Aims

1. To mobilize secretions.
2. To teach effective coughing and remove secretions.
3. To teach relaxation.
4. To teach breathing control.
5. To teach postural awareness.
6. To mobilize thorax and shoulder girdle.

Breathing Exercises
Breathing Exercises are commonly incorporated into the overall pulmonary rehabilitation program of patients with acute or chronic pulmonary disorders. Breathing exercises are designed to restrain the muscles of respiration and improve or redistribute ventilation, lessen the work of breathing, and improve the gas exchange and oxygenation. Active range of motion exercises, to the shoulders and trunk also help expand the chest, facilitate deep breathing, and often stimulate the cough reflex.

A. Indications for Breathing Exercises

1. Acute or chronic lung disease.
• Chronic obstructive lung disease.
• Pneumonia.
• Atelectasis.
• Pulmonary embolism.
• Acute respiratory distress.
2. Pain in the thoracic or abdominal area because of surgery or trauma.
3. Airway obstruction secondary to bronchospasm or retained secretions.
4. Deficit in the central nervous system that lead to muscle weakness.
• High spinal cord injury.
• Acute, chronic, or progressive myopathic or neuropathy diseases.
5. Severe orthopedic abnormalities, such as scoliosis and kyphosis, that affect respiratory function.
6. Stress management and relaxation procedures.

B. Goals of Breathing Exercises

• Improve ventilation.
• Increase the effectiveness of the cough mechanism.
• Prevent pulmonary impairments.
• Improve the strength, endurance, and coordination of respiratory muscles.
• Maintain or improve chest and thoracic spine mobility.
• Correct inefficient or abnormal breathing patterns.
• Promote relaxation.
• Teach the patient how to deal with shortness of breath attacks.
• Improve a patient’s overall functional capacity.

C. Precautions

• Never allow a patient to force expiration. Expiration should be relaxed and passive. Forced expiration only increases turbulence in the airways, which can lead to bronchospasm and increased airway restriction.
• Do not allow a patient to take a very prolonged expiration. This causes the patient to gasp with the next inspiration. The patient’s breathing pattern then becomes irregular and inefficient.
• Do not allow the patient to initiate inspiration with the accessory muscles and the upper chest. Advise the patient that the upper chest should be relatively quiet during breathing.
• Allow the patient to practice deep breathing for only three or four inspirations and expirations at a time to avoid hyperventilation.

All breathing patterns should be deep, voluntarily controlled, and relaxed, regardless of the pattern being taught to the patient.