Respiratory Physiotherapy in COPD

When breathlessness arrives in COPD, the most common reflex is to breathe faster and try harder. Unfortunately that response can increase air trapping and deepen the sensation.

In COPD the airways are narrowed and exhalation takes longer. When someone starts breathing quickly in alarm, a new breath is taken before the previous one has fully emptied. A little more air stays behind each time; the chest becomes hyperinflated, the diaphragm flattens further and cannot work efficiently. In other words, the harder you struggle the harder it gets.

The role of respiratory physiotherapy here is to teach concrete skills that break that cycle. These are learnable techniques; which one is used, and at what intensity, depends on the stage of the condition and current capacity.

Pursed-lip breathing

Take a normal breath in through the nose, then purse the lips gently as if blowing out a candle and breathe out over a longer period than you breathed in — for example in for two, out for four. This technique may help keep the airways open during exhalation and works towards reducing air trapping.

An important detail: the out-breath should not be forced or blown out hard. The aim is not to push air out but to allow it enough time to leave. Forced exhalation can close the airways early and produce the opposite effect.

Relieving positions

Body position during breathlessness can allow the accessory muscles of breathing to work more effectively. Positions commonly used:

• Sitting and leaning forward: elbows on knees or on a table, trunk slightly forward, shoulder girdle supported.
• Leaning against a wall: back to the wall, feet slightly forward, shoulders relaxed.
• Side lying with a high pillow: raising the trunk for people who become breathless in bed.
• Standing with the arms supported: hands resting on a counter, trolley or walking frame.

These positions also reduce the feeling of “I don't know what to do when I can't breathe”. What matters is that they are learned before an episode, in a calm moment.

Energy conservation and task simplification

An often-overlooked topic in COPD is how daily tasks are carried out. Small adjustments can make the same task noticeably less demanding:

• Reducing work that requires raising the arms above head height; keeping frequently used items at eye level
• Showering while seated, ventilating the bathroom and reducing steam
• Spreading heavy tasks across the day rather than doing two demanding tasks back to back
• Matching breath to movement: breathing out during the effort, in while resting
• Planning shopping with pauses rather than in one go; using a wheeled bag
• Sitting to dress and choosing slip-on shoes rather than laces

Where exercise training fits

In COPD, inactivity causes muscle loss and reduced conditioning independently of the disease itself, which means the same task requires more oxygen. Graded exercise training aims to address that picture.

Exercise intensity is set from the assessment and monitored using pulse, oxygen saturation and a breathlessness scale. During exacerbations the programme is paused or revised — a decision made together with your doctor.

Frequently Asked Questions