What is the benefit of purse lip breathing for individuals with Chronic Obstructive Pulmonary Disease (COPD)?

Benefits of Pursed Lip Breathing in COPD

Pursed lip breathing reduces respiratory rate, improves oxygen saturation, decreases dyspnea, and enhances exercise tolerance in patients with COPD by preventing airway collapse during expiration. 1

Mechanism of Action

Pursed lip breathing (PLB) works through several physiological mechanisms:

• Prolongs active expiration through half-opened lips, preventing airway collapse during exhalation 1
• Reduces respiratory rate, which decreases the work of breathing 1, 2
• Improves tidal volume, allowing for better gas exchange 1
• Decreases PaCO2 levels, reducing hypercapnia 1
• Improves oxygen saturation at rest and during exercise 3, 2

Clinical Benefits

Respiratory Parameters

• Reduces respiratory rate by approximately 4.4 breaths per minute during exercise 4
• Increases oxygen saturation by approximately 2% 2
• Decreases dynamic hyperinflation during exercise, shown by improved inspiratory capacity 5

Exercise Tolerance

• Increases 6-minute walk test distance by approximately 35 meters 4
• Particularly benefits patients with lower baseline exercise performance 4
• Patients with low expiratory peak flow (below 47.7% predicted) show the greatest improvement in exercise endurance 5

Symptom Management

• Helps patients cope with acute dyspnea 1
• Many patients with chronic lung disease use this technique instinctively 1
• Provides a non-pharmacological method to manage breathlessness 2

Implementation in Clinical Practice

PLB should be taught as part of a comprehensive pulmonary rehabilitation program:

1. Instruct patients to inhale through the nose
2. Exhale slowly through pursed (half-opened) lips, making the expiration phase longer than inspiration
3. Consider using ear oximetry as biofeedback to help patients learn the technique effectively 3
4. Encourage practice during periods of rest and incorporate during physical activity

Patient Selection

While most COPD patients can benefit from PLB, those most likely to show significant improvement include:

• Patients with lower expiratory peak flow (below 47.7% predicted) 5
• Those with poorer baseline exercise performance 4
• Patients experiencing dynamic hyperinflation during activity 5

Common Pitfalls and Considerations

• PLB should be used in conjunction with other treatments, not as a replacement for pharmacotherapy
• Some patients may develop thoracoabdominal asynchrony during PLB, which can limit its effectiveness 5
• Unlike PLB, diaphragmatic breathing has not shown consistent benefits in COPD and may actually increase the work of breathing in some patients 6
• Benefits may be more pronounced during submaximal exercise rather than at peak exertion 5

PLB represents a simple, cost-effective, non-invasive technique that should be incorporated into the management of COPD patients to improve their respiratory function, exercise capacity, and quality of life.