles in the neck and shoulders to help you breathe,” Gloria explains, “which in turn helps make your breathing feel more efficient and less tiring.”
Diaphragmatic breathing may benefit some people living with COPD, particularly when taught by a respiratory therapist or in a pulmonary rehabilitation program, Gloria says. “People with more advanced COPD or significant hyperinflation may find it less effective. Pursed-lips breathing has more consistent evidence for reducing shortness of breath during daily activities, so breathing techniques should be personalized.”
Diaphragmatic Breathing vs. Other Breathing Techniques
There’s always more than one way to breathe better, and each type of breathing exercise for lung health has its own benefits.
Deep Breathing
As one of many stress-reduction techniques, taking deep breaths can be helpful in moments of tension, but it might not be doable or easy for everyone all the time. For most people, a slower, guided breathing practice proves more helpful in the long run.
Pursed-Lips Breathing
Pursed-lips breathing is an easy and accessible way to control your breath. To practice it, close your lips and breathe in through your nose for two counts. Then, purse your lips like you’re blowing out a candle and exhale for four counts. This practice helps you slow your breathing, restoring your sense of control over the present moment and calming your body and mind.
Breathing Retraining
Breathing retraining exercises, like pursed-lips breathing and diaphragmatic breathing, offer the greatest benefits of deep breathing. These techniques offer a structured and intentional way not only to catch your breath but also to ease tension in the body, refocus your mind and strengthen your diaphragm.
While deep breathing can be done anywhere and anytime without any practice or preparation, pursed-lips breathing and diaphragmatic breathing take a bit more focus and effort but can have bigger benefits for your body overall. “These two techniques can help reduce shortness of breath, improve your breathing overall and help you relax, too,” Gloria says.
When in doubt, talk with your doctor about which mindful breathing techniques would be best for you and when each might come in handy.
How to Practice Diaphragmatic Breathing
Here’s how to do diaphragmatic breathing step by step:
- Get comfortable: Start by lying on your back on a flat surface, if possible. If you can’t lie down, sit in a reclined position (so you can see your belly) with your back supported.
- Place your hands: Place one hand on your sternum (upper chest) and the other on the soft part of your belly, just below your ribs.
- Imagine changing your breath: Set your intention to breathe into the belly, not the chest.
- Inhale: Inhale slowly and deeply through your nose, keeping your mouth closed and your chest still. The hand on your belly should rise as your belly rises.
- Exhale: Tighten your abdominal muscles and let them fall slowly as you exhale through pursed lips. The hand on your belly should move down to where it was before you inhaled.
Diaphragmatic breathing is relatively simple but can take some practice to master, so don’t be discouraged if it takes time. “Like any new skill, it works best when practiced regularly, not just when you’re already feeling short of breath, anxious or stressed,” Gloria explains.
Common Mistakes to Avoid
As you get started with diaphragmatic breathing, keep these pointers in mind:
- Try it at rest: Don’t attempt belly breathing for the first time when you’re already stressed. Wait until you’re calm and relaxed to try it out. “Trying to practice during a stressful situation without proper technique can actually make your body work harder to breathe,” Gloria reminds us.
- Work your way up: When you’re first starting out, don’t try belly breathing while exercising. Practice it while lying down, then while sitting up, then while standing and finally, during exercise. Learn more about exercise and lung capacity in this helpful article.
- Listen to your body: Don’t push through discomfort. If you feel physical pain or discomfort, stop right away and try again later.
Remember that with all breathing techniques, it’s OK to go slow and take your time.
Tips for Beginners
Use these tips to make diaphragmatic breathing easier for you:
- First, relax: Release your shoulders away from your neck and ears, relax your jaw and let your tongue release from the roof of your mouth.
- Modify as needed: The best way to practice is while lying down, and you can use a pillow under your head or knees if that’s more comfortable. If you’re sitting up, sit up tall in a chair that supports your back.
- Use a visual aid, if desired: Placing a light object, such as a tissue box, on your belly can help you see it rise and fall more easily.
- Take it slow: There’s never any rush with breathing techniques. Go at your own pace and pause or stop whenever you’d like.
Belly breathing might not feel natural at first. Trust that you’ll get the hang of it, and that you’re doing a good thing for your body. Your lungs will thank you in the long run.
Benefits of Diaphragmatic Breathing for COPD
A stronger, healthier diaphragm muscle is the main benefit of diaphragmatic breathing for COPD, but it can go a long way to help you manage stress, too, Gloria explains. “Slow, controlled breathing activates your parasympathetic nervous system — your body’s rest-and-digest response — which helps slow your heart rate, reduce stress hormones and promote a sense of calmness.”
Other pluses of this practice include:
- Improved breathing efficiency
- Less tension in the body
- Lowered blood pressure
- Noticeable lung function improvement
- Reduced shortness of breath
With practice and persistence, you can make belly breathing part of your everyday life to help soothe COPD symptoms, relax and breathe better overall.
Incorporating Diaphragmatic Breathing Into Your Daily Routine
First, talk with your healthcare provider. They’ll be familiar with your health history and COPD diagnosis and will be able to advise you on when to get started with belly breathing.
Getting Started
If you’re having trouble starting, know that that’s normal with any new breathing technique. Ask your doctor or a respiratory therapy expert to demonstrate diaphragmatic breathing for you, or look up one of the many helpful demonstration videos online. Where there’s a will, there’s always a way.
Staying Consistent
“Like with any new skill, diaphragmatic breathing becomes easier with regular practice,” Gloria says. “I recommend practicing for five to 10 minutes once or twice a day while sitting or lying down. Once it becomes familiar, it can also be used during stressful situations, episodes of anxiety or when you feel short of breath.”
When to Pause
If at any point while you’re practicing diaphragmatic breathing you start to feel tired, your muscles start to hurt or if you’re more focused on “am I doing this right?” than the breath itself, just take a moment to rest and try it again later.
When to Ask a Respiratory Therapist for Help
“If your breathing exercise increases your shortness of breath, causes dizziness or doesn’t seem to help, it’s a good idea to consult with a respiratory therapist,” Gloria says. “They can observe and evaluate your breathing and teach you proper techniques tailored to your condition.”
When to Go to the ER
As always, your safety comes first. Diaphragmatic breathing isn’t meant for emergencies. Don’t hesitate to go to your nearest ER if you experience emergency COPD symptoms like severe difficulty speaking or catching your breath.
