Controlled Breathing Pursed Lips Breathing

Authored by , Reviewed by Prof Cathy Jackson | Last edited | Certified by The Information Standard

Your doctor or nurse may suggest that you learn how to do 'controlled breathing'. This can help to ease shortness of breath (breathlessness) caused by various conditions.

Note: controlled breathing is in addition to any other medication or treatment which you may be prescribed for your condition. It is not suitable for everyone with breathing difficulties.

When you are short of breath, your breathing can become too fast, too shallow, or jerky. Because of this you may not get as much air into your lungs as possible. 'Controlled breathing' (sometimes called 'pursed lips breathing') will help you to get as much air as possible into your lungs. This may help to ease shortness of breath. It is one way to slow down your breathing and to make each breath as effective as possible.

Controlled breathing has been shown to improve your ability to exercise and also strengthen the muscles that are responsible for moving your chest wall when you breathe. However, it is not always helpful (beneficial) to everyone with shortness of breath. Your doctor will be able to advise you as to whether this is likely to help you.

It can be helpful to learn the technique when you are relaxed. Perhaps practise the technique 4-5 times a day at first. You can then use it whenever you become short of breath, or when you have to do something that makes you short of breath, such as climbing stairs.

Your doctor or nurse will explain how to do controlled breathing. The following is a reminder:

1. Sit upright, if possible

Sitting upright is usually better than lying down, or 'slouching', as it can increase the amount of space inside your lungs that can fill with air.

2. Breathe gently in and out and purse your lips when breathing out

If possible, breathe in through your nose and out through your mouth in a steady slow rhythm. Try to keep your mouth closed when you breathe in through your nose. As you breathe out, pucker or 'purse' you lips (as if you are about to whistle). This interferes very slightly with the air flowing out. Try to make your breath out twice as long as your breath in. This helps to empty your lungs of old air, and to make as much room in your lungs for fresh, oxygen-rich air. To do this you may find it helpful to count 'one, two' as you breathe in, and 'one, two, three, four' as you breathe out. Do not hold your breath between breathing in and out.

3. If possible, mainly use your lower chest muscle (diaphragm) to breathe

Your diaphragm is the big muscle under the lungs. It pulls the lungs downwards, which opens the airways to allow air to flow in. When we become breathless we tend to forget to use this muscle, and often use the muscles at the top of the chest and our shoulders instead. If you use these upper chest muscles, each breath is more shallow. So, you tend to breathe faster and feel more breathless if you use your upper chest muscles rather than your diaphragm.

You can check if you are using your diaphragm by feeling just below your breastbone (sternum) at the top of your tummy (abdomen). If you give a little cough, you can feel the diaphragm push out here. Put your hand here and, if you are using your diaphragm, you should feel your tummy move in as you breathe out and out as you breathe in.

4. Try to relax your neck, shoulders and upper chest muscles when you breathe

It is best to take the weight off your shoulders by supporting your arms on the side arms of a chair, or on your lap. A friend or relative standing behind you, gently massaging your shoulders, may encourage you to relax.

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Further reading and references

  • Holland AE, Hill CJ, Jones AY, et al; Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012 Oct 1710:CD008250. doi: 10.1002/14651858.CD008250.pub2.

  • Borge CR, Hagen KB, Mengshoel AM, et al; Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC Pulm Med. 2014 Nov 2114:184. doi: 10.1186/1471-2466-14-184.

  • Nield MA, Soo Hoo GW, Roper JM, et al; Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev. 2007 Jul-Aug27(4):237-44.

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