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Managing Breathlessness

Posted Thursday, 21 December 2023

Date issued: December 2023

Review date: December 2025

Ref: C-553/AP/Physiotherapy/Managing Breathlessness

PDF: Managing Breathlessness 2023.pdf[pdf] 264KB

What is breathlessness?

Breathlessness is different for everyone. Shortness of breath at times is healthy and normal. It’s a natural response when your body needs more Oxygen and energy after any physical activity. However, some people can get breathlessness due to their illness, they can experience an uncomfortable feeling of being out of breath.

Some people have breathlessness all the time. This is called chronic breathlessness. Other people have episodes of breathlessness that last for a short time, this is called acute breathlessness.

Acute Breathlessness at rest needs to be tested or treated as it can be a sign of a new medical condition. If experiencing breathlessness that last longer than the normal recovery time, than you should call your GP for an urgent appointment or NHS 111. Call 999 for immediate medical attention in the case of an emergency.

Insufficient breathing pattern

The feeling of breathlessness can often lead to the development of an inefficient breathing pattern, with small breaths coming in and out using the top part of your chest, and your shoulders hunched. The muscles that support breathing, particularly around your neck and shoulders are thus over-used to pull more air in. This increases the effort needed for breathing, making it less efficient.

What can you do to manage breathlessness?

There are lots of things you can do to help manage breathlessness.

You can try the suggestions in this booklet by yourself.

Breathing positions

Some positions can make it easier to fill your lungs with air when you breathe in. With all positions, try to relax the hands, wrists, shoulders, neck, and jaw as much as possible. The following positions may help to ease your breathlessness. Not every position will work for everyone Try them out and see what works best for you:
Sit upright in a chair, passively fixing the shoulder girdle to optimise ventilatory muscle efficiency and relief of breathlessness.
Assess the effectiveness of forward lean sitting to relieve your breathlessness. Leaning forward may also improve the movement of your diaphragm, which is the main muscle of breathing.

You can relax down onto pillows (as shown below). Having your legs apart may also help.
Sit or stand in a forward lean position with arms resting on a sturdy chair or a windowsill (Only for those patients for whom forward lean sitting or standing is effective).

Breathing techniques: Try different techniques to find what works best for you. There are different breathing techniques you can try to control your breathing when you feel out of breath. You might find that some of them work better than others for you.

Breathing Control: breathing gently using your Diaphragm - the main muscle of breathing. You may find it useful to put one hand on your chest and the other on your stomach. Slowly breathe in through your nose, with your mouth closed. Your stomach will move out against your hand. Next, breathe out through your nose. Your stomach will fall gently. Do not force your lungs to empty.

Rectangular breathing: Follow the sides of the rectangle with your eyes as you breathe in through your nose and you can breathe out with pursed lips.

Purse Lips breathing: Breathe gently through your nose, then purse your lips as though you’re blowing a candle. Blow out through your mouth with your pursed lips position.

Blow as you go: Breathe in before you make the effort. Then breathe out while you’re making the effort. For Example: breathe in before you step or stand up and breathe out as you step or stand.

Paced breathing: Count to yourself as you walk. For example: Breathe in for one step and breathe out for either one or two steps.

Use of Walking Aids: For some people, maintaining a Forward lean position by using a walking aid may enable you to walk further and feel less short of breath. For example: a walking stick, walking frame, 3 wheeled walker/4 wheeled walker (As prescribed by your Physiotherapist following an example) can provide you with a portable leaning position, which may ease your shortness of breath.

Energy Conservation, Home, and Lifestyle Adaptations: Maintaining quality of life with breathlessness involves adapting your lifestyle and home to enable you to be as independent as possible, while accepting that at times you may need support.

Top Tips for living well with breathlessness:

At times with breathlessness, you may feel fatigue, it would be advisable to plan your day in advance and prioritise the tasks that are most important to you. Pace yourself to make sure you have plenty of opportunities to rest.
Break down your activities into smaller tasks that are more manageable.
Hold a handheld battery fan near your face – this should help you feel less breathless.

Home and Tasks Adaptations:

Put items that you use frequently in easy-to-reach places.
Use a towelling robe after showering or bathing, as you’ll use less energy than drying off with a towel.
Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.
Be patient with yourself and give yourself time to do things. Try to recognise achievements in your day-to-day lifestyle.
Don’t be afraid to ask for support when you need it. Speak to your Occupational Therapist for further advice about managing your daily activities and adaptation to home environment.