Which breathing technique should a COPD patient be taught to ease dyspnea?

• A. Diaphragmatic breathing
• B. Controlled coughing
• C. Nasal breathing only
• D. Pursed-lip breathing

Answer: (D)

In COPD, dyspnea is worsened by air trapping and dynamic airway collapse during expiration. Techniques that prolong and regulate exhalation help keep airways open longer, raise a little back-pressure in the airways, and reduce the work of breathing. Pursed-lip breathing does exactly that: you exhale through a small, pursed opening, which slows and lengthens the expiratory phase, increases end-expiratory pressure, and prevents premature airway collapse. This improves complete emptying of the lungs, lowers respiratory rate, and eases the sensation of breathlessness, especially during activity or an uptick in symptoms.

Diaphragmatic breathing can be beneficial for overall breathing efficiency by using the diaphragm more, but it doesn’t specifically counteract expiratory airway collapse in COPD as effectively as pursed-lip breathing. Controlled coughing is primarily for clearing secretions, not directly for reducing dyspnea, and nasal breathing alone doesn’t address the expiratory airflow limitation COPD patients face. To perform pursed-lip breathing, inhale quietly through the nose, then exhale slowly through the lips as if blowing out a candle—exhale longer than the inhale, typically several seconds. Practice at rest and during activity to help manage episodes of breathlessness.