Slow and calming

Pursed-lip breathing

By GyroscopeUpdated November 15, 202612 sources

Family

Slow and calming

Breaths

10 a minute

Carbon dioxide

Steady

How well tested

Moderate

Risk

Low

Timer

Run it on this page

Pursed-lip breathing means breathing in through your nose and out slowly through lips pursed as if you were blowing out a candle. The small opening keeps your airways open longer, so trapped air gets out and your breathing slows down. In COPD studies it helped people walk farther, even when they didn’t feel less breathless. If you have COPD or asthma, it’s the first breathing exercise we’d learn.

When you’re short of breath, it feels like you can’t get enough air in, and the instinct is to gulp. With COPD, and with asthma too, a big part of the problem is getting air out. The American Lung Association explains that the lungs lose their springiness, stale air gets trapped, and there’s less room left to bring fresh air in.

Pursed-lip breathing looks too simple to do much. But some people with COPD start doing it on their own, without anyone teaching them, because it eases their breathing.

What it is and where it comes from

Doctors were measuring pursed-lip breathing by the 1960s. In 1966, Thoman, Stoker and Ross published a study of how well it worked for people with COPD. In 1970, Mueller, Petty and Filley measured what it did to breathing and to the gases in the blood.

Today MedlinePlus, from the US National Library of Medicine, teaches it as 2 counts in and 4 or more out. The American Lung Association uses the same counts.

How to do it

1. Sit down and relax. Feet on the floor, neck and shoulders loose.
2. Breathe in through your nose for 2 counts. Slowly, with your mouth closed.
3. Purse your lips. As if you were about to whistle or blow out a candle.
4. Breathe out through your lips for 4 counts or more. Let the air out on its own without forcing it, and don’t hold your breath.
5. Repeat until your breathing slows. The American Lung Association says to keep going until your breathing feels normal again.
6. Practice four or five times a day. MedlinePlus, where these steps come from, suggests doing it while you watch TV. Then it’s ready on stairs, when you bend or lift, when you exercise and when you feel anxious.

At 2 counts in and 4 out, you’re breathing 10 times a minute.

A simple way to picture it

Think of a garden hose with your thumb over the end. The narrow opening keeps the hose full and firm all the way back to the tap. Pursed lips do the same for your airways, holding them open a little longer while the air gets out.

What happens in your body

In healthy lungs, the breath out mostly takes care of itself, because the lungs are springy. When they lose that spring, the Cleveland Clinic says, trapped air pushes the diaphragm down and flattens it, so your main breathing muscle works less well.

Pursed lips slow the breath out and keep the airways open longer, so more of the trapped air gets out before the next breath comes in. In a 2005 study in Montreal, eight people with COPD breathed with and without pursed lips, first at rest and then on an exercise bike. With pursed lips, they breathed slower and deeper both times. On the bike, it eased breathlessness in the people whose lungs held less leftover air with pursed lips, and not in the rest.

If you watch your oxygen at home, When is a low number an emergency? on oxygen.guide covers what the numbers mean with a lung condition.

What the evidence shows

The clearest test came from Stockholm in 2008. Researchers had 32 people with moderate to severe COPD do two walking tests in random order. In one, they breathed through a mouthpiece that made pursed lips impossible. In the other, they could purse their lips as they liked. With pursed lips they walked 37 seconds longer, about 16 percent, and their oxygen dropped 1.2 points less. They didn’t rate their breathlessness or their tired legs any differently.

A 2013 study of COPD patients who didn’t purse their lips on their own found the same kind of thing. When they were taught to do it, they walked about 35 meters farther in six minutes and finished with a slower breathing rate. They didn’t feel any less breathless. Walking farther without feeling less breathless sounds odd, but both studies found it.

We couldn’t find a trial that tested whether pursed-lip breathing keeps people out of the hospital.

Who should skip it

Nobody needs to skip it. The important rules are about when it isn’t enough.

• Keep your plan. Take your inhalers and follow your COPD or asthma action plan exactly as your doctor set them. Nothing here replaces the plan a doctor gave you.
• Don’t force the air out. MedlinePlus says to let it out naturally, without pushing.
• Call 911 if you’re so short of breath you can’t talk, if you have chest pain, or if your lips or fingernails turn blue or gray. The American College of Emergency Physicians and MedlinePlus both list these as reasons to call.
• Shortness of breath at rest that comes on suddenly or gets in the way of talking is an emergency too, according to MedlinePlus. If it’s new and milder, call your doctor right away.