The Importance of Breathing: Simple Ways to Breathe Better and Manage Breathlessness

We breathe all day, every day, usually without even thinking about it. Breathing is something our bodies do automatically, but when we become unwell, less active, anxious or develop a respiratory condition, our breathing can change. We may start breathing faster, taking larger breaths, using the muscles around our neck and shoulders more, or becoming increasingly aware of every breath. For someone experiencing breathlessness, this can become a frustrating cycle of breathlessness, worry, faster breathing and increased effort.

The good news is that there are techniques that can help some people regain a greater sense of control over their breathing. Breathing exercises are not a cure for underlying heart or lung disease, but they can form an important part of managing symptoms alongside appropriate medical treatment, exercise and pulmonary rehabilitation.

What does "good breathing" actually mean?

There isn't one perfect way of breathing. At rest, healthy breathing should generally be quiet, comfortable and relatively effortless. Our diaphragm, the main muscle of breathing, does most of the work. When we breathe in, the diaphragm contracts and moves downwards, allowing the lungs to expand. When we breathe out at rest, the diaphragm relaxes and the lungs naturally recoil.

It is worth remembering that good breathing doesn't mean taking the biggest breath possible. When someone feels short of breath, repeatedly taking very large breaths can sometimes make them feel more uncomfortable. Instead, gentle, controlled breathing may be more helpful. At rest, try to allow your shoulders and upper chest to remain relaxed rather than consciously controlling every breath.

The diaphragm and accessory muscles

The diaphragm is our main breathing muscle, but it isn't working alone. When breathing becomes more difficult, the body can recruit additional muscles around the neck, shoulders and upper chest.

These are known as the accessory muscles of breathing and can help increase the size of the rib cage when we need to breathe more deeply.

This is useful during exercise or periods of significant respiratory distress. However, if these muscles are working hard all the time, you may notice your shoulders lifting with each breath, increased tension around your neck and upper chest, or visible effort when breathing. Sitting in a supported, slightly forward-leaning position can sometimes help. Resting your forearms on your thighs or on a table supports the shoulder girdle and can give the accessory muscles a better mechanical position to assist breathing.

Understanding shortness of breath

Shortness of breath, or breathlessness, can be caused by many different things. Respiratory conditions such as COPD, asthma, pulmonary fibrosis and bronchiectasis can cause breathlessness, as can heart problems, anaemia, infection, anxiety and general deconditioning.

For people with a chronic respiratory condition, becoming breathless during activity does not necessarily mean that something harmful is happening. In fact, exercise is an important part of pulmonary rehabilitation. The aim is often to learn how to manage breathlessness rather than avoiding activity altogether.

When you become breathless, try to slow down rather than immediately stopping everything. Find a comfortable position, relax your shoulders and allow your breathing to settle. Breathing gently in through your nose, if comfortable, followed by a slower breath out through relaxed or slightly pursed lips can help some people regain control of their breathing.

Pursed-lip breathing

Pursed-lip breathing is a commonly used technique for people experiencing breathlessness. Breathe in gently through your nose if this is comfortable, then breathe out slowly through lips that are gently pursed, as though you were blowing out a candle. Don't force the air out. The aim is simply to slow and control the exhalation.

Research suggests that pursed-lip breathing can reduce respiratory rate and feelings of breathlessness in some people, although its effectiveness varies between individuals. A Cochrane review of breathing exercises in COPD found that techniques including pursed-lip breathing, diaphragmatic breathing and yoga breathing may improve exercise capacity, although the effects on breathlessness and quality of life were less consistent.

Pacing and "blow as you go"

Pacing is one of the most useful skills for anyone who becomes breathless during everyday activities. Rather than rushing through a task and becoming extremely breathless, try to control your speed from the beginning. If walking to the kitchen makes you breathless, for example, avoid walking quickly because you want to get the activity over with. Slow your pace, breathe regularly and take a short pause if you need one.

Another useful technique is sometimes called "blow as you go". The principle is simple: breathe in before an effort and breathe out during the effort. When standing from a chair, take a breath in before you stand and breathe out as you stand. The same approach can be used when climbing stairs, lifting an object or bending down. Try to avoid holding your breath during physical effort.

You can also break larger tasks into smaller sections. Instead of trying to clean the whole house in one go, for example, clean one room and then have a rest. Pacing isn't about doing less; it is about managing your energy and breathing so that you can do more overall.

Exercise can help breathlessness

It might seem strange to suggest exercise to someone who is already breathless, but improving

physical fitness can actually make everyday activities feel easier. When muscles become stronger and more efficient, they require less effort to perform the same task. This can mean that walking, climbing stairs or completing household activities places less demand on the body's cardiovascular and respiratory systems.

Pulmonary rehabilitation is a good example. It combines individually prescribed exercise with education and support for people with chronic respiratory conditions. There is strong evidence that pulmonary rehabilitation can improve exercise capacity, reduce breathlessness and improve quality of life. NICE recommends pulmonary rehabilitation for appropriate people with COPD who have significant exercise limitation from breathlessness.

This is also why strengthening exercises are important. Someone with weak legs may become very breathless simply walking across a room because the activity is physically demanding. Improving leg strength through exercises such as sit-to-stands, step-ups and resistance training can help make everyday movement more efficient.

