From the Guidelines
Diaphragmatic breathing is a technique that involves moving the abdominal wall out during inspiration and reducing upper rib cage motion, with the goal of improving chest wall motion and ventilation distribution, although evidence from controlled studies does not support its use in patients with COPD 1.
Definition and Practice
Diaphragmatic breathing is a deep breathing technique that engages the diaphragm, the dome-shaped muscle located at the base of the lungs. To practice diaphragmatic breathing, one would typically sit or lie in a comfortable position, place one hand on the chest and the other on the abdomen, then inhale slowly through the nose, allowing the abdomen to expand while keeping the chest relatively still. However, the effectiveness of this technique in improving respiratory function or quality of life is not supported by recent evidence 1.
Benefits and Limitations
While diaphragmatic breathing is often recommended for its potential benefits in reducing anxiety, lowering blood pressure, and improving concentration, the current evidence base, particularly from high-quality studies like the one published in the American Journal of Respiratory and Critical Care Medicine 1, does not convincingly demonstrate these benefits in patients with chronic lung diseases. The technique aims to maximize oxygen intake, activate the parasympathetic nervous system to reduce stress, and strengthen the diaphragm over time, but its application and benefits are more theoretical than evidence-based in the context of COPD management 1.
Clinical Application
In clinical practice, especially concerning patients with chronic obstructive pulmonary disease (COPD), other breathing strategies such as pursed-lip breathing have shown more promise in reducing dyspnea and improving exercise tolerance 1. Techniques like forward leaning and the use of a rollator/walker while ambulating have also been noted to decrease dyspnea and increase exercise capacity in COPD patients 1. Therefore, when considering the management of respiratory diseases, it is crucial to prioritize evidence-based practices that have demonstrated clear benefits in morbidity, mortality, and quality of life 1.
From the Research
Definition of Diaphragmatic Breathing
- Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions 2.
- It has been described as breathing predominantly with the diaphragm while minimizing the action of accessory muscles that may assist with inspiration 3.
Characteristics of Diaphragmatic Breathing
- Diaphragmatic breathing is safe, simple, and not limited by places 4.
- It can be assessed using various methods, including ultrasound, X-ray fluoroscopy, and magnetic resonance imaging to evaluate diaphragm mobility, strength, thickness, and thickening 4.
- DB is associated with a significant increase in tidal volume and reduction in breathing frequency, leading to higher ventilation and oxygen saturation, with a reduction in dead space ventilation and ventilatory equivalent for carbon dioxide 5.
Effects of Diaphragmatic Breathing
- Diaphragmatic breathing may be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD) 2, 3, 5.
- It may also help in reducing stress, treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety, and improving the quality of life of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure 2.
- The combination of pursed lip breathing and diaphragmatic breathing can effectively promote pulmonary function and exercise capacity in patients with COPD 6.