Last time we talked about pursed lip breathing for COPD - what it is, and why it helps when you're short of breath (SOB). Today we're going to go a step further and learn about diaphragmatic - also called belly, or abdominal - breathing. Remember that some of these techniques can be used with other pulmonary disorders as well, but as always, check with your doctor or respiratory health care professional before starting to use any new technique or exercise.
Now, I'll tell you right up front - this is kind of technical, but just stick with me here because doing diaphragmatic breathing (and doing it correctly) can mean the difference between huffing and puffing and struggling your way through each day, or being in control of your breathing as you do the things you want to do.
First of all, let's review why we're even talking about learning how to breathe in the first place. You might be thinking, "I've been breathing since the moment I came into this world so why am I suddenly supposed to ‘learn' how to breathe?" The answer is simple. If you have COPD or another chronic lung disease that makes you short of breath, there have been changes in your body and you are no longer able to breathe as you once did.
So, what's going on in my lungs?
When lungs become damaged from cigarette smoking or other hazards in your environment, the elastic fibers within them start to deteriorate and the lungs begin to lose their elastic recoil - their ability to get air out efficiently. You can think of this by comparing a balloon to a paper bag. The air in the balloon comes out easily because the balloon is elastic. A paper bag is not. Over the years the loss of your lungs' elastic recoil gets worse and the lungs develop air trapping and over- inflation. This means that your lungs actually get bigger than they should be. And this leads to trouble because the extra, stale air compresses the good lung tissue so it can't do the job it should - kind of like when the air bag in your car inflates and is pressing on your chest. When your lungs are too big for the inside of your chest, it's crowded in there and your lungs have trouble expanding and recoiling. Also when this happens, your diaphragm, which is supposed to be in the shape of a dome, becomes flatter, putting you - and your lung movement - at a mechanical disadvantage.
No wonder it's so hard to breathe! You're spending more energy using the muscles around your collarbone, your neck, and between your ribs. Using these muscles to breathe not only takes a lot of energy but it can make you sore and tense in your shoulders and your back. More work for breathing plus less efficient lung expansion and movement adds up to a whole lot of effort and fatigue without a lot of results!
Shortness of Breath and Anxiety
Furthermore, when you become anxious (and who wouldn't be when they can't breathe!), your body releases adrenaline, which causes your heart to beat faster. The brain then tells your lungs that your heart is working harder and needs more oxygen. So you start to breathe faster and harder, and more and more shallow. Your brain then tells your heart that your lungs need more blood to process, and so the heart starts to beat even faster...and so on, and so on, until you are completely breathless.
When anxiety comes in, in addition to becoming more breathless, the muscles in your chest tighten. Using proper diaphragmatic breathing can go a long way in helping you avoid a situation such as this. If you have COPD you must breathe as efficiently as possible, using the muscle that was designed to do most of the work, instead of huffing and puffing with just the tops of your lungs, moving very little air and getting so tired out just breathing.
Diaphragmatic (Belly or Abdominal) Breathing
Your diaphragm is a large, flat sheet of muscle just below your rib cage and above your abdomen (your belly). Your diaphragm was meant to do most of the work of breathing, but people with lung disease struggle and tend to use the weaker muscles around the collarbone and between the ribs. By using your diaphragm when you breathe, you help your lungs expand more fully so they take in more air with less effort.
Here's a very simple animation that helps show how the diaphragm works. http://www.nlhep.org/lung_intro.html Watch it while you think of this: When the diaphragm comes down and flattens, your belly, or abdomen, should extend out. Yes, just like your tummy is looking bigger. When you breathe out properly, your belly should go in, and the diaphragm should go up, pushing on the bottoms of your lungs, helping you get rid of the stale, trapped air.
Diaphragmatic Breathing can be a hard concept to understand and a difficult technique to master. It takes practice, but it's worth it! Here are the basic steps. It works best in a reclining position.
1. Relax your shoulders. Drop them down as low as they'll go.
2. Put your hands on your abdomen with your fingers overlapped, just below your ribs.
3. Breathe in slowly through your nose, making your abdomen push out while you breathe in. (Remember to keep those shoulders down.)
4. Breathe out slowly, about twice as long than you breathed in, using pursed-lips. Gently, with your hands, push your belly in and think about expelling all that bad, stale air.
5. Practice this from time to time throughout the day.
If you experience muscle soreness or fatigue with this technique it is probably because you are either working too hard at it or not doing it correctly. That's why you should learn this with the supervision of a person who specializes in proper breathing techniques. Once you catch on, you will breathe easier and be less tired. And using this, along with the pursed lips breathing, will go a long way in helping you get through anxious episodes.
One more word of caution - Be careful of breathing methods or devices you may hear about in magazines or see on the internet. Remember, if something sounds too good to be true, it probably is!
Congratulations on getting all the way through to the end of this blog! Hang in there, my friend. Using proper breathing techniques with COPD can mean the difference between struggling to get through your day - or being in control, breathing better and getting on with your life!
I'll see you next time!
Disclaimer: The information is not to be substituted for medical advice. Always consult with your doctor before starting any new exercise or technique. These breathing techniques should be demonstrated and taught by a pulmonary health care professional, and when beginning, should be practiced for a just a few minutes at a time, a few times a day. This is for your information only. Feel free to bring this information to your doctor and ask him or her if working with these breathing retraining techniques would be appropriate for you.