Sputum and phlegm: helping to clear your chest

For people with conditions such as COPD or bronchiectasis, excess sputum can be a significant problem. Repeated hard coughing can be tiring and isn't always the most effective way of clearing mucus.

One technique commonly used by respiratory physiotherapists is the Active Cycle of Breathing Technique (ACBT). ACBT combines breathing control, deeper breathing exercises and forced expiration, often called a "huff". The huff involves breathing out firmly through an open mouth, as though trying to steam up a mirror, rather than repeatedly coughing forcefully.

The different parts of the cycle can help move mucus from the smaller airways towards the larger airways, where it can be cleared more easily. Research supports the use of ACBT for improving sputum clearance in people with chronic respiratory conditions, and NICE recommends airway-clearance techniques such as ACBT for appropriate people with COPD who have excessive sputum.

ACBT is not necessarily suitable for everyone, however, and people with significant sputum production, bronchiectasis or other respiratory conditions may benefit from assessment and individual instruction from a respiratory physiotherapist.

Why getting out of bed can help

When someone is unwell, it can be tempting to spend most of the day in bed. However, prolonged bed rest can contribute to muscle weakness and deconditioning, while posture can also influence lung function.

Research examining body position has found that lung volumes and measures of lung function are generally better in more upright positions than when lying down in many people. Sitting upright can allow greater chest expansion and may make coughing and sputum clearance easier. It also gives someone the opportunity to start moving again.

Getting out of bed and sitting in a comfortable chair, when medically and physically safe, can therefore be a useful part of recovery. It also breaks up long periods of inactivity. Sitting at the table for a meal, having a cup of tea with someone, reading or simply standing up and walking around the room all provide opportunities to move.

Of course, someone who is acutely unwell may need to remain in bed or require specific medical advice. Mobilisation should always be appropriate to the individual's medical condition and level of mobility.

A simple breathing routine

If you don't have a specific respiratory condition requiring an individualised programme, you can spend a few minutes practising relaxed breathing. Sit comfortably in an upright chair and allow your shoulders to relax. Take a few normal breaths without trying to make them particularly deep. If comfortable, breathe gently in through your nose and allow your lower chest and abdomen to move naturally, then breathe out slowly through relaxed or slightly pursed lips.

Practise for two to five minutes. The aim isn't to achieve a particular breathing rate or force your breathing to become deeper. Instead, focus on making your breathing feel quiet, relaxed and controlled. You can then try applying the same principles while walking or completing everyday activities.

Breathing, movement and independence

Breathing exercises are only one part of the picture. Good respiratory care is also about maintaining strength, fitness, mobility and confidence.

For someone with chronic respiratory disease, this might mean combining breathing-control techniques with pacing, airway-clearance techniques and a progressive exercise programme. For someone recovering from illness, it might mean gradually increasing the amount of time spent sitting out of bed, walking around the house and eventually getting outdoors.

The aim isn't necessarily to make you completely free of breathlessness. Instead, the goal may be to help you manage your breathing more effectively so that you can do more of the things that matter to you.

Books about breathing

Breathing has become increasingly popular outside traditional respiratory medicine, and several books have introduced the subject to a much wider audience.

Breath: The New Science of a Lost Art by James Nestor is an accessible exploration of the science, history and culture of breathing. It covers subjects including nasal breathing and different breathing practices. It is an interesting introduction, although some of the claims made in popular breathing literature extend beyond what is currently established by clinical research.

Breathe by Dr Belisa Vranich approaches breathing from an anatomical and practical perspective and includes exercises designed to increase awareness of breathing patterns.

The Breathing Cure by Patrick McKeown explores breathing habits and practical breathing exercises and is another popular introduction to the subject.

These books can be interesting and thought-provoking, but they should not replace medical assessment or respiratory physiotherapy when someone has significant or unexplained breathlessness.

When should breathlessness be checked?

Breathlessness shouldn't automatically be dismissed as part of getting older. New, unexplained or worsening breathlessness should be discussed with your GP or another appropriate healthcare professional.

There are many possible causes, including respiratory and heart conditions, infection, anaemia, medication effects and deconditioning. Seek urgent medical attention if breathlessness is severe or sudden, particularly if it is accompanied by significant chest pain, fainting, blue or grey lips or skin, confusion or severe deterioration.

How Physio At Home can help

At Physio At Home, we understand that breathlessness can have a major impact on everyday life. Our home-based physiotherapy service can help people understand how their breathing, strength, mobility and activity levels interact and develop realistic strategies for managing everyday activities.

Depending on the individual's needs, this might include advice around positioning, pacing, breathing control, mobility and exercise, as well as helping someone regain strength and confidence following illness or a period of reduced activity. For people with respiratory conditions and sputum problems, respiratory physiotherapy may also include assessment and education around appropriate airway-clearance techniques.

Our aim isn't simply to help you breathe more comfortably while sitting still. It's to help you use your breathing more effectively while doing the things that matter to you — getting up, walking, going outside and maintaining your independence.

Physio At Home — helping you move better, breathe with confidence and stay independent at home.

A final word about safety

Breathing exercises should be appropriate to the individual. If you have a diagnosed heart or lung condition, significant breathlessness, low oxygen levels, frequent chest infections or problems clearing sputum, seek individual advice from an appropriate healthcare professional or respiratory physiotherapist rather than relying solely on a generic online programme.

Breathing techniques are intended to complement, not replace, appropriate medical treatment.