Diaphragmatic Breathing Technique
Diaphragmatic breathing involves slow, controlled breathing where you actively expand your abdomen during inhalation while minimizing upper chest movement, followed by gentle abdominal contraction during exhalation. 1
Step-by-Step Technique
Starting Position
- Sit upright or lie on your back with knees bent and feet flat (supine position with trunk support is optimal for learning) 2, 3
- Place one hand on your upper chest and the other on your abdomen below the ribcage 1
Inhalation Phase
- Breathe in slowly through your nose for approximately 1 second, focusing on expanding your belly outward 1, 4
- The hand on your abdomen should rise significantly while the hand on your chest remains relatively still 2, 1
- Minimize upper rib cage motion and avoid using accessory respiratory muscles in the neck and shoulders 2, 4
Exhalation Phase
- Exhale slowly, allowing your abdominal muscles to contract gently and your belly to fall inward 1
- Exhalation should be passive and relaxed, taking approximately 1 second 4
- Some patients instinctively use pursed-lip breathing (exhaling through half-opened lips), which can reduce dyspnea 4
Key Performance Indicators
Correct Technique Markers
- Visible abdominal expansion during inspiration with minimal chest wall movement (ratio of rib cage to abdominal motion should decrease significantly) 5
- Increased tidal volume compared to baseline breathing 2
- Reduced respiratory rate 4
- No sensation of increased work of breathing or fatigue 2
Warning Signs to Stop or Modify
- Paradoxical abdominal motion (abdomen moving inward during inspiration instead of outward) indicates the technique should be modified or terminated 2
- Worsening dyspnea or increased fatigue during or after practice 2
- Increased asynchrony between chest and abdominal movement 5
Clinical Considerations
Patient Selection
- Patients with elevated respiratory rates and low tidal volumes that increase during diaphragmatic breathing are most likely to benefit 2
- Those with adequate diaphragmatic movement visible on assessment are good candidates 2
- Patients with severe hyperinflation and marked diaphragmatic flattening may not benefit and could experience worsened efficiency 2, 5
Position Modifications
- If paradoxical breathing occurs, try a more upright position or add trunk flexion (leaning forward) to improve diaphragm mechanics 2, 4
- Forward-leaning positions with arm support can decrease dyspnea and are clinically effective 4
Practice Recommendations
- Practice sessions should be supervised initially to ensure proper technique and identify any adverse responses 6
- For rehabilitation programs, training typically involves 16-week structured programs with weekly clinic sessions and daily home practice 6
- Adherence requires ongoing encouragement as patients often return to previous breathing patterns without continued reinforcement 6
Important Caveats
Diaphragmatic breathing is not universally beneficial - in patients with severe COPD and hyperinflation, it can actually reduce mechanical efficiency of breathing and increase oxygen consumption 5. The technique should be assessed individually with objective measures of tidal volume, respiratory rate, and patient comfort before continuing long-term practice 2, 5.