POSITIONING

When your muscles are relaxed, breathing is easier: try moving or changing positions to help with shortness of breath.

• Sitting up and leaning forward with your arms resting on your legs.

• Rest against the wall and lean forward with your hands on your thighs. This position relaxes your chest and shoulders, freeing them to help you breathe.

• Raising the head of the bed or using pillows to sit up, sitting or sleeping in a reclining chair.

PACED BREATHING

Paced breathing prevents or decreases shortness of breath when you walk or lift light objects. If possible, use your breathing muscles for one activity at a time: do not try to move and breathe in, or lift and breathe in.

• For walking: Stand still and breathe in, walk a few steps and breathe out, rest, and begin again. When walking, pace yourself and move slowly.

• For lifting: Hold the object, but do not lift it. Breathe in THEN lift the object. Breathe out. When carrying something, hold it close to your body. This saves energy.

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Dyspnea (pronounced disp–NEE–uh) is a medical term for difficult or labored breathing. It is the sensation you have when you feel you are not getting enough air or you are having trouble breathing. This may just be a problem when walking up stairs, or it may be so severe you may get short of breath during daily activities such as talking or eating. You might also feel like you are breathing faster or like you can’t take a deep breath, or a sensation of tightness in your chest. You might also feel tired, anxious or fearful.

There are several ways to help you manage shortness of breath without using medications. These include positioning, paced breathing, pursed-lip breathing and desensitization.

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ManagingShortness of Breath

PURSED-LIP BREATHING

Pursed lip breathing is one of the simplest ways to control shortness of breath. It provides a quick and easy way to slow your pace of breathing, making each breath more effective. It releases trapped air in the lungs, it keeps the airways open longer and decreases the work of breathing.

• Relax your neck and shoulder muscles.

• Breathe in (inhale) slowly through your nose for two counts, keeping your mouth closed. Don’t take a deep breath; a normal breath will do.

• Pucker or “purse” your lips as if you were going to whistle or gently blow out the flame of a candle.

• Breathe out (exhale) slowly through your pursed lips while counting to four. Try to breathe out until all the air is gone - always breathe out for longer than you breathe in.

Practice this technique 4-5 times a day at first so you can get the correct breathing pattern. Then use this technique during the difficult part of any activity, such as bending, lifting or stair climbing.

DESENSITIZATION/RELAXATION

Desensitization means that you are not so afraid when you are short of breath. Relaxation exercises can also take away fear and help your breathing.

• Practice pursed-lip breathing, positioning, and paced breathing. Then you will be more confident using these exercises when you are short of breath.

• Let people around you know when you are short of breath. Do not feel embarrassed because you cannot join others in some activities. You may be still be able to do what you always did—you may just take a little longer, or do them differently.

• Find ways to relax: Listen to calming music, get a massage, get reassurance from a calm friend, family member, or medical team member.

• Put a cool cloth on your neck or head.

• Use a fan blowing cool air onto the side of your face or open a window.

• Be creative. If you find a certain activity too difficult, try doing something else that is similar. For example, if gardening is not possible, try growing house plants!

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Inhale for two counts

Pucker or purse

Exhale for four counts

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http://www.nlm.nih.gov/medlineplus/ency patientinstructions/000471.htm

Updated 4/7/2012 by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

http://www.cc.nih.gov/ccc/patient_education/pepubs/dyspnea.pdf - External Health Links

National Institutes of Health Clinical Centers Handout 12/08.

http://www.lung.ca/_resources/Breathlessness_COPD_LungAssoc.pdf

Kamal AH, Maguire JM, Wheeler JL, Currow DC, Abernethy AP. Dyspnea Review for the Palliative Care Professional:Treatment Goals and Therapeutic Options. Journal of Palliative Medicine Volume 15, number 1, 2012.

Tucker RO, Nichols AC. UNIPAC 4 Managing Nonpain Symptoms.

Abernethy AP et al. Sustained Release Morphine Improves Dyspnea. BMJ vol.327:523-528, 2003.

Abernethy AP et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial Original Research Article. The Lancet, Vol. 376, Issue 9743 September 2010, Pages 784-793

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