Breathing Therapy

What can help breathing difficulties?

 Breathing Therapy Can Save a Life

When someone is struggling to breathe, the diagnosis’s name may help the doctor determine the course of treatment, but for the caregiver, all you want to do is help them breathe easier. Therefore, it is often useful to become familiar with both the common and unusual symptoms of a condition and the “home remedies” others have found helpful.  Knowing what to expect in advance and how you might handle those issues can save you a lot of panic.  Learning how to do breathing therapy at home and having the tools available in advance may save your family member’s life if time is critical.

Early Intervention Can Promote Healthier Living

Many early interventions exist that promote healthier living or improvement in symptoms that do not require a doctor’s order. As the family member’s condition changes, the doctor adds new treatments.  Some of these, you will do, and some, home health do.  In any case, the goal is to help your family members breathe better.

There is much you can do at home to help.  You have access to assistive devices, chest physical therapy, breathing exercises, and coughing exercises –all of which can provide effective breathing therapy to someone whose breathing is not normal. Examples of what you can do and how to do them are provided below.

Breathing Therapy Exercises

1. Diaphragmatic Breathing

With your family member sitting up straight, place your hand against their abdomen between their ribs. Have them take in a deep breath through their noise and exhale slowly. Do this focused, controlled breathing exercise about 10 times per hour.

2. Resisted Breathing

Help your family member to sit up. Place one of your hands on each side of their chest just under their arm pits (about mid-way).  Tell your family member to breath in as if they are trying to push your hands off their chest. While they breath in trying to expand their chest and internal lung space, you should gently add resistance to keep the lung from expanding.

3. Yawn (Inspiratory Hold)

Ask your family member to take a deep breath and hold it for 3-5 seconds. Exhale slowly.  Often the exhale will cause a cough.

4. Chin-to-Chest Breathing

Your family member may sit, lie on their side, or sit at a 90° angle with their chin resting against their chest. You would place your hand against the back of their head to help them keep their head down and in position. Have them take a deep breath through their nose and slowly exhale through pursed lips. This exercise helps slow breathing for fast respiratory rates.

5. Pursed Lip Breathing

As your family member is breathing out through pursed lips (pursed lips look like puckered lips) place your hand over the upper stomach (the V area between the ribs).  As your family member breaths out through pursed lips, they contract their stomach muscles.  You then start to push upward and into the diaphragm.  This process helps to remove trapped air from the lungs.

Coughing Exercises Used in Breathing Therapy

1. Cascade Cough

Instruct the person to take a deep breath, then cough several times until they feel there is no air left in their lungs. This maneuver helps to move secretions from smaller airways to larger ones where its easier to cough.

2. Huff Cough

This technique is similar to just creating an internal vibration feeling. Have the person take a deep breath and with their mouth open do a series of “huffs” as they exhale.  After they “huff” several times, they should try to cough.

3. End-Expiratory Cough

Take a deep breath, exhale slowly and when the lungs are almost empty, try to cough. It may not produce sputum, but it helps to move it from areas of smaller airways to larger ones.

Assistive Devices Used as Breathing Therapy

1. Incentive Spirometer

The purpose of this device is to improve lung volume. To use it, sit up straight, seal your lips around the mouthpiece, take a slow, deep breath and blow into the mouthpiece.  Your goal is to see how high you can make the ball rise and how long you can make it stay that high. Repeat this process five times trying to make the ball go higher each time. On the fifth time, try to cough instead of blow to see how high the ball goes.

2. Acapella Breathing Device

The Acapella Breathing Device is used to help remove mucus from airways.  You place it between your lips and blow through the mouth piece. As you blow, it causes a vibration which loosens secretions helping you to cough the stuff out. It has a dial to adjust the difficulty required to create the vibration also making it an effective exercise.

3. Nebulizer

A medication delivery device used to produce a fine mist that is inhaled into the lungs.  The medication is carried into the lungs on the mist and absorbed through the lining of the alveoli.

4. Inhaler

An inhaler is a medical device used to administer medication into the body via the lungs in an aerosolized format.

External Ventilator

An example of an external ventilator is a Hayek made by United Hayek Medical.

My husband used this device for several months.  During that time, Lynn had significant difficulty with keeping his carbon dioxide level from getting too high due to weak diaphragm muscles and airway obstruction related to pneumonia.

He could not push the “bad air” out of his lungs because his diaphragm muscles were too weak. The device saved his life by applying external pressure against his chest wall, pushing it down, to assist his diaphragm in doing its job.

He eventually strengthened his core chest muscles enough that he no longer needed the Hayek ventilator, and we were able to send it to the company.  Fortunately for Lynn, a Respiratory Therapist who used the equipment with ALS patients in another clinic suggested its use for him.

An example of an external ventilator.
An example of an external ventilator.
Performing chest percussion to help stimulate removal of secretions.
Performing chest percussion to help stimulate removal of secretions.

Chest Physical Therapy

1. Postural Drainage

The purpose of postural drainage is the drain the lung of congestion using gravity. The way it works is that you use pillows or wedges to raise or lower the chest and arms to position the lung section in such a way as to encourage it to drain.  The elevated position is held (if tolerated) for 5-20 minutes repeating the process ever four hours to keep the lung section drained. Using percussion and vibration, in association with postural drainage, is often beneficial.

2. Percussion

Percussion is often employed when an individual has a lot of thick, hard to expel secretions such as when you hear rales (coarse crackles). To perform percussion, form your hand into a cup shape, then strike the person’s back with the open-cupped hand using a rapid, rhythmic movement.

Do NOT do this if the person has broken bones, a fresh heart attack or surgery, fragile skin, bleeding disorders, a blood clot, or a bruised lung. It is always a good idea to discuss using percussion with a doctor first before you try it the first time to be on the safe side.

3. Vibration

Most of the time vibration is used following percussion; however, it may be used alone. This technique is not a shaking process; instead it involves a quiver motion that is more subtle. You place your hands above the lung area that is to receive the vibration with your arms straight but elbows not locked. As the person exhales, you create a quiver motion with your hands that is a fine tremulous motion (not a shake). Repeat the motion three times for each lung section.